floxuridine (Rx)

Brand and Other Names:FUDR
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 500mg/vial

GI Adenocarcinoma with Metastasis to Liver, Gallbladder, Bile Ducts

0.1-0.6 mg/kg/d continuous arterial infusion  

Monitor: CBC, LFTs

Gastric Cancer (Orphan)

Intraperitoneal treatment of gastric cancer

Orphan indication sponsor

  • Franco Muggia, M.D.; 160 East 34th Street; New York, NY 10016

Safety & efficacy not established

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Interactions

Interaction Checker

and floxuridine

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (10)

              • adenovirus types 4 and 7 live, oral

                floxuridine decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.

              • deferiprone

                deferiprone, floxuridine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.

              • fexinidazole

                fexinidazole and floxuridine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

              • influenza virus vaccine quadrivalent, adjuvanted

                floxuridine decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • influenza virus vaccine trivalent, adjuvanted

                floxuridine decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

              • lefamulin

                lefamulin and floxuridine both increase QTc interval. Avoid or Use Alternate Drug.

              • palifermin

                palifermin increases toxicity of floxuridine by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hrbefore, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.

              • pexidartinib

                floxuridine and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.

              • pretomanid

                floxuridine, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

              • tofacitinib

                floxuridine, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              Monitor Closely (17)

              • belatacept

                belatacept and floxuridine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

              • cholera vaccine

                floxuridine decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

              • dengue vaccine

                floxuridine decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

              • denosumab

                floxuridine, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

              • ethotoin

                floxuridine increases levels of ethotoin by unknown mechanism. Use Caution/Monitor. Based on case reports.

              • fingolimod

                floxuridine increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

              • fosphenytoin

                floxuridine increases levels of fosphenytoin by unknown mechanism. Use Caution/Monitor. Based on case reports.

              • fostemsavir

                floxuridine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

              • influenza A (H5N1) vaccine

                floxuridine decreases effects of influenza A (H5N1) vaccine by Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.

              • influenza virus vaccine (H5N1), adjuvanted

                floxuridine decreases effects of influenza virus vaccine (H5N1), adjuvanted by Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce immune response to H5N1 vaccine.

              • meningococcal group B vaccine

                floxuridine decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

              • ofatumumab SC

                ofatumumab SC, floxuridine. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

              • olaparib

                floxuridine and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity.

              • osilodrostat

                osilodrostat and floxuridine both increase QTc interval. Use Caution/Monitor.

              • phenytoin

                floxuridine increases levels of phenytoin by unknown mechanism. Use Caution/Monitor. Based on case reports.

              • siponimod

                siponimod and floxuridine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

              • sipuleucel-T

                floxuridine decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

              Minor (4)

              • maitake

                maitake increases effects of floxuridine by pharmacodynamic synergism. Minor/Significance Unknown. Maitake mushroom has anti-tumor effects (animal/in vitro research).

              • taurine

                floxuridine decreases levels of taurine by unspecified interaction mechanism. Minor/Significance Unknown.

              • vitamin A

                vitamin A, floxuridine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Antioxidants such as vitamin A enhance the efficacy, and reduce toxicity, of antineoplastic drugs.

              • vitamin E

                vitamin E, floxuridine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Antioxidants such as vitamin E enhance the efficacy, and reduce toxicity, of antineoplastic drugs.

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              Adverse Effects

              Frequency Not Defined

              Nausea

              Vomiting

              Diarrhea

              Mucositis

              Enteritis

              Stomatitis

              Myelosuppression

              Anemia

              Leukopenia

              Thrombocytopenia

              Alopecia

              Erythema

              Photosensitivity

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              Warnings

              Black Box Warnings

              The drug 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

              Contraindications

              Hypersensitivity

              Poor nutritional status

              Myelosuppression (leukocyte count <5000/cu.mm or decreases rapidly, or Plts <100,000/cu.mm)

              Cautions

              Hepatic/renal impairment

              Discontinue if leukocyte count falls to <3500/cu.mm or decr rapidly, or if Plt count falls to <100,000/cu.mm)

              Discontinue immediately in MI occurs

              Discontinue in case of stomatitis, esophagopharyngitis, leukopenia, thrombocytopenia, intractable vomiting, GI bleeding, hemorrhage, diarrhea

              Pts who have received high-dose pelvic irradiation or alkylating agents

              Avoid pregnancy

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              Pregnancy & Lactation

              Pregnancy Category: D

              Lactation: excretion in milk unknown; contraindicated

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Half-Life: 16 min

              Metabolism: liver

              Metabolites: urea, fluorouracil, dihydrofluorouracil, expired CO2 metabolite

              Excretion: urine

              Mechanism of Action

              Metabolized to 5-FU; inhibits DNA synthesis during S phase by inhibition of thymidylate synthetase

