Ftoruracil
When ATH:
L01BC02
Characteristic.
Antimetabolite group of structural analogs of pyrimidine. White or white with a distinctive yellowish white crystalline powder. It is soluble in water, очень мало — ethanol. Molecular weight - 130,08.
Pharmacological action.
Antitumor, cytostatic.
Application.
Malignant breast tumors, stomach, pancreas, rectum and other parts of the colon, bladder cancer, prostate, ovary, cervix, liver, Malignant tumors of the head and neck.
Contraindications.
Hypersensitivity, terminal stage of the disease, kaxeksija, bone marrow aplasia (число лейкоцитов менее 5·109/l, количество тромбоцитов менее 100·109/l), gastric ulcer and duodenal ulcer, yazvennыy colitis, severe functional impairment of the liver and kidneys, severe systemic infection (or the threat of their development).
Pregnancy and breast-feeding.
Contraindicated in pregnancy. At the time of treatment should stop breastfeeding.
Side effects.
From the nervous system and sensory organs: dizziness, rare ataxia, dysarthria, nistagmo, violation of spatial orientation, confusion, euphoria, optic neuritis, photophobia, excessive tearing, sleznыh ducts stenosis.
Cardio-vascular system (hematopoiesis, hemostasis): leukopenia (typically occurs after 9-14 days after each course, white blood cell count is restored after about 30 days), neutropenia (incl. hemolytic), thrombocytopenia, arrhythmia, angina, išemiâ, myocardial infarction, cardiomyopathy, heart failure, tromboflebit.
From the respiratory system: seldom-defined signes of pneumonit (cough, breathlessness), bronchospasm.
From the digestive tract: nausea, vomiting, mucositis (ulcerative stomatitis, ulcerative lesions of the gastrointestinal mucosa, esophagitis, proctitis), diarrhea, decreased appetite.
For the skin: dermatitis (itching and skin rash usually on the limbs and less frequently on the trunk), dry and cracked skin; in some cases, alopecia (obratimaâ), partial loss of the nail, hyperpigmentation in the nail bed, and the other parts of the body, palmar-plantar eritrodizesteziya (tingling in the hands and feet, followed by the appearance of pain, redness and swelling), photosensitivity.
Other: infection (usually asymptomatic, less frequently-fever or chills, cough or hoarseness, pain in the lower back or side, painful or difficult urination), muscular weakness, generalized allergic reactions, anaphylactic shock, nose bleed.
Cooperation.
The efficacy and / or toxicity of FU modulate interferon alfa-2a, methotrexate, calcium folinate. Mitomycin term use potentiates the occurrence of hemolytic-uremic syndrome.
Preparations + radiation therapy, causing myelosuppression, strengthen fluorouracil induced leukopenia and / or thrombocytopenia.
When administered live virus vaccines can intensify vaccine virus replication and increased side effects or reducing the production of antibodies in the patient's body in response to the vaccine; inactivated vaccines - reduction of production of antiviral antibodies.
Overdose.
When used in recommended doses, it is unlikely the occurrence of overdose. Spetsificheskiy no known antidote.
Possible increased sensitivity to the drug in people with an enzyme deficiency degidropirimidindegidrogenazy.
Dosing and Administration.
The route of administration, mode and dosage in each case determined individually and are dependent on the indication, stage of the disease, the state of the hematopoietic system, regimens. Misleading I / bolus or infusion, B / A, intracisternally.
B / drip, 1 g / m2/d, continuously for 96-120 hours; in combination with other property- 600 mg / m2 in / in 1 and 8 days course. When used in combination with calcium folinate dosage fluorouracil typically reduced by 25-30%.
Precautions.
The use of fluorouracil should be under the supervision of a qualified physician, has experience in anticancer therapy. Patients need to be in hospital for at least during the first course of treatment. Additional course of fluorouracil should be prescribed only after the resolution of the previously conducted toxicity rate.
Fluorouracil recommended exclusively for parenteral administration,, should not be administered intrathecally because of the danger of neurotoxic action.
During treatment, blood is examined at least 3 once a week, at the first signs of oppression blood-daily. With a sharp oppression of packed red blood cells transfused blood formation, use stimulants blood. During treatment prescribed vitamins (thiamine etc.); We need a thorough oral care.
After radiation therapy, or the use of other antitumor agents fluorouracil appointment is admissible in 1-1,5 months, subject to the full restoration of blood picture. It should also appoint drug earlier than 3-4 weeks after complicated surgeries. It is not recommended to inject the drug with extensive metastases in the bone marrow.
Be wary appoint elderly patients (more likely to age renal dysfunction, which may require dose reduction).
Dental procedures should be completed before the start of therapy or deferred until the normalization of the blood picture (may increase the risk of microbial infection, slowing the healing process, krovotochivosty right). During treatment caution when using toothbrushes, threads or toothpicks.
It is necessary to provide a reduction of the starting dose in patients with poor function of the bone marrow, impaired liver or kidney disease. Be particularly careful in patients, previously treated with cytotoxic drugs, incl. alkylating agents, or radiation therapy in high doses.
Since there is no data on the safety purpose during pregnancy, in women with preserved reproductive function should be used only in conjunction with adequate contraception.
The use of fluorouracil immediately cease at the first sign of complications: diarrhea, inflammation of the mucosa of the esophagus and pharynx, ulceration and bleeding in the digestive tract, any bleeding at other sites, severe leukopenia or a rapid decline in the number of leukocytes (particularly granulocytes). At a resolution (disappearance) side effects of treatment continues at a lower dose.
Special precautions (the rejection of the / m injection, a urine test, feces and secret occult blood, refusal to take acetylsalicylic acid, potential platelet transfusions, etc..) must be observed in the case of thrombocytopenia. Patients who develop leukopenia should be carefully monitored for signs of infection. Patients with neutropenia with an increase in body temperature of antibiotics should be started empirically.
Use caution to avoid accidental cuts with sharp objects (safety razor, scissors), Avoid contact sports or other situations, which are likely to hemorrhage or trauma. During treatment, avoid contact with people, received the vaccine against polio, patients with bacterial infections.
The appearance of signs of depression of bone marrow function (unusual bleeding or hemorrhage, black tarry stools, blood in urine or feces or point of red spots on the skin, and others.) require immediate doctor's advice.
Exercise caution in combination therapy; taking each medication at the scheduled time.
The syndrome, Palmar-Plantar jeritrodizestezii you can assign pyridoxine inside the dose of 100-150 mg/day.
Cautions.
Observe the necessary rules for the use and destruction of the drug. Breeding fluorouracil should be conducted by trained personnel in specially equipped place (in special cabinets with hood), using the protective garment (disposable gloves, goggles, masks), observing precautions in the preparation of injectable solutions and disposal of needles, syringes, ampoules and the remainder of the unused product.
