Toposar

Toposar is a prescription medication used to treat small cell lung cancer and testicular cancer. Toposar belongs to a group of drugs called podophyllotoxin derivatives, which slow or stop the growth of cancer cells.

This medication comes as a capsule and is taken by mouth. It is usually taken once a day for 4 or 5 days in a row. This cycle may be repeated once every 3 to 4 weeks, depending on your response to the medication.

This medication comes in an injectable form to be given directly into a vein (IV) by a healthcare provider. It is usually given in cycles, once a day or every other day, for up to 5 days.

Some of the common side effects of Toposar include nausea, vomiting, hairloss, and low counts of certain blood cells.

Oral/Injectable:

Toposar is a prescription medication used to treat cancer of the testicles that has not improved or that has worsened after surgery and treatment with other medications and radiation therapy. Toposar is also approved to treat small cell lung cancer (SCLC).

Toposar is used in combination with other chemotherapy medications.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

• Pharmacia, Inc.

• Teva Parenteral Medicines, Inc.

Oral/Injectable:

Toposar may cause serious and potentially life-threatening side effects. See "Toposar Precautions."

The following side effects were reported during clinical trials:

• lower than normal levels of red blo
• od cells, white blood cells and blood platelets
• nausea
• vomiting
• low blood pressure
• severe allergic reactions (anaphylactic-like reactions)
• reversible hair loss
• stomach pain
• loss of appetite
• weight loss
• diarrhea
• constipation
• sores in mouth and throat
• liver toxicity
• unusual tiredness
• eye pain

This is not a complete list of Toposar side effects. Ask your doctor or pharmacist for more information.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• cisplatin (Platinol)
• cyclosporine (Gengraf, Neoral, Sandimmune)

This is not a complete list of Toposar drug interactions. Ask your doctor or pharmacist for more information.

Oral/Injectable:

Toposar can affect the ability of the bone marrow to produce red and white blood cells as well as platelets, potentially leading to serious side effects such as anemia, infections, and bleeding. Your doctor will order laboratory tests regularly before and during your treatment.

Tell your doctor right away if you experience any of the following symptoms:

• fever
• chills
• sore throat
• body aches and pains
• cough and congestion
• unusual bleeding or bruising
• bloody or black, tarry stools
• bloody vomit 
• vomit resembling coffee grounds.

Toposar can cause a serious and potentially life-threatening allergic-type reaction. Tell your doctor right away if you experience any of the following symptoms:

• rash
• hives
• itching
• difficulty breathing or swallowing
• fast or irregular heartbeat

Abnormally low blood pressure can occur if this medication is administered too quickly. Signs of low blood pressure include dizziness and fainting.

Toposar may increase the risk that you will develop other cancers.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Toposar there are no specific foods that you must exclude from your diet when receiving Toposar.

Before receiving Toposar, tell your doctor if you:

• are allergic to any ingredient in Toposar 
• have kidney or liver disease
• have anemia
• have an infection
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category D. Toposar may harm your unborn baby and is generally not recommended for use in pregnant women. In some circumstances, the benefits of this medication to the woman may outweigh the possible risks to the unborn baby.

If you become pregnant while receiving Toposar, tell your doctor right away.

Tell your doctor if you are breastfeeding. It is not known if Toposar is excreted in human breastmilk or if it will harm your nursing baby.

Oral:

Toposar comes as a capsule and is taken by mouth. It is usually taken once a day for 4 or 5 days in a row. This cycle may be repeated once every 3 to 4 weeks, depending on your response. The length of treatment depends on the types of drugs you are taking, how well your body responds to them, and the type of cancer you have.

Take Toposar at around the same time(s) every day. Follow the directions on your prescription label carefully. Take Toposar exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Injectable:

Toposar is a liquid medication that is infused (slowly injected into a vein) by a healthcare provider in a medical facility, in combination with other chemotherapy medicines. The infusions usually last 30 to 60 minutes. Toposar is usually given in cycles - once a day or every other day for five days, followed by a three or four week break. The number of cycles you receive will be determined by your healthcare provider.

If you are experiencing potentially serious side effects, your doctor may reduce your dosage or interrupt your therapy.

Oral:

• In small cell lung cancer, the recommended dose of Toposar capsules is 2 times the IV dose rounded to the nearest 50 mg
  • For example: two times 35 mg/m2/day for 4 days to 50 mg/m2/day for 5 days.
  • The dosage should be modified to take into account
    • the effects of other drugs in combination, or
    • the effects of prior x-ray therapy

Injectable:

• The Toposar dosage is highly individualized and is based on the cancer being treated, your height and weight, how well your body responds to the medication, and other medications and other medical conditions you have.
• Cancer of the Testicles
  • The Toposar dose ranges from 50 to 100 mg per m²  a day for 5 days to 100 mg per m²  a day every other day for 3 doses (days 1, 3, and 5 of a treatment cycle).
• Small Cell Lung Cancer
  • The Toposar dose ranges from 35 mg per m²  a day for 4 days to 50 mg per m²  a day for 5 days.
  • Doses are reduced in patients with kidney disease.

If you take too much this medication, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If this medication is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

Oral:

• Toposar capsules must be stored under refrigeration 2° to 8°C (36° to 46°F).
• The capsules are stable for 36 months under such refrigeration conditions.
• Keep this and all other medications out of the reach of children.

Injectable:

• Keep all infusion and laboratory appointments and notifiy your doctor right away if you have to reschedule an appointment. Toposar works best if given on schedule.

Toposar should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents. Severe myelosuppression with resulting infection or bleeding may occur.