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              Administration

              IV Incompatibilities

              Y-site: allopurinol, cefepime

              IV Compatibilities

              Additive: carboplatin, cisplatin, etoposide, fluorouracil, leucovorin

              Y-site: amifostine, aztreonam, etoposide PO4, filgrastim, fludarabine, gemcitabine, granisetron, melphalan, ondansetron, paclitaxel, piperacillin-tazobactam, sargramostim, teniposide, thiotepa, vinorelbine

              IV Preparation

              Dilute with 5 mL SWI for a final concentration of 100 mg/mL

              IV Administration

              Dilute in D5W or NS

              Store reconstituted soln at 2-8°C if necessary & use within 2 wk

              Use infusion pump, either external or implanted

              Storage

              Store intact vials at 15-30°C (59-86°F)

              Reconstituted vials are stable for up to weeks under refrigeration at 2-8°C (36-46°F)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              floxuridine injection
              -
              0.5 gram vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              floxuridine injection

              FLOXURIDINE - INJECTION

              (flox-YOUR-eh-deen)

              COMMON BRAND NAME(S): FUDR

              USES: Floxuridine is used to treat certain types of stomach/intestinal cancer that have spread to the liver. It is a chemotherapy drug that is used to slow or stop cancer cell growth.

              HOW TO USE: This medication is given by injection into an artery using a continuous infusion pump. It is given through a catheter placed inside the artery that supplies blood to the tumor. This method directs the medication to the tumor so that it can have a stronger effect on the tumor with less risk of serious side effects in the rest of the body. When starting the first course of treatment with this medication, you should be in a hospital where you can be monitored for possible serious side effects.This medication will be prepared and mixed for you by a health care professional. Dosage is based on your medical condition, weight, and response to treatment.This medication should be used as long as you continue to benefit from the treatment. When serious side effects appear, your doctor will stop treatment with this medication. After the side effects have lessened, treatment will resume.

              SIDE EFFECTS: Nausea, vomiting, mild diarrhea, loss of appetite, tiredness, redness at the injection site, or dry skin may occur. Nausea and vomiting can be severe. In some cases, your doctor may prescribe medication to prevent or relieve nausea and vomiting. Eating several small meals or limiting activity may help lessen some of these effects. If these effects persist or worsen, tell your doctor or pharmacist promptly.Temporary hair loss may occur. Normal hair growth should return after treatment has ended.Many people using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects.This medication can lower the body's ability to fight an infection. Tell your doctor promptly if you develop any signs of an infection such as fever or chills.Tell your doctor right away if you have any serious side effects, including: mouth sores, sore throat, painful/difficult swallowing, persistent or severe vomiting/diarrhea, easy or unusual bruising/bleeding, black stools, blood/mucus in the stools, vomit that looks like coffee grounds, cramps/pain in the stomach/abdomen, yellowing eyes/skin, dark urine, weakness, weight loss, skin problems (e.g., peeling/darkening of the skin), muscle/joint pain.Get medical help right away if any of these rare but very serious side effects occur: chest/jaw/left arm pain, warmth/swelling/pain/leaking at the injection site, pain/swelling/redness/weakness of the arms or legs, calf pain/swelling that is warm to the touch, shortness of breath, coughing up blood, sudden vision changes, weakness on one side of the body, severe clumsiness/trouble walking, trouble speaking, confusion, severe headache.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using floxuridine, tell your doctor or pharmacist if you are allergic to it; or to fluorouracil; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: poor nutrition, decreased bone marrow function/blood cell disorders (e.g., anemia, leukopenia, thrombocytopenia), a serious infection.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver problems, kidney problems, past high-dose radiation treatment of the pelvis.Do not have immunizations/vaccinations without the consent of your doctor, and avoid contact with people who have recently received polio vaccine by mouth or flu vaccine inhaled through the nose.Floxuridine can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like safety razors and nail cutters, and avoid activities such as contact sports.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.This medication is not recommended for use during pregnancy. It may harm an unborn baby. Discuss the use of reliable forms of birth control (such as condoms, birth control pills) with your doctor.It is not known whether this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: drugs that may decrease bone marrow function (e.g., azathioprine, trimethoprim/sulfamethoxazole), past or present use of alkylating-type cancer drugs (such as cyclophosphamide, melphalan).Floxuridine is very similar to fluorouracil. Do not use medications containing fluorouracil while using floxuridine.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Laboratory and/or medical tests (e.g., complete blood counts) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: The drug is given continuously as an infusion. If your infusion is interrupted, contact your doctor or pharmacist right away.

              STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.