VUMON
Clinical safety rating: caution
Comprehensive clinical and safety monograph for VUMON (VUMON).
Teniposide is a semisynthetic podophyllotoxin derivative that inhibits topoisomerase II, causing DNA strand breaks and preventing relegation, thereby inhibiting DNA replication and cell division. It is cell cycle phase-specific, acting primarily in the S and G2 phases.
| Metabolism | Extensively metabolized in the liver via CYP3A4 and CYP2C8. Metabolites include 4'-demethyl-epipodophyllotoxin glucuronide and other conjugates. |
| Excretion | Primarily hepatobiliary excretion with fecal elimination (approximately 44% of dose); renal excretion accounts for about 6-10% as unchanged drug and metabolites. |
| Half-life | Terminal elimination half-life is biphasic: initial phase half-life of 1-4 hours, terminal phase half-life of 15-25 hours in adults; clinical context: prolonged in hepatic impairment. |
| Protein binding | >99% bound, primarily to albumin. |
| Volume of Distribution | 0.15-0.35 L/kg, indicating extensive tissue distribution. |
| Bioavailability | Oral bioavailability is approximately 50% (range 25-75%) with high interindividual variability. |
| Onset of Action | Intravenous administration: antineoplastic effect onset within minutes; oral absorption: clinical effect onset within 1-2 hours. |
| Duration of Action | Duration of action varies by dosing schedule; typical antineoplastic effect persists for 24-48 hours after IV administration, supporting daily or weekly dosing. |
| Molecular Weight | 656.7 |
130 mg/m2 IV over 1-2 hours daily for 3 consecutive days, repeated every 21 days.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required for GFR ≥30 mL/min. For GFR <30 mL/min, reduce dose by 25%. |
| Liver impairment | Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 25%. Child-Pugh C: Reduce dose by 50%. |
| Pediatric use | 130 mg/m2 IV over 1-2 hours daily for 3 consecutive days, repeated every 21 days. Safety and efficacy in children <2 years not established. |
| Geriatric use | No specific dose adjustment, but monitor renal and hepatic function closely due to age-related decline. |
| 1st trimester | Contraindicated due to teratogenic effects; avoid use unless absolutely necessary. |
| 2nd trimester | Contraindicated; may cause fetal harm. |
| 3rd trimester | Contraindicated; may cause fetal harm and neonatal toxicity. |
Clinical note
Comprehensive clinical and safety monograph for VUMON (VUMON).
| Placental transfer | Crosses placenta in animal studies; human data limited but presumed. |
| Breastfeeding | Excreted in human milk; potential for serious adverse reactions in nursing infants. Discontinue nursing or discontinue drug. |
| Lactation Rating | L5 |
■ FDA Black Box Warning
Teniposide 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. Anaphylactic-like reactions have been reported with teniposide, which may be life-threatening.
| Serious Effects |
Known hypersensitivity to teniposide or any componentSevere bone marrow suppressionSevere hepatic impairmentPregnancy
| Precautions | Severe myelosuppression (neutropenia, thrombocytopenia, anemia) is dose-limiting; monitor blood counts frequently. Hypersensitivity reactions (including anaphylaxis) may occur, especially with rapid infusion. Hypotension can occur if infused too rapidly. Mucosal inflammation and alopecia are common. Hepatic and renal impairment may require dose adjustment. May cause secondary leukemia (acute myeloid leukemia) with chromosomal translocations. Extravasation may cause tissue necrosis. |
| Food/Dietary | No specific food interactions documented. Maintain adequate hydration to prevent tumor lysis syndrome. Avoid grapefruit and Seville oranges due to potential CYP3A4 interaction (theoretical). |
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| Teratogenic Risk | Pregnancy Category D. First trimester: High risk of major congenital malformations including neural tube defects, craniofacial anomalies, and limb defects. Second and third trimesters: Risk of intrauterine growth restriction, oligohydramnios, and fetal myelosuppression. Contraindicated in pregnancy unless no alternative. |
| Fetal Monitoring | Complete blood counts (CBC) with differential before each dose; monitor for myelosuppression. Liver function tests (LFTs) and renal function tests (serum creatinine, BUN). In pregnant patients: serial fetal ultrasound for growth and anatomy, umbilical artery Doppler if indicated. |
| Fertility Effects | May cause ovarian failure with amenorrhea and premature menopause; azoospermia or oligospermia in males. Reversible in some patients but may lead to permanent infertility. |
| Clinical Pearls | VUMON (teniposide) is a podophyllotoxin derivative used in pediatric ALL. Administer IV over 30-60 minutes to minimize hypotension risk. Premedicate with antihistamines for hypersensitivity reactions. Monitor for myelosuppression, especially neutropenia and thrombocytopenia. Requires test dose in patients with prior hypersensitivity to etoposide. Extravasation causes tissue necrosis; use central line preferred. |
| Patient Advice | Your blood counts will be monitored frequently; contact your doctor if you develop fever, bruising, or unusual bleeding. · Report immediate symptoms of allergic reaction: hives, difficulty breathing, swelling of face or throat. · This medication may cause nausea and vomiting; antiemetics can be prescribed. · Avoid live vaccines during treatment and for 6 months after. · Use effective contraception during and for 3 months after treatment; this drug can harm a fetus. · Inform your doctor of all medications, especially blood thinners and seizure drugs. |