In the U.S.—

In Canada—

Another commonly used name is VM-26.

• Antineoplastic

Teniposide (ten-i-POE-side) belongs to the group of medicines called antineoplastics. Teniposide injection is used along with other medicines to treat acute lymphoblastic leukemia (ALL), non-Hodgkin's lymphoma (NHL), and neuroblastoma.

Teniposide interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by teniposide, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects may not be serious but may cause concern.

Teniposide is to be administered only by or under the immediate supervision of your doctor. It is available in the following dosage form:

Parenteral
• Injection (U.S. and Canada)

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For teniposide, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to teniposide. Also tell your health care professional if you are allergic to any other substances, such as castor oil.

Pregnancy—Teniposide has not been studied in pregnant women. However, studies in animals have shown that teniposide causes slower development or death of the fetus and birth defects, such as defects of the spine or ribs, deformed extremities, being born without eyes, and a defect or absence of breast-bone. Be sure that you have discussed this with your doctor. Tell your doctor right away if you think you have become pregnant while receiving teniposide.

Breast-feeding—It is not known if teniposide passes into the breast milk. However, due to the potential for serious side effects, if you are breast-feeding or plan to breast-feed while receiving this medicine, be sure that you have discussed this with your doctor.

Children—Children with Down syndrome may be more sensitive to the effects of this medicine compared to other children. Your doctor may decide to start treatment with this medicine at a lower dose.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of teniposide in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking teniposide, it is especially important that your health care professional know if you are taking any of the following:

• Acyclovir (e.g., Zovirax) or
• Anticonvulsants (seizure medicine) or
• Antidiabetics, oral (diabetes medicine taken by mouth) or
• Anti-infectives by mouth or by injection (medicine for infection) or
• Antipsychotics (medicine for mental illness) or
• Captopril (e.g., Capoten) or
• Carbamazepine (e.g., Tegretol)
• Enalapril (e.g., Vasotec) or
• Flecainide (e.g., Tambocor) or
• Gold salts (medicine for arthritis) or
• Imipenem or
• Inflammation or pain medicine, except narcotics or
• Lisinopril (e.g., Prinivil, Zestril) or
• Maprotiline (e.g., Ludiomil) or
• Penicillamine (e.g., Cuprimine) or
• Pimozide (e.g., Orap) or
• Procainamide (e.g., Pronestyl) or
• Promethazine (e.g., Phenergan) or
• Ramipril (e.g., Altace) or
• Sulfasalazine (e.g., Azulfidine) or
• Tiopronin (e.g., Thiola) or
• Tocainide (e.g., Tonocard) or
• Tricyclic antidepressants (medicine for depression) or
• Trimeprazine (e.g., Temaril)—Concurrent use of these agents with teniposide may cause blood disorders

• Alpha interferons (e.g., Intron A, Roferon-A) or
• Amphotericin B by injection (e.g., Fungizone) or
• Antineoplastics, other (cancer medicine) or
• Antithyroid agents (medicine for overactive thyroid) or
• Azathioprine (e.g., Imuran) or
• Chloramphenicol (e.g., Chloromycetin) or
• Colchicine or
• Cyclophosphamide (e.g., Cytoxan) or
• Flucytosine (e.g., Ancoban) or
• Ganciclovir (e.g., Cytovene) or
• Mercaptopurine (e.g., Purinethol) or
• Plicamycin (e.g., Mithracin) or
• Zidovudine (e.g., AZT, Retrovir)—Concurrent use of these agents with teniposide increases the risk of infection

• Sodium salicylate or
• Sulfamethizole (e.g., Thiosulfil Forte) or
• Tolbutamide (e.g., Orinase)—Taking these medicines while receiving teniposide may cause the level of teniposide in the body to be higher than usual, which may increase the chance of unwanted effects

• If you have ever been treated with radiation or cancer medicines—Teniposide may increase the effects of these medicines or radiation therapy on the blood

• Blood disorders due to bone marrow depression or
• Infection—There may be an increased risk of infections or worsening infections because of the body's reduced ability to fight them

• Chickenpox (including recent exposure) or
• Herpes zoster (shingles)—Risk of severe disease affecting other parts of the body

• Down syndrome—Patients who have this condition may be more sensitive to this medicine

• Hypoalbuminemia or
• Kidney disease or
• Liver disease—These conditions may cause the level of teniposide in the body to be higher than usual, which may increase the chance of unwanted effects

Teniposide often causes nausea and vomiting, which usually are not severe. However, it is very important that you continue to receive the medicine, even if you begin to feel ill. Ask your doctor, nurse, or pharmacist for ways to lessen these effects.

Dosing—

The dose of teniposide will be different for different patients. The dose that is used may depend on a number of things, including the patient's weight, other medical conditions, and whether or not other medicines are also being taken. Because this medicine can cause very serious side effects, your doctor will be watching your dose very carefully and may change it as needed. If you have any questions about the proper dose of teniposide, ask your doctor.

It is very important that your doctor check your progress at regular visits to make sure that teniposide is working properly and to check for unwanted effects.

It is important to tell your doctor or nurse right away if redness, pain, swelling, or a lump under the skin occurs in the area where the injection is given.

While you are being treated with teniposide, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's approval. Teniposide may lower your body's resistance, and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not take oral polio vaccine, since there is a chance they could pass the polio virus on to you. Also, avoid persons who have taken oral polio vaccine within the last several months. Do not get close to them, and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.

Teniposide can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

• More common
  • Black, tarry stools;  blood in urine or stools;  chills;  cough or hoarseness;  fever;  hives ;  lower back or side pain;  painful or difficult urination;  pinpoint red spots on skin;  shortness of breath;  tightness in chest, or wheezing;  troubled breathing ;  unusual bleeding or bruising 
  
  

Check with your doctor as soon as possible if any of the following side effects occur:

• More common
  • Flushing of face;  sores in mouth or on lips;  unusually fast heartbeat;  unusual tiredness 
  
  

• Less common
  • Skin rash 
  
  

• Rare
  • Decreased urination;  swelling of face, fingers, feet, or lower legs;  yellow eyes or skin  
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Diarrhea;  nausea and vomiting 
  
  

This medicine often causes a temporary loss of hair. After treatment with teniposide has ended, normal hair growth should return.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor, nurse, or pharmacist.