How Will I Know If I Have Cardiotoxicity
People who get heart symptoms or other problems from 5FU chemotherapy usually feel the side effects during the first or second cycles of treatment. Most people go through these chemotherapy regimens without heart complications.
If you don’t have symptoms during your first or second cycles, then it is unlikely you will have heart side effects later.
- Last Edited 01/31/2019
Food And Drug Interactions
- There are no known interactions of fluorouracil with food.
- Check with your doctor or pharmacist about all other prescription medicines and over-the-counter medicines and dietary supplements you are taking before starting this medicine as there are known drug interactions with 5-fluoroucacil. Also, check with your doctor or pharmacist before starting any new prescription or over-the-counter medicines, or dietary supplements to make sure that there are no interactions.
About 275000 Patients Receive 5
5-fluorouracil is one of the more toxic chemotherapy regimens. Less than 10% of cancer patients experience 3-4 grade side effects. What if you are one of those 275,000 patients who experience 5-fluorouracil chemotherapy side effects???
The short, long-term and late stage side effects of chemotherapy and radiation are just a part of being a cancer patient. Right? But what if you could reduce your risk of short, long-term and late stage side effects?
5-fluorouracil chemotherapy is so toxic that it kills patients. I thought that FDA approval meant that the approved therapy was safe and effective. I guess the FDAs definition of safe and my definition of safe differ...
Further, according to the article below, about 275,000 patients receive 5-fluorouracil alone or in a combination regimen. Of these patients, less than 10% will experience grade 3-5 toxicity. Does this mean that 10% or 27,500 cancer patient risk severe collateral damage from chemotherapy?
According to the article, only about 1300 patients pass away from the side effects
What bothers me about the article/study linked below is that there are integrative therapies that studies have shown reduce the collateral damage of 5-fluorouracil.
To learn more about integrative therapies, scroll down the page, post a question and I will reply ASAP.
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Who Should Not Receive 5fu Chemotherapy
People with a deficiency of an enzyme called dihydropyrimidine dehydrogenase shouldnt receive 5FU. Because DPD helps to break down 5FU in the body, a deficiency in this enzyme can lead to life threatening complications.
5FU is also not recommended if you:
When To Contact Your Team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects arent getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven’t listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
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Dpd Testing Before Treatment
Before starting this treatment, you should have a blood test to check whether you have low levels of an enzyme called DPD. This is called DPD deficiency. People who have low DPD levels can develop serious or life-threatening side effects if they have 5FU. If you have DPD deficiency, this can affect the treatments that are available for you.
You will not know without a test if you have DPD deficiency, as there are no symptoms. Testing can detect most cases of DPD deficiency, but not all cases. You can talk to your cancer doctor about your risk of having DPD deficiency before you start treatment.
Possible Side Effects Of Chemo
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in hair follicles and in the lining of the mouth and intestines, are also dividing quickly. These cells can be affected by chemo too, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and how long you take them. Common side effects of chemo can include:
Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:
- Increased chance of infections
- Easy bruising or bleeding
Other side effects are specific to certain drugs. Ask your cancer care team about the possible side effects of the specific drugs you are getting. For example:
Most of these side effects tend to go away over time after treatment ends. Some, such as hand and foot numbness from oxaliplatin, may last for a long time. There are often ways to lessen these side effects. For example, you can be given drugs to help prevent or reduce nausea and vomiting or you may be told to keep ice chips in your mouth while chemo is being given to lower the chances of getting mouth sores.
Older people seem to be able to tolerate some types of chemo for colon or rectal cancer fairly well. Age is no reason to withhold treatment in otherwise healthy people.
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Fluorouracil May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- loss of appetite
- pink, red, or dark brown urine
- red or tarry black bowel movements
Fluorouracil may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
How Should This Medicine Be Used
Fluorouracil injection comes as a solution to be given intravenously by a doctor or nurse in a medical facility. The length of treatment depends on the types of drugs you are taking, how well your body responds to them, and the type of cancer you have.
Your doctor may need to delay your treatment or change your dose if you experience certain side effects. It is important for you to tell your doctor how you are feeling during your treatment with fluorouracil injection.
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Vascular Endothelial Dysfunction & Impaired Oxygen Delivery
Vascular dysfunction with microthrombi formation has been shown to be a potential mechanism that results in fluoropyrimidine-induced cardiotoxicity. The microthrombotic occlusion is usually not detectable by coronary angiography . Several animal studies examined the direct toxic effects of 5-FU on vascular endothelial cells and noted direct endothelial damage and subsequent platelet and fibrin accumulation, which was confirmed by electron microscopy . Experimental studies also suggest that the use of anticoagulation therapy may partially mitigate this toxicity . Some authors, on the other hand, believe free oxygen radicals also play a role in cytotoxic endothelial dysfunction .
Spasojevic et al. demonstrated that 5-FU causes changes to the erythrocyte membranes leading to increased fluidity and conversion of the erythrocyte from its usual biconcave shape to an echinocyte shape . The resulted membrane changes diminish the erythrocytes ability to deliver and transport oxygen, resulting in myocardial ischemia and injury.
Possible Side Effects Of Fluorouracil
There are a number of things you can do to manage the side effects of fluorouracil. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:
Low White Blood Cell Count
White blood cells are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever , sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn’t heal.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick .
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your oncology care team before scheduling dental appointments or procedures.
- Ask your oncology care team before you, or someone you live with, has any vaccinations.
Low Red Blood Cell Count
Low Platelet Count
Loss or Thinning of Scalp and Body Hair
Nail and Skin Changes
Hand Foot Syndrome
Nausea and/or Vomiting
Less common, but important side effects can include:
Sexual & Reproductive Concerns
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Increased Risk Of Getting An Infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
When You Have Fluorouracil
You usually have fluorouracil as part of a course of several cycles of treatment. You generally have up to 6 cycles of treatment. Each cycle lasts 2, 3 or 4 weeks.
You have continuous treatment through a small portable pump. The nurse attaches it to your central line. This means you can go home with it. You go back to hospital regularly for the nurse to change your pump, and to see how youre doing.
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What Are Warnings And Precautions For Fluorouracil
- Fluorouracil should be administered under the supervision of an experienced cancer chemotherapy physician because of the possibility of severe toxic reactions
- Patient should be hospitalized for initiation of the therapy because of the risk for severe toxic reactions
- This medication contains fluorouracil. Do not take Adrucil if you are allergic to fluorouracil or any ingredients contained in this drug
Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.
What Are Side Effects Associated With Using Fluorouracil
Side effects of Fluorouracilinclude:
- Sensitivity of skin to sunlight
- Hand-foot syndrome
- Low white blood cell counts
Other side effects of fluorouracil include:
- Ophthalmic findings
This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.
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How Do Antineoplastic Antimetabolites Work
Antineoplastic antimetabolites are a class of drugs used to treat breast, ovarian, colon, or rectalcancer. They are also used to treat rheumatoid arthritis , psoriasis , hairy cell leukemia , chronic lymphocytic leukemia , chronic myelogenous leukemia , cutaneous T-cell lymphoma , peripheral T-celllymphoma , and acute myeloid leukemia .
Antimetabolites belong to a class of medications called antifolate antineoplastic agents that work by blocking the action of a certain substance in the body that may help cancer cells multiply.
Antineoplastic antimetabolites are administered intravenously and via oral routes.
Antineoplastic antimetabolites work in the following ways:
They are a type of antibiotics that are only used in cancer chemotherapy.
- They work by slowing down or stopping the growth of cancer cells.
- They work by suppressing the immune system to reduce joint damage in rheumatoid arthritis.
- They belong to a class of medications called folateanalogmetabolic inhibitors that work by killing cancer cells and limiting the development of new cancer cells.
- They help in treating psoriasis by slowing down the growth of skin cells and prevent scale formation.
Patient Education For 5
All patients and caregivers should be aware of the potential for rare but life-threatening early-onset severe toxicities from 5-FU and capecitabine and the need to address those toxicities within 96 hours of treatment. Although the symptoms are early onset, most patients will be at home in the event that severe toxicities occur and will need to report them immediately by calling the clinic.
Patient education should include specific examples of the dramatic change from baseline that may indicate severe toxicity. Brutcher et al. used the example of an active and independent patient who starts a planned 14-day cycle pf capecitabine and cannot walk to the bathroom independently by day 10. They also emphasized that 5-FU or capecitabine should not affect patients ability to perform activities of daily living that they had been able to in the past, so any inability should be reported immediately to the oncology nurse.
Although severe toxicities from 5-FU or capecitabine are rare, early intervention is key to saving lives and achieving best outcomes. For more information, refer to the full article by Brutcher et al.
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What Other Information Should I Know
Keep all appointments with your doctor and the laboratory.Your doctor will/may order certain lab tests to check your body’s response to fluorouracil.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Fu Is Most Effective When Used In Combination With Other Drugs
By itself, 5FU may not be very effective. This is because cancer cells have several mechanisms by which they can become resistant to 5FU.
5FU is far more effective when combined with other cancer drugs. For example, when 5FU is used alone for advanced colorectal cancer, the treatment response rate is
In many cases, 5FU is delivered directly into your bloodstream , which means it can reach many areas throughout the body. This is called systemic treatment.
There are several ways that you can receive 5FU intravenously. These include the following:
- Peripheral IV line: This is a thin tube placed into a vein in your arm or in the back of your hand.
- Central venous catheter : A CVC consists of a narrow, flexible tube called a catheter thats inserted through your chest and into a large vein near your heart. A port is used to deliver medicine into a CVC.
- PICC line: A PICC line is a catheter thats inserted into a vein in your arm and threaded to a large vein near your heart. The end of the catheter sticks out through your skin and its opening is covered with a special cap.
- Bolus dose : Many people on chemotherapy regimens containing 5FU get an IV bolus as a loading dose . This is followed by a connection to a home infusion system where the drug runs slowly over many hours .
Chemotherapy is given in cycles. One cycle consists of several weeks of treatment followed by a rest period that gives your body time to recover. For 5FU, youll typically have six cycles of treatment.
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What Side Effects May I Notice From Receiving This Medication
Side effects that you should report to your doctor or health care professional as soon as possible:
Side effects that usually do not require medical attention :
This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Additional Quick Tips For 5
- Avoid sun exposure.
- Wear SPF15 or higher sunblock because of photosensitivity.
- Modify activities of daily living to decrease friction and heat exposure to hands and feet to prevent hand-foot syndrome
- Keep hands and feet moist with emollients.
5-FU is approved for a number of cancer diagnoses, including breast, colon, rectal, pancreatic, and gastric cancers. 5-FU is also available in a cream formulation that is used for the treatment of actinic keratoses and superficial basal cell carcinomas when conventional methods are impractical. Although you will not deal with this in the infusion area, in the topical preparation, a thin coating is commonly applied to affected skin lesions twice per day. Treatment may continue over several weeks.
However, 5-FU is typically given as an injection into the vein, as a slow IV push, or as an infusion. It is considered an irritant, not a vesicant. You will frequently see this drug when treating patients with colon or rectal carcinomas. The infusion is commonly set up as continuous, in which the patient will be hooked up to small pump . The pump is programmed to infuse chemotherapy very slowly, administering a few milliliters every hour to last for 4648 hours. This is part of the very common FOLFOX regimen. The second “F” stands for fluorouracil. If you read the previous post in this series, you’ll recognize the “OX” as oxaliplatin. I’ll get to the first few letters, “FOL,” in my next post .
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Chemotherapy For Colorectal Cancer
Chemotherapy is treatment with anti-cancer drugs that may be injected into a vein or taken by mouth. These drugs travel through the bloodstream and reach most parts of the body. Chemo is often used to treat colorectal cancer.
Chemo may be used at different times during treatment for colorectal cancer:
- Adjuvant chemo is given after surgery. The goal is to kill cancer cells that might have been left behind at surgery because they were too small to see, as well as cancer cells that might have escaped from the main colon or rectal cancer to settle in other parts of the body but are too small to see on imaging tests. This helps lower the chance that the cancer will come back.
- Neoadjuvant chemo is given before surgery to try to shrink the cancer and make it easier to remove. This is often done for rectal cancer.
- For advanced cancers that have spread to other organs like the liver, chemo can be used to help shrink tumors and ease problems they’re causing. While it’s not likely to cure the cancer, this often helps people feel better and live longer.