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Fluorouracil: Comprehensive 5-FU Chemotherapy & Treatment Guide
Summary or Key Points
Fluorouracil, commonly known as 5-FU chemotherapy, is a widely used medication for treating various cancers, including skin, colorectal, and breast cancers. It works by interfering with the growth of cancer cells. Depending on the condition, Fluorouracil can be applied topically or administered intravenously. It is crucial to follow your healthcare provider’s instructions and promptly report any side effects. For personalized care, consider consulting one of our telemedicine providers.
Names of Medication
US Brand Name: Carac, Efudex, Fluoroplex
Generic Name: Fluorouracil
The generic name, Fluorouracil, is the active ingredient, while the brand names are assigned by manufacturers. Fluorouracil is often referred to as 5-Fluorouracil or 5-FU in chemotherapy treatments.
Pharmacologic Category
Antimetabolite
Pyrimidine Analog
Dosing
Fluorouracil is used to treat several types of cancer and skin conditions. The dosage varies depending on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers for guidance on Fluorouracil therapy.
Basal Cell Carcinoma
Topical Application: Apply a thin layer of 5% Fluorouracil cream or solution to the affected area twice daily for 3 to 6 weeks. Treatment may continue for up to 10 to 12 weeks, depending on your response.
Squamous Cell Carcinoma
Topical Application: Apply 5% Fluorouracil cream or solution to the affected area twice daily for 3 to 6 weeks. Your healthcare provider may adjust the duration based on your response.
Colorectal Cancer
Intravenous (IV) Administration: 400 mg/m² as an initial dose, followed by 2400 mg/m² to 3000 mg/m² over 46 hours every 2 weeks. The length of treatment depends on the stage of cancer and how well you respond to therapy.
Gastric Cancer
Intravenous (IV) Administration: 400 mg/m² as a bolus dose, followed by 2400 mg/m² to 3000 mg/m² over 46 hours every 2 weeks. The duration of treatment will be determined by your healthcare provider.
Pancreatic Cancer
Intravenous (IV) Administration: 400 mg/m² as a bolus dose, followed by 2400 mg/m² to 3000 mg/m² over 46 hours every 2 weeks. Treatment duration will vary based on your individual response.
Breast Cancer
Intravenous (IV) Administration: 500 mg/m² once daily for 5 days, repeated every 28 days. The length of treatment depends on the stage of cancer and your response to therapy.
Head and Neck Cancer
Intravenous (IV) Administration: 1000 mg/m² per day for 4 days, repeated every 3 to 4 weeks. Your healthcare provider will determine the appropriate treatment duration.
Actinic Keratosis
Topical Application: Apply 5% Fluorouracil cream or solution to the affected area twice daily for 2 to 4 weeks. Treatment may be extended up to 6 weeks depending on your response.
Keratoacanthoma
Topical Application: Apply 5% Fluorouracil cream or solution to the affected area twice daily for 3 to 6 weeks. Your healthcare provider may adjust the duration based on your response.
Anal Cancer
Intravenous (IV) Administration: 1000 mg/m² per day for 4 days, repeated every 4 weeks. The duration of treatment will be determined by your healthcare provider.
Dosage Forms and Strengths
Topical Cream: 5% (Carac, Efudex, Fluoroplex)
Topical Solution: 2%, 5% (Efudex)
Intravenous Injection: 50 mg/mL
Administration Instructions
Fluorouracil can be administered either topically or intravenously, depending on the condition being treated. For topical use, apply a thin layer of cream or solution to the affected area as directed by your healthcare provider. Be sure to wash your hands before and after applying the medication, and avoid contact with your eyes, nose, and mouth. For intravenous administration, a healthcare professional will administer the medication in a clinical setting.
Adverse Reactions and Side Effects
Like all medications, Fluorouracil can cause side effects. Some are common, while others are rare but more serious. If you experience any side effects, contact your healthcare provider immediately. You can also schedule a telemedicine appointment with one of our providers for advice on managing Fluorouracil side effects.
Common Side Effects:
- Skin irritation: Redness, dryness, or peeling of the skin where the medication is applied.
- Nausea and vomiting: Feeling nauseous or vomiting is common with intravenous use.
- Diarrhea: Loose or watery stools may occur, especially with intravenous administration.
Less Common but Serious Side Effects:
- Severe allergic reactions: Swelling of the face, lips, or throat, difficulty breathing, or hives. Seek emergency medical attention if this occurs.
- Bone marrow suppression: A decrease in blood cells that can lead to infections, fatigue, or easy bruising. Your doctor will monitor your blood counts regularly.
- Severe skin reactions: Painful blisters, sores, or ulcers on the skin where the medication is applied.
Contraindications
A contraindication is a specific situation or condition where a medication should not be used because it may cause harm. If you have any of the following conditions, you should not take Fluorouracil. Always consult your healthcare provider before starting any new medication. If you’re unsure, one of our telemedicine providers can help you determine if Fluorouracil is appropriate for you.
- Pregnancy: Fluorouracil can cause harm to an unborn baby, including birth defects. It is contraindicated during pregnancy unless the benefits outweigh the risks.
- Severe bone marrow suppression: If you have a weakened immune system or low blood cell counts, Fluorouracil can further suppress bone marrow function, increasing the risk of infections or bleeding.
