Before Using This Medicine

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

Other medical problems—The presence of other medical problems may affect the use of teniposide. Make sure you tell your doctor if you have any other medical problems, especially:

• 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