fluorouracil

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fluorouracil

 [floor″o-u´rah-sil]
a uracil analogue that interferes with DNA synthesis; used intrvenously as an antimetaboliteantineoplastic agent for palliative treatment of carcinomas of the breast and gastrointestinal tract; also used topically for treatment of actinic keratoses and superficial basal cell carcinomas. Called also 5-fluorouracil (5-FU).
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

fluorouracil (5-fluorouracil, 5-FU)

Adrucil, Efudex, Fluoroplex

Pharmacologic class: Antimetabolite

Therapeutic class: Antineoplastic

Pregnancy risk category D

Action

Inhibits DNA and RNA synthesis, leading to death of rapid-growing neoplastic cells. Cell-cycle-S-phase specific.

Availability

Cream: 1%, 5%

Injection: 50 mg/ml in 10-ml ampules and 10-, 20-, and 100-ml vials

Solution: 1%, 2%, 5%

Indications and dosages

Advanced colorectal cancer

Adults: 370 mg/m2 I.V. for 5 days, preceded by leucovorin 200 mg/m2 daily for 5 days; may be repeated q 4 to 5 weeks. No single daily dose should exceed 800 mg.

Colon, rectal, breast, gastric, and pancreatic cancer

Adults: Initially, 12 mg/kg/day I.V. for 4 days; then 6 mg/kg I.V. on days 6, 8, 10, and 12. Maximum dosage is 800 mg/day. For maintenance, start 30 days after last dose. If no toxicity, use dosage from first course. If toxicity occurs, give 10 to 15 mg/kg/week as single dose after toxicity subsides. Don't exceed 1 g/week.

Actinic (solar) keratoses

Adults: 1% solution or cream applied once or twice daily to lesions on head, neck, or chest; 2% to 5% solution or cream may be needed for other areas.

Superficial basal cell carcinoma

Adults: 5% solution or cream applied b.i.d. for 3 to 6 weeks (up to 12 weeks)

Contraindications

• Hypersensitivity to drug or its components

• Bone marrow depression

• Dihydropyrimidine dehydrogenase enzyme deficiency (with topical route)

• Poor nutritional status

• Serious infection

• Pregnancy or breastfeeding

Precautions

Use cautiously in:

• renal or hepatic impairment, infections, edema, ascites

• obese patients.

Administration

Consult facility's cancer protocols to ensure correct dosage, administration technique, and cycle length.

• Give antiemetic before fluorouracil, as ordered, to reduce GI upset.

• Know that drug may be given without dilution by direct I.V. injection over 1 to 3 minutes.

• For I.V. infusion, dilute with dextrose 5% in water, sterile water, or normal saline solution in plastic bag (not glass bottle). Infusion may be given over a period of 24 hours or more.

Be aware of the importance of leucovorin rescue with fluorouracil therapy, if prescribed.

• Check infusion site frequently to detect extravasation.

• Use nonmetal applicator or appropriate gloves to apply topical form.

• Avoid applying topical form to mucous membranes or irritated skin.

• Don't use occlusive dressings over topical form.

• Know that pyridoxine may be given with fluorouracil to reduce risk of palmar-plantar erythrodysesthesia (hand-foot syndrome).

Adverse reactions

CNS: confusion, disorientation, euphoria, ataxia, headache, weakness, malaise, acute cerebellar syndrome or dysfunction

CV: angina, myocardial ischemia, thrombophlebitis

EENT: vision changes, photophobia, lacrimation, lacrimal duct stenosis, nystagmus, epistaxis

GI: nausea, vomiting, diarrhea, stomatitis, anorexia, GI ulcer, GI bleeding

Hematologic: anemia, leukopenia, thrombocytopenia

Skin: alopecia, maculopapular rash, melanosis of nails, nail loss, palmar-plantar erythrodysesthesia, photosensitivity, local inflammation reaction (with cream), dermatitis

Other: fever, anaphylaxis

Interactions

Drug-drug. Bone marrow depressants (including other antineoplastics): additive bone marrow depression

Irinotecan: dehydration, neutropenia, sepsis

Leucovorin calcium: increased risk of fluorouracil toxicity

Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, lactate dehydrogenase, urinary 5-hydroxyindoleacetic acid: increased levels

Albumin, granulocytes, platelets, red blood cells, white blood cells (WBCs): decreased levels

Drug-behaviors. Sun exposure: increased risk of phototoxicity

Patient monitoring

Watch for signs and symptoms of toxicity, especially stomatitis and diarrhea. If these occur, stop drug and notify prescriber. Note that toxicity may take 1 to 3 weeks to develop.

