• Treatment of serious fungal infections including:
  • Endocarditis,
  • Meningitis,
  • Septicemia,
  • Urinary tract infections,
  • Pulmonary infections.

Contraindicated in:

• Hypersensitivity
• Complete dihydropyrimidine dehydrogenase (DPD) enzyme deficiency (↑ risk of 5–fluorouracil toxicity)
• Lactation: Lactation.

Use Cautiously in:

• Bone marrow depression (especially following radiation therapy or antineoplastics)
• OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk.

Exercise Extreme Caution in:

• Renal impairment (blood level monitoring, ↓ dose, and ↑ dosage interval recommended if CCr <40 mL/min).

CV: chest pain.

Derm: photosensitivity, pruritus, rash, urticaria.

EENT: hearing loss.

Endo: hypoglycemia.

F and E: hypokalemia.

GI: diarrhea, nausea, vomiting, abdominal pain, dry mouth.

GU: azotemia.

Hemat: leukopenia, pancytopenia, anemia, APLASTIC ANEMIA, eosinophilia, thrombocytopenia.

Neuro: dizziness, ataxia, confusion, drowsiness, fatigue, headache, peripheral neuropathy, SEIZURES.

Resp: dyspnea.
Misc: fever.

Drug-Drug:

• Additive bone marrow depression with other bone marrow depressant drugs, including antineoplastics and radiation therapy.
• Amphotericin B may ↑ toxicity of flucytosine but may also increase its antifungal activity.
• Cytarabine may ↓ its antifungal activity.

(Generic available)

• Capsules: 250 mg; 500 mg;

• PO (Adults): 12.5–37.5 mg/kg every 6 hr.
• PO (Children): 12.5–37.5 mg/kg every 6 hr.

Ancobon

• Following penetration into fungi, converted to fluorouracil, which interferes with fungal DNA and RNA synthesis.
• Synergistic action with amphotericin B against some fungi.

• Fungicidal action against susceptible organisms.

Spectrum:

• Active against only a small number of fungi, mainly:
  • Candida albicans,
  • Cryptococcus neoformans.

Therapeutic Classification: antifungals

Absorption: Well absorbed (80–90%) from the GI tract following oral administration.

Distribution: Widely distributed. Crosses the blood-brain barrier.

Metabolism/Excretion: Undergoes minimal hepatic metabolism; deaminated by gut bacteria to 5–fluorouracil (metabolized by dihydopyrimidine dehydrogenase); 80–90% excreted unchanged by the kidneys.

Half-life: 2.5–5 hr (↑ in renal impairment).

(antifungal blood levels)

• Advise patient to take medication as directed, even if feeling better. Missed doses should be taken as soon as remembered, if not almost time for next dose; do not double doses.
• May cause dizziness or drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
• Caution patient to use sunscreen and wear protective clothing to prevent photosensitivity reactions.
• Instruct patient to notify health care professional promptly if rash, fever, sore throat, yellowing of skin or eyes, changes in color of stool or urine, diarrhea, unusual bleeding or bruising, unusual tiredness, or weakness occurs.
• Emphasize the importance of follow-up exams to determine effectiveness of treatment.
• May cause fetal harm. Instruct females to notify health care professional immediately if pregnancy is planned or suspected or if breastfeeding.

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