Home Drug Guide Fluorouracil

Drug Guide

Generic Name

Fluorouracil

Brand Names Fluoroplex, Efudex, Adrucil, Carac, Tolak

Classification

Therapeutic: Antineoplastic agent, Antimetabolite

Pharmacological: Pyrimidine analog

FDA Approved Indications

  • Treatment of actinic keratosis, superficial basal cell carcinoma, and certain types of colorectal and breast cancers

Mechanism of Action

Fluorouracil inhibits thymidylate synthase, leading to decreased DNA synthesis and cell death, particularly in rapidly dividing cancer cells.

Dosage and Administration

Adult: Varies based on condition; for topical use, apply thin layer to affected area as directed, typically twice daily.

Pediatric: Use is off-label; dosing depends on condition and site of application.

Geriatric: Adjust doses based on renal and hepatic function, with close monitoring.

Renal Impairment: Use with caution; dosage adjustments may be necessary.

Hepatic Impairment: Use with caution; monitor hepatic function and adjust dose accordingly.

Pharmacokinetics

Absorption: Poorly absorbed through intact skin; systemic absorption can occur after topical application, especially in damaged skin.

Distribution: Widely distributed; crosses the placental barrier.

Metabolism: Primarily hepatic via dihydropyrimidine dehydrogenase (DPD); variability in DPD activity affects toxicity.

Excretion: Renal excretion of metabolites.

Half Life: Approximately 10-20 minutes systemically, but half-life can vary with formulation and route.

Contraindications

  • Known hypersensitivity to fluorouracil or other pyrimidines.
  • Bone marrow depression.
  • Pregnancy and breastfeeding—use only if potential benefit justifies potential risk.

Precautions

  • Monitor blood counts during systemic therapy.
  • Use cautiously in patients with hepatic or renal impairment.
  • Avoid topical application on large or open wounds, or compromised skin.

Adverse Reactions - Common

  • Mild local skin reactions (erythema, burning, itching) (Common)
  • Mucositis or stomatitis (Common)

Adverse Reactions - Serious

  • Bone marrow suppression, including leukopenia, neutropenia, anemia, thrombocytopenia (Serious; monitoring required)
  • Hand-foot syndrome (palmar-plantar erythrodysesthesia) (Serious; more common with topical formulations in prolonged use)
  • Allergic contact dermatitis (Serious; rare)

Drug-Drug Interactions

  • Warfarin (may increase bleeding risk)
  • Other myelosuppressive agents

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Baseline CBC, hepatic and renal function tests. Monitor skin and mucous membrane status.

Diagnoses:

  • Impaired skin integrity
  • Risk for bleeding
  • Risk for infection

Implementation: Apply topically as prescribed; handle systemic formulations with proper protective equipment.

Evaluation: Assess skin response, blood counts, and systemic side effects regularly.

Patient/Family Teaching

  • Apply medication exactly as prescribed.
  • Report signs of skin irritation, skin breakdown, bleeding, or infection.
  • Avoid unnecessary sun exposure or skin trauma during topical therapy.

Special Considerations

Black Box Warnings:

  • Use with extreme caution in pregnant women due to potential fetal harm.
  • Potential for severe toxicity if DPD deficiency is present.

Genetic Factors: Dihydropyrimidine dehydrogenase (DPD) deficiency increases risk of severe toxicity.

Lab Test Interference: Can cause false elevations in certain lab tests due to tissue necrosis.

Overdose Management

Signs/Symptoms: Severe myelosuppression, neurotoxicity, mucositis, skin reactions.

Treatment: Supportive care; leucovorin rescue may be considered; dialysis is not effective for removal.

Storage and Handling

Storage: Store at room temperature, protected from light.

Stability: Stable for specified period as per manufacturer instructions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.