- Known hypersensitivity to Fluorouracil: If you have had an allergic reaction to Fluorouracil in the past, avoid this medication to prevent severe allergic reactions.
- Dihydropyrimidine dehydrogenase (DPD) deficiency: This rare genetic condition prevents the body from breaking down Fluorouracil properly, leading to severe toxicity. If you have this condition, Fluorouracil is contraindicated.
Drug to Drug Interactions
Fluorouracil, also known as 5-FU chemotherapy, can interact with other medications, potentially increasing side effects or reducing its effectiveness. It’s crucial to inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements. Below are some common medications that may interact with Fluorouracil:
- Leucovorin (Wellcovorin): Often used to enhance Fluorouracil’s effects, it can also increase the risk of side effects such as mouth sores and diarrhea.
- Phenytoin (Dilantin): Fluorouracil can raise phenytoin levels in your blood, potentially leading to toxicity, which may cause symptoms like confusion, dizziness, and difficulty walking.
- Warfarin (Coumadin): Combining Fluorouracil with warfarin can increase the risk of bleeding. Your doctor may adjust your warfarin dose and monitor your blood clotting levels more closely.
- Allopurinol (Zyloprim): Commonly used for gout, allopurinol can reduce the effectiveness of topical Fluorouracil when applied to the skin.
Fluorouracil in Pregnancy
Is it Safe to Take Fluorouracil During Pregnancy?
No, Fluorouracil is not safe during pregnancy. It is classified as a Category D medication by the FDA, meaning it poses significant risks to the unborn baby, including birth defects or miscarriage. If you are pregnant or planning to become pregnant, consult your healthcare provider for alternative treatments. If you are already taking Fluorouracil and discover you are pregnant, contact your healthcare provider immediately.
Fluorouracil While Breastfeeding
Is it Safe to Use Fluorouracil While Breastfeeding?
Fluorouracil is not recommended while breastfeeding, as it may pass into breast milk and harm a nursing baby. If you are breastfeeding, discuss alternative treatments with your healthcare provider. If Fluorouracil is necessary, your doctor may advise you to stop breastfeeding during treatment.
Estimated Cost of Fluorouracil Medication
The cost of Fluorouracil varies depending on the form (topical or injectable) and the pharmacy. Without insurance, a 30-day supply of topical Fluorouracil cream (5% cream) typically costs between $60 and $100 with a GoodRx coupon. Injectable forms used for cancer treatment may range from $200 to $500 or more per treatment cycle. Check with your pharmacy for accurate pricing, and consider using a GoodRx coupon to help reduce out-of-pocket costs.
Possible Alternatives to Fluorouracil
If Fluorouracil is not suitable for you, or if you are exploring additional treatment options, there are alternatives available. Always discuss these options with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers can help you explore these alternatives.
- Basal cell carcinoma: Alternatives include surgical excision, cryotherapy (freezing the tumor), or other topical treatments like imiquimod (Aldara). Radiation therapy may also be an option.
- Squamous cell carcinoma: Surgical removal is often the first-line treatment. Radiation therapy or topical treatments like imiquimod may also be considered.
- Colorectal cancer: Alternatives include chemotherapy agents like oxaliplatin or irinotecan, and targeted therapies like bevacizumab (Avastin). Surgery and radiation are also common treatments.
- Gastric cancer: Treatment options include chemotherapy drugs like cisplatin or targeted therapies like trastuzumab (Herceptin). Surgery and radiation therapy are also commonly used.
- Pancreatic cancer: Alternatives include gemcitabine (Gemzar) or nab-paclitaxel (Abraxane). Surgery and radiation therapy may also be part of the treatment plan.
- Breast cancer: Depending on the type and stage, alternatives may include hormonal therapies like tamoxifen, chemotherapy agents like doxorubicin, or targeted therapies like trastuzumab (Herceptin).
- Head and neck cancer: Treatment options may include surgery, radiation therapy, or chemotherapy agents like cisplatin. Targeted therapies like cetuximab (Erbitux) may also be considered.
- Actinic keratosis: Alternatives include cryotherapy, photodynamic therapy, or topical treatments like imiquimod (Aldara) or diclofenac (Solaraze).
- Keratoacanthoma: Surgical excision is often the preferred treatment. In some cases, cryotherapy or radiation therapy may be used.
- Anal cancer: Alternatives include chemotherapy agents like mitomycin and radiation therapy. Surgery may be an option in some cases.
Recent Updates on Fluorouracil Research
Recent studies are focused on improving Fluorouracil’s effectiveness while minimizing side effects. One area of research involves combination therapies, where Fluorouracil is used alongside other drugs to enhance its cancer-fighting abilities. For example, combining Fluorouracil with immunotherapy drugs has shown promise in treating cancers like colorectal cancer.
Another area of research is the development of new Fluorouracil formulations that may be better tolerated. Researchers are exploring nanoparticle-based delivery systems that could target cancer cells more precisely, reducing damage to healthy tissues and minimizing side effects.
While these studies are ongoing, it’s important to stay in close communication with your healthcare provider to ensure you receive the most up-to-date and effective treatment. If you have questions about new treatment options, our telemedicine providers are available to discuss the latest research and how it may apply to your care.