• Monitor CBC, WBC and platelet counts, and kidney and liver function test results.

• Assess fluid intake and output.

• With long-term use, watch for serious rash on hands and feet. If it occurs, consult prescriber regarding need for pyridoxine.

• Assess for bleeding tendency.

• Monitor blood glucose level in patients at risk for hyperglycemia.

Patient teaching

Emphasize importance of taking leucovorin as prescribed with high-dose therapy.

Instruct patient to report signs and symptoms of toxicity, particularly stomatitis and diarrhea. Tell him that these may not occur for 1 to 3 weeks.

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

• Tell patient to avoid activities that can cause injury. Instruct him to use soft toothbrush and electric razor to avoid gum and skin injury.

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

• Tell patient that drug may cause reversible hair loss.

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

Advise female to inform prescriber immediately if she is pregnant. Caution her not to breastfeed.

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

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

fluor·o·u·ra·cil (FU),

(flōr'ō-yū'ră-sil),
A pyrimidine analogue; an antineoplastic effective in the treatment of some carcinomas; the cells of certain neoplasms incorporate uracil into ribonucleic acid more readily than do normal tissue cells.
Farlex Partner Medical Dictionary © Farlex 2012

fluorouracil

(flo͝or′ō-yo͝or′ə-sĭl, flôr′-)
n.
An antineoplastic agent, C4H3FN2O2, used especially in the treatment of cancers of the skin, breast, and digestive system.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

fluorouracil

5-FU, Efudex® Oncology An antimetabolite that interferes with DNA synthesis, and deprives DNA of functional thymidine; 5-FU is used for bladder CA, for terminal CA and, topically, for actinic keratosis Side effects BM toxicity, mucosal inflammation
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

flu·o·ro·u·ra·cil

(FU, FUra) (flōr'ō-yū'ră-sil)
An antineoplastic effective in the treatment of some carcinomas.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

fluorouracil

A pyrimidine anticancer drug. The drug is on the WHO official list.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

Fluorouracil

A cell-killing (cytotoxic) medication that can be applied in cream form to treat cancer of the penis.
Mentioned in: Penile Cancer
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

flu·o·ro·u·ra·cil

(flōr'ō-yū'ră-sil)
Antineoplastic effective in treatment of some carcinomas.
Medical Dictionary for the Dental Professions © Farlex 2012
References in periodicals archive ?
The "new kid on the block" is the 0.5% cream (Carac), indicated for the topical treatment of multiple AKs of the face and anterior scalp.
The deal for Dermik gives Valeant leading brands such as BenzaClin for the treatment of acne, Carac for the treatment of keratoses, and Sculptra, a facial injectable for the correction of facial wrinkles and folds.
The study was sponsored by Dermik Laboratories Inc., which makes Carac, the formulation of 0.5% fluorouracil tested in the study.
Another useful combination is cryotherapy, a 4- to 6-week wait, then Carac once daily for 30 days, with follow-up 4-6 weeks later and again in 6-12 months, said Dr.
Other newly available products, notably 5-fluorouracil (Carac cream, 0.5%) and didofenac (Solaraze gel, 3%) have also been found to expose and eradicate subclinical AKs.
A Fama Distribution release (in Switzerland) of a Carac Prods.
Other newly available products, notably 5-fluorouracil cream 0.5% (Carac) and diclofenac gel 3% (Solaraze) have also been found to expose and eradicate subclinical AKs.
Fluorouracil cream (Carac) has been reported to produce a complete response in 53% of lesions, he said in an interview.
The 5-EU cream contains 10% of the dose contained in the other topical 5-EU products now available, said a spokesperson for Dermik Laboratories, which markets the product under the trade name Carac.