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

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 ?
Flucytosine and cryptococcosis: Time to urgently address the worldwide accessibility of a 50-year-old antifungal.
For the 12 months ended June 2011, the US brand sales for Flucytosine and Chloroquine Phosphate were about USD20m collectively, according to IMS Health data.
For candida species, all were susceptible to amphotericin B, nystatin, fluconazole, flucytosine, ketoconazole and econazole, while 3(60%) were resistant to miconazole.
The result generated as genus-level, group-level identification, while the Vitek 2 AST-YSO7 Card evaluated the sensitivity and resistance of Amphotericin B, Fluconazole, Micafungin, Caspofungin, Voriconazole, and Flucytosine.
J had a CM recurrence, and amphotericinksks B and flucytosine were reinitiated.
(52,53) "Emerging cases of drug resistance to currently available drugs has limited the spectrum of currently available antifungal agents." (54) "Drugs for systemic antifungal treatments include amphotericin B, various azole derivatives, and flucytosine." (5)
(NASDAQ: TOCA) for Toca 511 (vocimagene amiretrorepvec) and Toca FC (flucytosine) for the treatment of patients with glioma, a type of brain tumor, the company said.
He was started on amphotericin B lipid complex and flucytosine for cryptococcal meningitis.
asahii clinical isolates from nongranulocytopenic patients showed reduced susceptibility in vitro to AMB, flucytosine, fluconazole, itraconazole and ketoconazole.
The patient was prescribed intravenous amphotericin B (1 mg/kg/d) and intravenous flucytosine (2 g/6 h) (Table); after 5 days of therapy, culture of a repeat lumbar puncture sample was negative.
Adding flucytosine or rifampicin may increase the effectiveness of amphotericin.
The therapeutic modalities include itraconazole 200mg daily with or without flucytosine (30mg/kg QID); terbinafine 250mg daily and in extensive cases intravenous amphotericin B.