floxuridine

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.

Contraind./Precautions ⬆ ⬇

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.

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).

Availability ⬆ ⬇

(Generic available)

Powder for injection: 500 mg/vial

Assessment ⬆ ⬇

Monitor vital signs prior to and frequently during therapy.
Assess mucous membranes, number and consistency of stools, and frequency of vomiting frequently during therapy. Assess for signs of infection (fever, chills, sore throat, cough, hoarseness, pain in lower back or side, difficult or painful urination). Assess for bleeding (bleeding gums; bruising; petechiae; guaiac test stools, urine, and emesis). Avoid IM injections and rectal temperatures. Apply pressure to venipuncture sites for 10 min. Report symptoms of toxicity (stomatitis or esophagopharyngitis, uncontrollable vomiting, diarrhea [≥5 loose stools/day], GI bleeding, myocardial ischemia, leukocyte count <3500/mm³, platelet count <100,000/mm³, hemorrhage from any site, erythema at catheter insertion site); discontinue floxuridine if symptoms of toxicity occur; may be reinitiated at a lower dose when side effects have subsided.
Monitor intake and output, appetite, and nutritional intake. Adjusting diet as tolerated may help maintain fluid and electrolyte balance and nutritional status.
Assess for abdominal pain, cramping, anorexia, or jaundice with hepatic artery infusion; may indicate hepatotoxicity. Heartburn or black, tarry stools may indicate dislodgment of catheter.
Monitor site of intra-arterial infusion for bleeding, localized skin reaction, or impaired circulation, which may indicate catheter displacement.

Lab Test Considerations:

Monitor hepatic, renal, and hematologic function prior to and periodically during therapy. Notify health care provider immediately if WBC <3500/mm³ or platelets <100,000/mm³; may require discontinuation of floxuridine. ↑ serum alkaline phosphatase, AST, ALT, LDH, and bilirubin may indicate drug-induced hepatotoxicity or biliary sclerosis.
- Interferes with BSP, prothrombin, and sedimentation rate assays.

Implementation ⬆ ⬇

High Alert: Fatalities have occurred with incorrect administration of chemotherapeutic agents. Before administering, clarify all ambiguous orders; double-check single, daily, and course-of-therapy dose limits; and have second practitioner independently double-check original order, calculations, and infusion pump settings.
Should be given only by or under the supervision of a qualified physician who is experienced in cancer chemotherapy and intra-arterial drug therapy. Due to risk of toxicity, patient should be hospitalized for 1st course of therapy.
Y-Site Incompatibility:
- allopurinol
- cefepime

IV Administration:

Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard equipment in specially designated containers.
Intra-arterial Infusion Pump: Reconstitution: Reconstitute 5-mL vial with 5 mL of sterile water for injection.Concentration: 100 mg/mL. Further dilute in D5W or 0.9% NaCl to volume required by arterial infusion pump. Solution is stable for 2 wk if refrigerated.
Y-Site Compatibility:
- aztreonam
- etoposide phosphate
- filgrastim
- fludarabine
- gemcitabine
- granisetron
- levofloxacin
- melphalan
- meperidine
- ondansetron
- paclitaxel
- piperacillin/tazobactam
- rituximab
- sargramostim
- sodium acetate
- thiotepa
- trastuzumab
- vinorelbine

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.

Evaluation/Desired Outcomes ⬆ ⬇

Tumor size regression.

Code ⬆

NDC Code

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9270- Floxuridine
  - 0143-9270-01- 1 VIAL in 1 BOX, UNIT-DOSE (0143-9270-01) / 5 mL in 1 VIAL

63323- Fresenius Kabi USA, LLC
- 63323-145- Floxuridine
  - 63323-145-07- 1 VIAL in 1 CARTON (63323-145-07) / 5 mL in 1 VIAL

81643- JND Therapeutics, Inc.
- 81643-9270- Floxuridine
  - 81643-9270-1- 1 VIAL in 1 BOX, UNIT-DOSE (81643-9270-1) / 5 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