VUMON

Clinical safety rating: caution

Comprehensive clinical and safety monograph for VUMON (VUMON).

How it works

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.

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for VUMON (VUMON).

Breastfeeding	Excreted into human breast milk; M/P ratio not determined. Potential for severe adverse reactions in nursing infants including myelosuppression and carcinogenesis. Discontinue breastfeeding or avoid VUMON.
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.

Warnings & precautions

■ 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.

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to teniposide, cremophor EL, or any component of the formulation. Severe bone marrow suppression (unless due to underlying disease). Severe hepatic impairment.

Clinical Precautions

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.

Clinical Tips & Counseling

Drug interactions

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VUMON

Clinical safety rating: caution

Comprehensive clinical and safety monograph for VUMON (VUMON).

How it works

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for VUMON (VUMON).

Breastfeeding	Excreted into human breast milk; M/P ratio not determined. Potential for severe adverse reactions in nursing infants including myelosuppression and carcinogenesis. Discontinue breastfeeding or avoid VUMON.
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.

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to teniposide, cremophor EL, or any component of the formulation. Severe bone marrow suppression (unless due to underlying disease). Severe hepatic impairment.