What bilirubin level requires etoposide dose reduction?

Bilirubin 1.5–3 mg/dL: reduce dose by 50%. Bilirubin above 3 mg/dL: reduce by 75%. Bilirubin above 5 mg/dL: hold etoposide. Etoposide is approximately 94% protein-bound; hyperbilirubinemia displaces it and increases free drug toxicity.

Does renal impairment require etoposide adjustment?

Yes. Etoposide clearance correlates with GFR. Reduce dose by 25% for GFR 15–49 mL/min; consider 50% reduction or alternative agent for GFR below 15 mL/min or dialysis patients.

Etoposide Hepatic Dose Adjustment

Adjust etoposide dose based on hepatic function: reduce by 50% for bilirubin 1.5–3 mg/dL or AST above 3x ULN; hold for bilirubin above 5 mg/dL or severe hepatic impairment.

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Frequently Asked Questions

What bilirubin level requires etoposide dose reduction?

Does renal impairment require etoposide adjustment?