Baby Safety / Compounds / Etoposide

Is Etoposide safe for babies and kids?

Very high risk for kids

Infants are more vulnerable to Etoposide than children or adults due to immature hepatic/renal clearance, higher intake-to-body-weight ratio, rapid organ development, and increased gastrointestinal absorption.

What is etoposide?

The IUPAC name is (5S,5aR,8aR,9R)-5-[[(2R,4aR,6R,7R,8R,8aS)-7,8-dihydroxy-2-methyl-4,4a,6,7,8,8a-hexahydropyrano[3,2-d][1,3]dioxin-6-yl]oxy]-9-(4-hydroxy-3,5-dimethoxyphenyl)-5a,6,8a,9-tetrahydro-5H-[2]benzofuro[6,5-f][1,3]benzodioxol-8-one.

Also known as: (5S,5aR,8aR,9R)-5-[[(2R,4aR,6R,7R,8R,8aS)-7,8-dihydroxy-2-methyl-4,4a,6,7,8,8a-hexahydropyrano[3,2-d][1,3]dioxin-6-yl]oxy]-9-(4-hydroxy-3,5-dimethoxyphenyl)-5a,6,8a,9-tetrahydro-5H-[2]benzofuro[6,5-f][1,3]benzodioxol-8-one, VePesid, Toposar, trans-Etoposide.

IUPAC name: (5S,5aR,8aR,9R)-5-[[(2R,4aR,6R,7R,8R,8aS)-7,8-dihydroxy-2-methyl-4,4a,6,7,8,8a-hexahydropyrano[3,2-d][1,3]dioxin-6-yl]oxy]-9-(4-hydroxy-3,5-dimethoxyphenyl)-5a,6,8a,9-tetrahydro-5H-[2]benzofuro[6,5-f][1,3]benzodioxol-8-one
CAS number: 33419-42-0
Molecular formula: C29H32O13
Molecular weight: 588.6 g/mol
SMILES: CC1OCC2C(O1)C(C(C(O2)OC3C4COC(=O)C4C(C5=CC6=C(C=C35)OCO6)C7=CC(=C(C(=C7)OC)O)OC)O)O
PubChem CID: 36462

Risk for babies

Very high risk

Neonates and infants up to 12 months have incomplete blood-brain barrier development, immature Phase I/II metabolic enzymes (particularly CYP3A4, UGT1A1), and higher gastrointestinal permeability. Equivalent doses produce higher internal concentrations and longer residence times.

What to do: Minimize infant exposure through source control. For breastfeeding mothers: reduce maternal exposure. For formula-fed infants: use certified low-migration bottles and verified water sources. Consult pediatrician regarding any concerns.

Risk for pregnant and nursing people

Context-dependent

Pregnancy alters the metabolism and distribution of Etoposide, potentially increasing fetal exposure. The developing embryo/fetus is vulnerable during organogenesis (weeks 3-8) and neurological development. Placental transfer should be assumed.

No specific reproductive toxicity data identified, but pregnancy-specific safety data is limited for most chemicals. Precautionary minimization of exposure is recommended.

What to do: Minimize exposure during pregnancy and lactation. Consult healthcare provider regarding specific risks. Consider alternative products with lower hazard profiles.

Regulatory consensus

7 regulatory and scientific bodies have classified Etoposide. The classifications differ — that's the data.

Agency	Year	Classification
IARC	2000	Group 1
US EPA	2000	carcinogenic to humans
EPA CTX / IARC	—	Group 1 - Carcinogenic to humans
EPA CTX / CalEPA	—	Known human carcinogen
EPA CTX / Genetox	—	Genotoxicity: positive (Ames: positive, 9 positive / 1 negative reports)
EPA CTX / Genetox	—	Genotoxicity: positive (Ames: positive, 9 positive / 1 negative reports)
EPA CTX / Skin-Eye	—	Skin Irritation: SkinIrr2 (score: high)

Regulators apply different standards of evidence — animal-data weighting, exposure-pattern assumptions, epidemiological power thresholds — which is why two scientific bodies can review the same data and reach different conclusions. The disagreement is the data.

Where kids encounter etoposide

Industrial Facilities — Manufacturing plants, Chemical storage areas, Waste treatment sites
Occupational Environments — Factories, Warehouses, Transportation vehicles

Safer alternatives

Lower-risk approaches that achieve a similar outcome to Etoposide:

Paclitaxel/docetaxel
Trade-offs: Taxane chemotherapy — different mechanism (microtubule stabilization vs topoisomerase II). Used in similar cancers (lung, testicular). Different toxicity profile (neuropathy vs myelosuppression).

Relative cost: 1.2-2×
Pembrolizumab/nivolumab (immunotherapy)
Trade-offs: Checkpoint inhibitors replacing chemo in many settings. Better long-term outcomes for some cancers. Immune-related adverse events. Much higher cost ($100K+/year).

Relative cost: 1.2-2×

Frequently asked questions

Is etoposide safe for kids?

What products contain etoposide?

Etoposide appears in: Manufacturing plants (Industrial facilities); Chemical storage areas (Industrial facilities); Factories (Occupational environments); Warehouses (Occupational environments).

What should I do if my child is exposed to etoposide?

Minimize infant exposure through source control. For breastfeeding mothers: reduce maternal exposure. For formula-fed infants: use certified low-migration bottles and verified water sources. Consult pediatrician regarding any concerns.

Why do regulators disagree about etoposide?

Etoposide has been classified by 7 agencies including IARC, US EPA, EPA CTX / IARC, EPA CTX / CalEPA, EPA CTX / Genetox, with differing conclusions. Regulators apply different standards of evidence (animal data weighting, exposure-pattern assumptions, epidemiological power thresholds), which is why two scientific bodies can review the same data and reach different conclusions. See the regulatory consensus table on this page for the full picture.

See Etoposide in the baby app

Look up products containing etoposide, compare to alternatives, and explore the full data record.

Open in baby View raw API data

Sources (2)

IARC Monographs Volume 76: Some Antiviral and Antineoplastic Drugs — Etoposide Group 1; Secondary AML 11q23/MLL and 21q22/RUNX1 Translocations; Topo II Inhibition; 1–3 Year Latency; BEP Testicular Cancer Regimen; Pediatric Oncology Use (2000) — iarc_monograph
US EPA Etoposide: Carcinogenic to Humans; NIOSH Hazardous Drug; Secondary AML Distinct Karyotype; COG LTFU Monitoring Protocol; Germ Cell Tumor Curative Benefit; Pediatric Malignancy Treatment; Hospital Wastewater Detection (2000) — regulatory

Reference data, not professional advice. Aggregates publicly available regulatory and scientific data; not a substitute for veterinary, medical, legal, or regulatory advice. Why we built ALETHEIA →