flucytosine


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flucytosine

Ancobon, Ancotil (UK)

Pharmacologic class: Fluorinated pyrimidine analog

Therapeutic class: Antifungal

Pregnancy risk category C

Action

Unclear. Thought to interfere with protein synthesis in cells of susceptible fungi after conversion to fluorouracil.

Availability

Capsules: 250 mg, 500 mg

Indications and dosages

Severe fungal infections caused by susceptible strains of Candida species (including septicemia, endocarditis, urinary tract infections [UTIs]), and pulmonary infections) and Cryptococcus species (including meningitis, pulmonary infections, and UTIs)

Adults: 50 to 150 mg/kg P.O. daily in four equally divided doses q 6 hours

Dosage adjustment

• Renal impairment (glomerular filtration rate below 50 ml/minute)

Off-label uses

• Chromomycosis

Contraindications

• Hypersensitivity to drug or other antifungals

Precautions

Use cautiously in:

• renal impairment, underlying hepatic disease, bone marrow depression

• pregnant or breastfeeding patients

• children (safety not established).

Administration

• Give capsules a few at a time over 15 minutes to minimize nausea and vomiting.

• Know that drug is rarely used alone. Expect to give another antifungal or amphotericin B concurrently.

Adverse reactions

CNS: headache, dizziness, confusion, hallucinations, vertigo, psychosis, ataxia, paresthesia, parkinsonism, peripheral neuropathy

CV: chest pain, cardiac arrest

EENT: hearing loss

GI: nausea, vomiting, diarrhea, dyspepsia, ulcerative colitis, abdominal discomfort, anorexia, duodenal ulcer, hemorrhage

GU: azotemia, crystalluria, renal failure

Hematologic: eosinophilia, anemia, leukopenia, aplastic anemia, thrombocytopenia, bone marrow depression, agranulocytosis

Hepatic: jaundice

Metabolic: hypokalemia, hypoglycemia

Respiratory: dyspnea, respiratory arrest

Skin: rash, pruritus, urticaria, photosensitivity

Interactions

Drug-drug. Amphotericin B: synergistic effects, increased risk of toxicity

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, gamma-glutamyltransferase: increased levels

Glucose, granulocytes, hemoglobin, platelets, potassium, white blood cells: decreased levels

Patient monitoring

• Monitor kidney and liver function test results.

• Carefully monitor blood glucose level and hematologic test results.

Assess for serious cardiovascular, renal, respiratory, and hematologic adverse reactions.

• Evaluate electrolyte levels, particularly potassium.

• Assess for signs and symptoms of bleeding.

Patient teaching

• Advise patient to take capsules over 15-minute period to reduce GI upset.

Instruct patient to immediately report unusual bleeding or bruising.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• Instruct patient to minimize GI upset by eating frequent, small servings of food and drinking adequate fluids.

• Advise female patient to inform prescriber if she is pregnant or breastfeeding.

• Tell patient he'll undergo regular blood testing during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

flucytosine

/flu·cy·to·sine/ (floo-si´to-sēn″) an antifungal used in the treatment of severe candidal and cryptococcal infections.

flucytosine

[flo̅o̅sī′təsēn]
an antifungal.
indications It is prescribed as an adjunct in the treatment of certain serious fungal infections, usually Candida or Cryptococcus.
contraindications Known hypersensitivity to this drug prohibits its use. Close monitoring is required when administering it to patients with renal disorders, bone marrow depression, or AIDS.
adverse effects Among the more serious adverse effects are GI disturbances, including enterocolitis, abnormal liver function, hepatomegaly, and bone marrow depression. Also causes hallucinations, confusion and other CNS effects, respiratory depression, peripheral neuropathy, and hearing loss.

flucytosine

5-FC, Ancobon Infectious disease An anti-fungal given with amphotericin B to ↓ emergence of resistant strains Adverse effects Liver damage. See AIDS.

flucytosine

A drug used to treat fungus infections within the body. It can be taken by mouth and is effective against CRYPTOCOCCOSIS, chromomycosis and thrush (CANDIDIASIS). Side effects are minor.

antifungal agent 

Any substance which destroys or prevents the growth of fungi. It is one of the antibiotic groups. There are several classes of antifungal drugs: Polyenes, which cause an increase in fungal cell wall permeability leading to its death. Examples: amphotericin B, natamycin, nystatin. Azoles, which act either by inhibiting the synthesis of ergosterol, a component of fungal cell wall or by causing direct wall damage. Examples: clotrimazole, econazole, fluconazole, itraconazole, ketoconazole, miconazole. Pyrimidines, which interfere with the normal function of fungal cells. Example: flucytosine. Syn antimycotic agent.
References in periodicals archive ?
Midway through this bird's course of treatment, oral antifungals were changed from terbinafine and fluconazole to flucytosine and fluconazole to more closely mimic protocols used for the treatment of cryptococcosis in people and achieve better activity in the eye.
Primary resistance to flucytosine among clinical isolates of Candida spp.
Access to flucytosine for HIV-infected patients with cryptococcal meningitis--an urgent need.
Treatment of cryptococcal meningitis with combination amphotericin B and flucytosine for four as compared with six weeks.
According to the company, Flucytosine Capsules are the first approved generic version of Valeant Pharmaceuticals International's Ancobon Capsules.
Successful treatment of Balamuthia GAE has been reported in some, but not all, patients administered a combination of flucytosine, pentamidine, sulfadiazine, fluconazole or amphotericin B, azithromycin or clarithromycin, and miltefosine (3,8).
Evolving role of flucytosine in immunocompromised patients: new insights into safety, pharmacokinetics, and antifungal therapy.
Susceptibility of dermatiaceous fungi to amphotericin B, miconazole, ketoconazole, flucytosine and rifampin alone and in combination.
albicans (Cuadro 4), es de particular importancia, si consideramos la resistencia que este organismo presenta actualmente a diferentes antifungicos: flucytosine, griseofulvina, azoles, (Albertson et al.
In some cases, it makes sense to add flucytosine, 100 mg/kg per day, and then fluconazole, 400 mg per day for 10 weeks.
Clinicians use the antifungal drugs amphotericin B, fluconazole and flucytosine to treat cryptococcal meningitis.