floxuridine

Contraindicated in:

Hypersensitivity;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Renal impairment;
Hepatic impairment;
History of high-dose pelvic irradiation or previous use of alkylating agents;
Infection;
Depressed bone marrow reserve;
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: alopecia, erythema, maculopapular rash

Endo: gonadal suppression

GI: bleeding, diarrhea, gastritis, nausea, stomatitis, vomiting, anorexia, ulcer

Hemat: anemia, leukopenia, thrombocytopenia

Neuro: fatigue, headache

Misc: fever

Interactions ⬆ ⬇

Drug-drug:

Additive bone marrow depression with other bone marrow depressants (other antineoplastics and radiation therapy).
Pentostatin may ↑ risk of fatal pulmonary toxicity; avoid concurrent use.
May ↓ antibody response to live-virus vaccines and ↑ risk of adverse reactions.

Availability ⬆ ⬇

(Generic available)

Powder for injection: 500 mg/vial

Route/Dosage ⬆ ⬇

IA (Adults ): 0.1–0.6 mg/kg/day as a continuous infusion for 14 days, followed by a 2-wk rest (only heparinized saline administered during this rest period).

Action ⬆ ⬇

Inhibits DNA and RNA synthesis by preventing thymidine production (cell-cycle S phase-specific).

Therapeutic effects:

Death of rapidly replicating cells, particularly malignant ones.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: antimetabolites

Pharmacokinetics ⬆ ⬇

Absorption: Administered intra-arterially only, resulting in direct delivery to tumor sites.

Distribution: Distributes mostly to tumor site as a result of elective intra-arterial administration.

Metabolism/Excretion: Rapidly converted to floxuridine monophosphate (an active metabolite) and fluorouracil; 60–80% excreted by the lungs as respiratory CO. Small amounts of fluorouracil (<10–15%) excreted unchanged by the kidneys.

Half-Life: Fluorouracil: 20 hr.

Time/Action Profile ⬆ ⬇

(effects on blood counts‡)

ROUTE	ONSET	PEAK	DURATION
Intra-arterial	1–9 days	9–21 days	30 days

‡Noted as effects due to conversion to fluorouracil.

Patient/Family Teaching ⬆ ⬇

Explain purpose of floxuridine to patient.
Instruct patient to notify health care provider if fever, chills, sore throat, signs of infection, bleeding gums, bruising, petechiae, blood in urine or stool, jaundice, abdominal pain, local irritation at the site of arterial cannulation, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Caution patient not to drink alcoholic beverages or take products containing aspirin or NSAIDs.
Advise patient to rinse mouth with clear water after eating and drinking and to avoid flossing to minimize stomatitis. Health care provider may order viscous lidocaine or other local agents if mouth pain interferes with eating. Stomatitis pain may require treatment with opioid analgesics.
Discuss with patient the possibility of hair loss. Explore methods of coping.
Instruct patient not to receive any vaccinations without advice of health care provider.
Rep: May cause fetal harm. Advise women of reproductive potential to use effective contraception and avoid breastfeeding during therapy.
Emphasize the importance of routine follow-up lab tests to monitor progress and to check for side effects.

section name header

Indications ⬇

Contraind./Precautions ⬆ ⬇