Today's med: Fluorouracil (flure oh YOOR a sil)
(brand names: Adrucil, Carac, Efudex, Fluoroplex)
Index terms: 5-FU, 5-Fluorouracil, 5-Fluracil, Fluoro Uracil, Florouracil, FU)
Antimetabolite (Pyrimidine Analog)
Fludarabine, Decitabine, Clofarabine, Pentostatin, Nelarabine,Gemcitabine hydrochloride, Fludarabine Phosphate
Indications:
Treatment of breast cancer, colon cancer, rectal cancer, pancreatic cancer, and stomach (gastric) cancer
Treatment of anal cancer, bladder cancer, cervical cancer, esophageal cancer, head and neck cancer, hepatobiliary cancers, neuroendocrine tumors, penile cancer (metastatic), thymic cancers, and unknown primary cancer
Contraindications: Hypersensitivity to fluorouracil or any component of the formulation; poor nutritional states; depressed bone marrow function; potentially serious infections.
Adverse Effects:
Gastrointestinal: Anorexia, bleeding, diarrhea, esophagopharyngitis, mesenteric ischemia (acute), nausea,
sloughing, stomatitis, ulceration, vomiting; Hematologic: Agranulocytosis, anemia, leukopenia (nadir: days;
9-14; recovery by day 30), pancytopenia, thrombocytopenia; Local: Thrombophlebitis; Ocular: Lacrimation,
lacrimal duct stenosis, photophobia, visual changes; Respiratory: Epistaxis; Miscellaneous: Anaphylaxis,
generalized allergic reactions
Standard Dosing: I.V.: Administration rate varies by protocol; refer to specific reference for protocol. May be administered by I.V. push, I.V. bolus, or as a continuous infusion. Avoid extravasation (may be an irritant).
**Increase dietary intake of thiamine.
Breast cancer (unlabeled dosing): I.V.:
CEF regimen: 500 mg/m2 on days 1 and 8 every 28 days (in combination with cyclophosphamide and epirubicin) for 6 cycles (Levine, 1998)
CMF regimen: 600 mg/m2 on days 1 and 8 every 28 days (in combination with cyclophosphamide and methotrexate) for 6 cycles (Goldhirsch, 1998; Levine, 1998)
FAC regimen: 500 mg/m2 on days 1 and 8 every 21-28 days (in combination with cyclophosphamide and doxorubicin) for 6 cycles (Assikis, 2003)
Colorectal cancer (unlabeled dosing): I.V.:
FLOX regimen: 500 mg/m2 bolus on days 1, 8, 15, 22, 29, and 36 (1 hour after leucovorin) every 8 weeks (in combination with leucovorin and oxaliplatin) for 3 cycles (Kuebler, 2007)
FOLFOX6 and mFOLFOX6 regimen: 400 mg/m2 bolus on day 1, followed by 1200 mg/m2/day continuous infusion for 2 days (over 46 hours) every 2 weeks (in combination with leucovorin and oxaliplatin) until disease progression or unacceptable toxicity (Cheeseman, 2002)
FOLFIRI regimens: 400 mg/m2 bolus on day 1, followed by 1200 mg/m2/day continuous infusion for 2 days (over 46 hours) every 2 weeks (in combination with leucovorin and irinotecan) until disease progression or unacceptable toxicity; after 2 cycles, may increase continuous infusion fluorouracil dose to 1500 mg/m2/day (over 46 hours) (Andre, 1999)
Roswell Park regimen: 500 mg/m2 (bolus) on days 1, 8, 15, 22, 29, and 36 (1 hour after leucovorin) every 8 weeks (in combination with leucovorin) for 4 cycles (Haller, 2005)
See additional protocols for Gastric, Pancreatic, Anal, Bladder, Cervical, Esophageal, Head and neck, squamous cell and Hepatobilliary Cancers...
Dosage adjustment for toxicity: According to the manufacturer, treatment should be discontinued for the following:Stomatitis or esophagopharyngitis, leukopenia (WBC <3500/mm3), rapidly falling white blood cell count, intractable vomiting, diarrhea, frequent bowel movements, watery stools, gastrointestinal ulcer or bleeding, thrombocytopenia (platelets <100,000/mm3), hemorrhage
Monitoring Parameters
CBC with differential and platelet count, renal function tests, liver function tests, signs of palmar-plantar erythrodysesthesia syndrome, stomatitis, diarrhea, hemorrhage, or gastrointestinal ulcers or bleeding
D;
The National Comprehensive Cancer Network (NCCN) breast cancer guidelines (v.3.2012) state that chemotherapy, if indicated, may be administered to pregnant women with breast cancer as part of a combination chemotherapy regimen (common regimens administered during pregnancy include doxorubicin, cyclophosphamide, and fluorouracil); chemotherapy should not be administered during the first trimester, after 35 weeks gestation, or within 3 weeks of planned delivery.
Drug
interactions: LINK:
A total of 252 drugs (1839 brand and generic names) are known to interact with fluorouracil.
- 49 major drug interactions (1256 brand and generic names)
- 200 moderate drug interactions (574 brand and generic names)
- 3 minor drug interactions (9 brand and generic names)
fluorouracil ↔ multivitamins with minerals
Major Drug Interaction
Products containing folic acid may increase the effects of fluorouracil. You may be more likely to develop serious side effects such as anemia, bleeding problems, infections, and nerve damage when these medications are used together. Contact your doctor
if you experience severe nausea and vomiting, diarrhea, paleness of skin, fatigue, dizziness, fainting, unusual bleeding or bruising, blood in the stools, fever, chills, body aches, flu-like symptoms, skin reactions, mouth ulcers or sores, and/or numbness, burning or tingling in your hands and feet. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
if you experience severe nausea and vomiting, diarrhea, paleness of skin, fatigue, dizziness, fainting, unusual bleeding or bruising, blood in the stools, fever, chills, body aches, flu-like symptoms, skin reactions, mouth ulcers or sores, and/or numbness, burning or tingling in your hands and feet. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Vitamin K Antagonists (eg, warfarin): Fluorouracil (Systemic) may increase the serum concentration of Vitamin K Antagonists. Consider therapy modification
CYP2C9 Substrates: CYP2C9 Inhibitors (Strong) may decrease the metabolism of CYP2C9 Substrates. Consider therapy modification
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Consider therapy modification
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Monitor therapy
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Vaccinial infections may develop. Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Avoid combination
5FluroUracil Cancer...
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