Floxuridine

A to Z Drug Facts

Actions Floxuridine rapidly catabolizes to 5-fluorouracil. The primary effect is to interfere with the synthesis of deoxyribonucleic acid (DNA) and to a lesser extent inhibit the formation of ribonucleic acid (RNA). However, when floxuridine is given by continuous intra-arterial infusion, its direct anabolism to floxuridine-monophosphate is enhanced, thus increasing the inhibition of DNA. Floxuridine is metabolized in the liver. The drug is excreted intact and as metabolites.

 Indications Palliative management of GI adenocarcinoma metastatic to the liver administered by continuous regional intra-arterial infusion as long as cancer does not extend beyond area perfused by a single artery.

Tumors of the liver, gallbladder, bile ducts, or kidneys.

 Contraindications Patients in a poor nutritional state, those with depressed bone marrow function or those with potentially serious infections.

 Route/Dosage

Hepatic Artery Infusion

ADULTS: Implantable pump Using an implantable pump, administer 0.1 to 0.6 mg/kg/day for 1 to 6 wk, followed by a 14-day rest period between courses. Repeat cycles as long as response continues.

Solid Tumors

ADULTS: IV infusion 0.5 to 1 mg/kg/day for 6 to 15 days or until toxicity occurs.

Interactions

Cimetidine

Cimetidine may increase the bioavailability of floxuridine.

Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Arterial aneurysm; ischemia; thrombosis; embolism; fibromyositis. DERMATOLOGIC: Localized erythema; alopecia; rash. GI: Nausea and vomiting; diarrhea; enteritis; mucositis; duodenal ulcers; elevated LFTs; hepatic necrosis; hepatic abscesses; intra- and extrahepatic biliary sclerosis; acalculous cholecystitis. HEMATOLOGIC: Bone marrow suppression, nadir at 9 to 14 days; bleeding at the catheter site. OTHER: Fever and malaise; infection of the catheter site.

 Precautions

Pregnancy: Category D. Lactation: Undetermined. Children: Safety and efficacy in pediatric patients not established. Extravasation: Local irritation or phlebitis may occur. Refer to your institution-specific protocol. Discontinue use: According to product labeling, promptly discontinue floxuridine if any of the following occur: myocardial ischemia, mucositis or esophagopharyngitis, leukopenia with WBC < 3500/mm³, intractable vomiting, frequent diarrhea, GI ulcer or bleeding, thrombocytopenia with platelets < 100,000/mm³, or hemorrhage from any site. Special risk patients: Use with extreme caution in poor-risk patients who have had high-dose pelvic irradiation or previous use of alkylating agents, who have wide-spread involvement of bone marrow by metastatic tumors, or impaired hepatic or renal function.

 Administration/Storage

• Store powder for injection at room temperature. Protect from light. Refrigerate reconstituted solutions. Floxuridine is chemically stable for up to 2 wk under refrigeration. Use preservative-free solutions of floxuridine within 24 hr of reconstitution.
• Reconstitute each vial of powder with 5 mL Sterile Water for Injection for a floxuridine concentration of 100 mg/mL.
• Further dilute the calculated daily dose with 5% Dextrose or 0.9% Sodium Chloride to an appropriate volume for infusion pump delivery.
• For intra-arterial administration, infuse with an appropriate pump to overcome pressure in large arteries.
• Heparin may be added to floxuridine infusions to prevent thrombotic complications.

 Assessment/Interventions

• Careful monitoring of the WBC and platelet count is recommended.

 Patient/Family Education

• Contraceptive measures are recommended for men and women during therapy.
• Notify healht care provider if chills, nausea, vomiting, unusual bleeding or bruising, yellowing of skin or eyes, abdominal pain, flank or joint pain, or swelling of feet or legs occurs.
• Notify health care provider if the following become pronounced: diarrhea, fever, weakness
• Drink plenty of liquids while taking this drug.
• Inform patients of expected toxic effects, particularly oral manifestations.
• Alert patient to the possibility of alopecia as a result of therapy, and inform patient that alopecia is usually a transient effect.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts