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Flucytosine

Flucytosine, a fluorinated pyrimidine analogue, is a synthetic antimycotic drug. Chemically it is referred to as 4-amino-5-fluoro-2(1H)-pyrimidinon. The sum formula is C4H4FN3O. Fucytosine has the CAS-Number 2022-85-7. It is structurally related to the cytostatic flourouracil and to floxuridine. It is available in oral and in some countries also in injectable form. A common brand name is AncobonĀ®. The drug is dispensed in capsules of 250 mg and 500 mg strength. The injectable form is diluted in 250ml NaCl-solution to contain 2.5 grams totally (10mg per ml). more...

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The solution is physically incompatible with other drugs including Amphotericin B.

Pharmacology

Mechanisms of action

Two major mechanisms of acton have been elucidated, one is that the drug is intrafungally converted into the cytostatic flourouracil that undergoes further steps of activation and finally interacts as 5-fluorouridinetriphosphate with RNA-biosynthesis and disturbs therefore the building of certain essential proteins. The other mechanism is the conversion into 5-flourodeoxyuridinemonophosphate which inhibits fungal DNA-synthesis.

Spectrum of susceptible fungi and Resistance

Flucytosine is as well in vitro and in vivo active against some strains of Candida and Cryptococcus. Limited studies demonstrate that Flucytosine may be of value against infections with Sporothrix, Aspergillus, Cladosporium, Exophila, and Phialophora. Resistance is quite commonly seen as well in treatment naive patients and under current treatment with Flucytosine. In different strains of Candida resistance has been noted to occur in 1 to 50% of all specimen obtained from patients.

Pharmacokinetic data

Flucytosine is well absorbed (75 to 90%) from the GI-Tract. Intake with meals slows the resorption, but does not decrease the amount resorbed. Following an oral dose of 2 grams peak serum levels are reached after approximately 6 hours. The time to peak level decreases with continued therapy. After 4 days peak levels are measured after 2 hours. The drug is eliminated renally. In normal patients Flucytosine has reportedly a half-life of 2.5 to 6 hours. In patients with impared renal function higher serum levels are seen and the drug tends to cumulate in these patients. The drug is mainly excreted unchanged in the urine (90% of an oral dose) and only traces are metabolized and excreted in the feces. Therapeutic serum levels range from 25 to 100mcg/ml. Serum levels in exceed of 100mcg are associated with a higher incidence of side-effects. Periodic measurements of serum levels are recommended for all patients and are a must in patients with renal damage.

Human overdose

Symptoms and their severities are unknown, because Flucytosine is used under close medical supervision, but expected to be an excess of the usually encountered side-effects on bone-marrow, GI-Tract, liver, and kidney-function. Vigouros hydration and hemodialysis may be helpful to remove the drug from the body. Hemodialysis is particular useful in patients with impaired renal function.

Human carcinogenity

It is not known, if Flucytosine is a human carcinogen. The issue has been raised because traces of 5-fluorouracil, which is a known carcinogen, are found in the colon resulting from the metabolization of Flucytosine.

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Stability of flucytosine 50 mg/mL in extemporaneous oral liquid formulations
From International Journal of Pharmaceutical Compounding, 3/1/03 by Foy, Elizabeth

Stability of flucytosine 50 mg/mL in extemporaneous oral liquid formulations.

VandenBussche HL, Johnson CE, Yun J, et al. Am J Health Syst Pharm 2002;59: 1853-1855.

The stability of a flucytosine 50-mg/mL oral liquid, prepared from the contents of flucytosine capsules mixed with equal volumes of Ora-Plus and either Ora-Sweet SF or strawberry syrup, is described. At least 99% of the initial flucytosine concentration was retained in both suspensions for 90 days, and this did not vary when stored at 23 deg C to 25 deg C or 3 deg C to 5 deg C. A procedure for compounding the flucytosine 50-mg/mL oral liquid is provided.

Compounding: The practice of pharmacy or a liability risk?

Spies AR.

Drug Top 2002;146(Jul 15):36-45. (ACPE approved for 2 hours of CE credit; available online from the Drug Topics website: www.drugtopics.com).

The author discusses current regulations regarding the compounding of drugs for human and animal use. Also, the author briefly highlights the legislative history related to compounding in humans following the US Food, Drug & Cosmetic Act in 1938 until the adoption of the Food & Drug Administration (FDA) Modernization Act in 1997. Based on the cases of Thompson v. Western Medical Centers and beans v. Caraway,2 guidelines to assist pharmacists in compounding prescription and over-the-counter drugs for humans are presented by the author. Using the FDA Compliance Policy Guide for Compounding of Drugs for Use in Animals3 as a reference, Spies provides three useful figures that deal with the necessary requirements for compounding a new animal drug, the labeling requirements for medications compounded for veterinary use, and situations involving veterinary compounding that are likely to be subject to regulatory action. The author points out that although the current laws and regulations allow pharmacists to compound, those compounding pharmacists who overstep the provisions of these acts may be faced with civil and criminal sanctions.

Not discussed in this article is the FDA's compounding guidance4 posted on the Internet in May 2002. The guidance describes nine potential actions that suggest that a pharmacy has gone beyond the limits of legitimate compounding for humans. Comments concerning this guidance are encouraged.

References

1. Thompson v. Western States Medical Center, 122 S.Ct. 1497, 152 L.Ed.2d 563, 2002 U.S. LEXIS 3035; 70 U.S.L.W. 4275 (2002).

2. Jeans v. Caraway, 649 So.2d 1141; 1995 La.App.LEXIS 179 (La. App. 3d Cir. 1995).

3. Sec.608.400 Compounding of Drugs for Use in Animals (CPG 7125.40). July 3,1996, Federal Register Doc. 96-16973. Available at: http://www.fda.gov/ora/compliance-ref/cpg/ cpgvet/cpg608-400.html. Accessed: November 25, 2002.

4. Sec.460.2 Pharmacy Compounding (CPG 460.200). Issued March 16, 1992; reissued May 29, 2002. Available at: http://www.fda. gov/ora/compliance-ref/cpg/cpgdrg/ cpg460-200.html. Accessed: January 22, 2003.

Copyright International Journal of Pharmaceutical Compounding Mar/Apr 2003
Provided by ProQuest Information and Learning Company. All rights Reserved

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