FLOXURIDINE
| FLOXURIDINE (flox-yoor'i-deen) FUDR Classifications: antineoplastic; antimetabolite, pyrimidine; Therapeutic: antineoplastic; antimetabolite Prototype: Fluorouracil Pregnancy Category: D |
Availability
500 mg powder for injection
Action
Pyrimidine antagonist and cell-cycle specific. Catabolized to fluorouracil in the body; highly toxic because it blocks an enzyme essential to normal DNA and RNA synthesis.
Therapeutic Effect
Proliferative cells of neoplasms are affected more than healthy tissue cells.
Uses
Palliative agent in management of selected patients with GI metastasis to liver.
Unlabeled Uses
Carcinoma of breast, ovary, cervix, urinary bladder, and prostate not responsive to other antimetabolites.
Contraindications
Existing or recent viral infections; pregnancy (category D); lactation.
Cautious Use
Poor nutritional status, bone marrow depression, serious infections; high-risk patients: prior high-dose pelvic irradiation, use of alkylating agents; impaired kidney or liver function.
Route & Dosage
| Carcinoma Adult: Intraarterial 0.1–0.6 mg/kg/d by continuous intraarterial infusion |
Administration
| Intraarterial Infusion PREPARE: Direct: Reconstitute with 5 mL sterile distilled water for injection; further dilute with D5W or NS injection to a volume appropriate for the infusion apparatus to be used. ADMINISTER: Direct: It is administered by pump to overcome pressure in large arteries and to ensure a uniform rate. Examine infusion site frequently for signs of extravasation. If this occurs, stop infusion and restart in another vessel. INCOMPATIBILITIES Y-site: Allopurinol, cefepime. |
- Keep reconstituted solutions, which are stable at 2°–8° C (36°–46° F), for no more than 2 wk.
- Store at 15°–30° C (59°–86° F) unless otherwise directed.
Adverse Effects (≥1%)
CNS: Vertigo, convulsions, depression, hemiplegia. CV: Myocardial ischemia, angina. GI: Nausea, vomiting, stomatitis, diarrhea, cramps, anorexia, enteritis, gastritis, esophagopharyngitis. Hematologic: Leukopenia, thrombocytopenia. Skin: Dermatitis, alopecia (usually reversible), erythema or increased skin pigmentation (photosensitivity), dry skin, pruritic ulcerations, rash. Body as a Whole: Hiccups, fever, epistaxis, decreased resistance to disease. Urogenital: Renal insufficiency.Interactions
Drug: Metronidazole may increase general floxuridine toxicity; may increase or decrease serum levels of phenytoin, fosphenytoin; hydroxyurea can decrease conversion to active metabolite.Pharmacokinetics
Distribution: Distributed to tumor, intestinal mucosa, bone marrow, liver, and CSF; probably crosses placenta. Metabolism: Rapidly metabolized in liver to fluorouracil. Elimination: 15% excreted in urine, 60–80% excreted through lungs as carbon dioxide. Half-Life: 16 min.Nursing Implications
Assessment & Drug Effects
- Discontinue therapy promptly with onset of any of the following: Stomatitis, esophagopharyngitis, intractable vomiting, diarrhea, leukopenia (WBC <3500/mm3), or rapidly falling WBC count, thrombocytopenia (platelets 100,000/mm3), GI bleeding, hemorrhage from any site.
- Lab tests: Obtain baseline and periodic total and differential leukocyte counts, Hct, platelet count, serum uric acid creatinine, and liver function tests.
Patient & Family Education
- Be aware that floxuridine sometimes causes temporary thinning of hair.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug