What is the treatment for fluorouracil (5-FU) or capecitabine overdose using uridine triacetate?

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Treatment of Fluorouracil (5-FU) or Capecitabine Overdose with Uridine Triacetate

Uridine triacetate should be administered at a dose of 10 g orally every 6 hours for 20 doses within 96 hours following the end of 5-FU or capecitabine administration for overdose or early-onset severe toxicity. 1, 2

Indications for Uridine Triacetate

  • Indicated for emergency treatment of adult and pediatric patients following fluorouracil or capecitabine overdose regardless of symptoms 2
  • Indicated for patients exhibiting early-onset, severe, or life-threatening toxicity affecting the cardiac or central nervous system 2
  • Indicated for patients with unusually severe adverse reactions (e.g., gastrointestinal toxicity, neutropenia) within 96 hours following fluorouracil or capecitabine administration 1, 2

Administration Protocol

  • Administer 10 g orally every 6 hours for a total of 20 doses (5-day course) 1
  • Treatment should begin as soon as possible after overdose or recognition of severe toxicity 3
  • Most effective when initiated within 24 hours of fluoropyrimidine administration, with decreasing efficacy when started later 3
  • Must be administered within 96 hours of last fluoropyrimidine dose, as 50% mortality was observed in patients treated beyond this window 1
  • Can be mixed with food (such as applesauce) to improve palatability and followed with water 4
  • Consider antiemetic premedication (e.g., ondansetron) to prevent nausea and vomiting 4

Mechanism of Action and Efficacy

  • Uridine triacetate is an oral prodrug of uridine that competes with cytotoxic fluoropyrimidine metabolites for incorporation into nucleotides 5
  • Clinical trials demonstrated 96% survival rate in patients treated with uridine triacetate compared to only 16% survival in historical controls receiving supportive care alone 6, 1
  • Provides rapid reversal of severe cardiac and neurologic toxicities 1
  • Prevents or facilitates recovery from mucositis and leukopenia 6
  • Allows 38% of patients to resume chemotherapy within 30 days (mean time to resumption: 19.6 days) 1, 6

Monitoring and Expected Outcomes

  • Monitor for common adverse reactions including vomiting (8.1%), nausea (4.6%), and diarrhea (3.5%) 6
  • Assess for resolution of fluoropyrimidine-related toxicities including:
    • Cardiac toxicity (including arrhythmias) 1
    • Neurologic toxicity 6
    • Gastrointestinal toxicity (diarrhea, mucositis) 1, 6
    • Myelosuppression 6
  • Laboratory values should be monitored daily during treatment 4

Important Considerations and Caveats

  • Uridine triacetate is not recommended for non-emergency treatment of adverse reactions as it may diminish the efficacy of fluoropyrimidines 2
  • The 96-hour window for administration is critical - efficacy decreases significantly after this timeframe 1, 3
  • Consider testing for dihydropyrimidine dehydrogenase (DPD) deficiency in patients with severe toxicity, as this genetic variation increases risk of fluoropyrimidine toxicity 7
  • For patients with known DPD deficiency requiring future fluoropyrimidine therapy, consider dose reductions (50% for heterozygous mutations) or alternative chemotherapy regimens (for homozygous mutations) 7

By following this protocol, healthcare providers can significantly improve survival and reduce morbidity in patients experiencing fluoropyrimidine overdose or severe toxicity.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Use of uridine triacetate for the management of fluorouracil overdose.

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 2011

Research

Review of the fluoropyrimidine antidote uridine triacetate.

British journal of clinical pharmacology, 2025

Guideline

Treatment Considerations for Patients with DPD Mutations Requiring Chemotherapy

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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