Management of fluoropyrimidine overdose or overexposure

Written By Christian Capper

Background

Fluorouracil (5-FU) and capecitabine are fluoropyrimidines widely used for the treatment of solid tumours. Exceeding the absolute dose or infusion rate can result in serious or life-threatening toxicity.

Fluoropyrimidine overdose or overexposure can manifest as severe forms of common adverse reactions such as mucositis, diarrhoea or cytopenias, or patients may quickly develop central neurotoxicities (e.g. altered mental state, encephalopathy and coma) and acute cardiac toxicities (e.g. arrhythmias, heart failure, and cardiac arrest) which can be fatal.

Fluoropyrimidine overdose or overexposure may be due to:

  • infusion pump malfunction or mis-programming

  • dose calculation errors

  • excess or accidental ingestion of oral fluorouracil analogues (e.g. capecitabine)

  • concomitant drugs that inhibit fluorouracil metabolism

  • dihydropyrimidine dehydrogenase (DPD) deficiency resulting in fluorouracil overexposure.

Read the full resource: https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management/prophylaxis-and-treatment/738-management-of-fluoropyrimidine-overdose-or-ove#background

Christian Capper
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