Fluorouracil

Near complete or total absence of dihydropyrimidine dehydrogenase (DPD) activity. Bone marrow depression (after treatment with radiotherapy or other antineoplastic agents); serious infections (e.g. Herpes zoster, chickenpox). Seriously debilitated patients. Concomitant use with antiviral nucleoside drugs (e.g. brivudine, sorivudine and analogues) and live vaccines. Pregnancy and lactation.

Patients with history of heart disease, partial DPD deficiency. Renal and hepatic impairment. Patient Counselling This drug may cause visual changes, if affected do not drive or operate machinery. Avoid prolonged exposure to UV radiation (e.g. natural sunlight, tanning salon). Avoid topical application to mucous membranes Monitoring Parameters Monitor CBC with differential and platelet count, renal function tests, LFTs, INR and prothrombin time (in patients receiving concomitant-coumarin derivative anticoagulants). Monitor for signs and symptoms of palmar-plantar erythrodysesthesia syndrome, cardiotoxicity, CNS toxicity, stomatitis, diarrhoea and hyperammonemic encephalopathy.

Significant: Hand-and-foot syndrome/palmar-plantar erythrodysaesthesia syndrome, hyperammonemic encephalopathy (e.g. altered mental status, confusion, disorientation, coma, ataxia), mucositis, neurologic toxicity (e.g. confusion, disorientation, ataxia, visual disturbance. Topical: Hypersensitivity (e.g. severe pruritus or eczema, allergic contact dermatitis), local skin reactions (e.g. erythema followed by vesiculation, desquamation, erosion; local oedema, irritation, pain, pruritus, scaling, scarring, soreness, stinging, ulceration), photosensitivity. Blood and lymphatic system disorders: Pancytopenia, febrile neutropenia, thrombophlebitis. Cardiac disorders: Angina. Eye disorders: Lacrimal duct stenosis, visual changes, excessive lacrimation, photophobia, eye movement disturbance, optic neuritis, diplopia, decreased visual acuity, conjunctivitis, blepharitis. Gastrointestinal disorders: Gastrointestinal ulceration and bleeding, sloughing, nausea, vomiting, watery diarrhoea, dehydration sepsis. General disorders and administration site conditions: Delayed wound healing, fatigue, weakness, fever. Immune system disorders: Anaphylaxis, generalised allergic reactions. Infections and infestations: Infections. Metabolism and nutrition disorders: Hyperuricaemia, anorexia. Nervous system disorders: Headache, dizziness, somnolence. Psychiatric disorders: Euphoria. Respiratory, thoracic and mediastinal disorders: Bronchospasm, epistaxis. Skin and subcutaneous tissue disorders: Dry skin, fissuring, vein pigmentation, alopecia.
Potentially Fatal: Bone marrow suppression (e.g. neutropenia, thrombocytopenia, anaemia), gastrointestinal toxicity (e.g. stomatitis, diarrhoea), cardiotoxicity (e.g. angina, MI, arrhythmia, heart failure, cardiogenic shock).

Increased INR with warfarin. May increase the plasma concentration of phenytoin. Cimetidine may increase plasma concentration of fluorouracil. May increase risk of toxicity with other cytotoxic agents used in combination with chemotherapy or in radiation therapy. Anti-tumour efficacy or toxicity may be altered by metronidazole, allopurinol. Increased risk of agranulocytosis with clozapine.

Cytotoxic Chemotherapy

L01BC02 - fluorouracil ; Belongs to the class of antimetabolites, pyrimidine analogues. Used in the treatment of cancer.