Fluorouracil Information
Pronunciation
flure oh YOOR a sil
What is this drug used for?
• It is used to treat colorectal cancer.
• It is used to treat breast cancer.
• It is used to treat stomach cancer.
• It is used to treat pancreatic cancer.
• It may be given to you for other reasons. Talk with the doctor.
Frequently reported side effects of this drug
• Lack of appetite
• Dry skin
• Hair loss
• Nail changes
Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:
• Infection
• Bleeding like vomiting blood or vomit that looks like coffee grounds; coughing up blood; blood in the urine; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding.
• Chest pain
• Shortness of breath
• Excessive weight gain
• Swelling in the arms or legs
• Abnormal heartbeat
• Dizziness
• Passing out
• Severe abdominal pain
• Severe nausea
• Vomiting
• Severe diarrhea
• Swelling of hands or feet
• Change in balance
• Severe fatigue
• Confusion
• Severe mouth irritation
• Burning or numbness feeling
• Involuntary eye movements
• Headache
• Mouth sores
• Sensitivity to lights
• Severe loss of strength and energy
• Vision changes
• Severe injection site pain, burning, edema, or redness
• Redness or irritation of palms or soles of feet
• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.
Medication Safety Issues
Sound-alike/look-alike issues:
Fluorouracil may be confused with floxuridine, flucytosine
High alert medication:
This medication is in a class the Institute for Safe Medication Practices (ISMP) includes among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.
Administration issues:
Continuous infusion: Serious errors have occurred when doses administered by continuous ambulatory infusion pumps have inadvertently been given over 1 to 4 hours instead of the intended extended continuous infusion duration. Depending on protocol, infusion duration may range from 46 hours to 7 days for fluorouracil continuous infusions. Ambulatory pumps utilized for continuous infusions should have safeguards to allow for detection of programming errors. If using an elastomeric device for ambulatory continuous infusion, carefully select the device and double check the flow rate. Appropriate prescribing (in single daily doses [not course doses] with instructions to infuse over a specific time period), appropriate training/certification/education of staff involved with dispensing and administration processes, and independent double checks should be utilized throughout dispensing and administration procedures.
Storage and Stability
Store intact vials at 20°C to 25°C (68°F to 77°F). Do not freeze. Protect from light. Pharmacy bulk vials should be used within 4 hours of initial entry. Syringes and solutions diluted for infusion may be stored for up to 4 hours (at room temperature) prior to administration (according to the manufacturer). Fluorouracil 50 mg/mL in NS was stable in polypropylene infusion pump syringes for 7 days when stored at 30°C (86°F) (Stiles 1996). Stability of fluorouracil 1 mg/mL or 10 mg/mL in NS or D5W in PVC bags was demonstrated for up to 14 days at 4°C (39.2°F) and 21°C (69.8°F) (Martel 1996). Stability of undiluted fluorouracil (50 mg/mL) in ethylene-vinyl acetate ambulatory pump reservoirs was demonstrated for 3 days at 4°C (39.2°F) (precipitate formed after 3 days) and for 14 days at 33°C (91.4°F) (Martel 1996). Stability of undiluted fluorouracil (50 mg/mL) in PVC ambulatory pump reservoirs was demonstrated for 5 days at 4°C (39.2°F) (precipitate formed after 5 days) and for 14 days at 33°C (91.4°F) (Martel 1996). Follow USP 797 recommendations for beyond use dates based on the level of risk for preparation.
Adverse Reactions
Toxicity depends on duration of treatment and/or rate of administration.
Cardiovascular: Angina pectoris, cardiac arrhythmia, cardiac failure, cerebrovascular accident, ischemic heart disease, local thrombophlebitis, myocardial infarction, vasospasm, ventricular ectopy
Central nervous system: Cerebellar syndrome (acute), confusion, disorientation, euphoria, headache
Dermatologic: Alopecia, changes in nails (including nail loss), dermatitis, hyperpigmentation (supravenous), maculopapular rash (pruritic), palmar-plantar erythrodysesthesia, skin fissure, skin photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis, xeroderma
Gastrointestinal: Anorexia, diarrhea, esophagopharyngitis, gastrointestinal hemorrhage, gastrointestinal ulcer, mesenteric ischemia (acute), nausea, stomatitis, tissue sloughing (gastrointestinal), vomiting
Hematologic & oncologic: Agranulocytosis, anemia, leukopenia (nadir: days 9 to 14; recovery by day 30), pancytopenia, thrombocytopenia
Hypersensitivity: Anaphylaxis, hypersensitivity reaction (generalized)
Ophthalmic: Lacrimal stenosis, lacrimation, nystagmus, photophobia, visual disturbance
Respiratory: Epistaxis
Rare but important or life-threatening: Dysgeusia (Syed 2016) –
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