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5-Fluorouracil [5-FU]: Brands, Price & Uses in Bangladesh
5-Fluorouracil [5-FU] is a cytotoxic antimetabolite (fluoropyrimidine) chemotherapy agent used, always under the supervision of a physician experienced in cancer chemotherapy and more.
About 5-Fluorouracil [5-FU]
Indications of 5-Fluorouracil [5-FU]
5-Fluorouracil [5-FU] is a cytotoxic antimetabolite (fluoropyrimidine) chemotherapy agent used, always under the supervision of a physician experienced in cancer chemotherapy, for the following indications:
Systemic (Intravenous/Intra-arterial) Use — Established, Combination-Based
- Colorectal cancer (established): as part of combination chemotherapy regimens (e.g., with leucovorin/folinic acid, and commonly with oxaliplatin [FOLFOX] or irinotecan [FOLFIRI]) for adjuvant treatment and for metastatic/advanced disease.
- Gastric (stomach) cancer (established): as part of combination chemotherapy regimens for advanced or metastatic disease.
- Pancreatic cancer (established): as part of combination regimens for locally advanced or metastatic disease.
- Breast cancer (established, adjunct): as part of older combination regimens (e.g., with cyclophosphamide and methotrexate) in selected patients.
- Esophageal, anal, and certain head and neck cancers (guideline-supported, combination): typically combined with radiotherapy and/or other cytotoxic agents (e.g., with mitomycin and radiation for anal cancer; with cisplatin for esophageal/head-and-neck cancer) as part of established multimodal protocols.
5-Fluorouracil [5-FU] for systemic cancer treatment is used only in combination with leucovorin and/or other antineoplastic agents, or with radiotherapy, per the specific tumor protocol; it is not used as a stand-alone, self-directed treatment.
Topical Use — Established
- Actinic keratosis (established): topical cream/solution for multiple actinic (solar) keratoses of the face, ears, scalp, and other sun-exposed areas.
- Superficial basal cell carcinoma (established, when surgery is not appropriate): topical 5% cream/solution, used only when conventional surgical excision is medically or cosmetically inappropriate, and only under dermatologist supervision with follow-up.
5-Fluorouracil [5-FU] is not appropriate for self-directed use in any form; systemic use requires oncology supervision and topical use requires dermatologist supervision with appropriate follow-up to confirm treatment response.
Dosage & Administration of 5-Fluorouracil [5-FU]
Dosing of 5-Fluorouracil [5-FU] is highly individualized, calculated by body surface area or by protocol-specific fixed/weight-based schedules, and must always be determined and adjusted by the treating oncologist based on the specific cancer, combination regimen, prior toxicity, and laboratory results. 5-Fluorouracil [5-FU] has a narrow margin between effective and toxic doses.
| Indication / Setting | Typical Adult Regimen (illustrative — actual dose per treating oncologist's protocol) |
|---|---|
| Colorectal cancer (e.g., FOLFOX/FOLFIRI-type regimens) | 5-Fluorouracil [5-FU] bolus and/or continuous intravenous infusion combined with leucovorin, given on a defined multi-day cycle (commonly repeated every 2 weeks), with oxaliplatin or irinotecan added per regimen |
| Colorectal/gastric cancer (older bolus regimens, e.g., Mayo Clinic or Roswell Park schedules) | 5-Fluorouracil [5-FU] given as a short intravenous bolus with leucovorin on specific days of a 4–5 week cycle |
| Topical — Actinic keratosis | 5% (or lower-strength) cream/solution applied to affected skin once or twice daily for approximately 2–4 weeks, as directed by the treating physician |
| Topical — Superficial basal cell carcinoma | 5% cream/solution applied twice daily for approximately 3–6 weeks (or longer, per response), only under dermatologist supervision |
Before starting systemic 5-Fluorouracil [5-FU], testing for dihydropyrimidine dehydrogenase (DPD) deficiency is recommended where available, since patients with reduced DPD activity are at markedly increased risk of severe toxicity (see Precautions and Warnings). See Dosage, Administration, Use in Special Populations, and Precautions and Warnings for renal/hepatic considerations, dose modification for toxicity, and monitoring requirements. 5-Fluorouracil [5-FU] must never be self-administered systemically and must only be given in a supervised oncology (or, for topical use, dermatology) setting.
Side Effects of 5-Fluorouracil [5-FU]
Side effects of 5-Fluorouracil [5-FU] depend on the route (systemic vs. topical), dose, schedule (bolus vs. continuous infusion), and combination regimen used.
Systemic Use — Common
- Myelosuppression: leukopenia, neutropenia, thrombocytopenia, anemia (increasing risk of infection, bleeding, or need for transfusion)
- Nausea, vomiting, diarrhea (can be severe and dose-limiting)
- Stomatitis and mucositis (mouth/gut sores)
- Alopecia (hair thinning/loss)
- Hand-foot syndrome (palmar-plantar erythrodysesthesia), especially with continuous infusion schedules
- Photosensitivity and skin/nail hyperpigmentation
- Fatigue
Systemic Use — Serious / Less Common
- Severe myelosuppression with febrile neutropenia or serious infection
- Cardiotoxicity: chest pain, coronary vasospasm, arrhythmias, and rarely myocardial infarction or cardiac arrest, particularly in patients with pre-existing coronary artery disease
- Neurotoxicity: cerebellar ataxia, confusion, and rarely encephalopathy (more common with DPD deficiency or high doses)
- Severe gastrointestinal ulceration or bleeding
- Ocular effects with prolonged use (excessive tearing, lacrimal duct narrowing)
Topical Use
- Local skin reactions at the application site — redness, burning, itching, crusting, erosion, and peeling are common and expected as part of the treatment response; healing typically continues for some weeks after stopping treatment.
- Temporary hyper- or hypopigmentation of treated skin.
Patients (or caregivers) should promptly report fever, unusual bleeding or bruising, severe mouth sores, chest pain, or severe skin reactions to the treating physician.
Contraindications of 5-Fluorouracil [5-FU]
5-Fluorouracil [5-FU] is contraindicated in patients with any of the following:
- Known hypersensitivity to 5-Fluorouracil [5-FU] or any component of the formulation.
- Known complete dihydropyrimidine dehydrogenase (DPD) deficiency, due to the risk of severe, life-threatening toxicity (see Precautions and Warnings).
- Severe bone marrow suppression (severely depressed bone marrow function), for systemic administration.
- Pregnancy, for systemic administration (see Pregnancy and Lactation).
- Concomitant or recent (within approximately 4 weeks) treatment with brivudine, sorivudine, or other potent DPD-inhibiting antiviral agents, due to the risk of severe, potentially fatal toxicity (see Interaction).
Other risk factors (e.g., poor nutritional status, active serious infection, partial DPD deficiency, significant hepatic or renal impairment) require caution and careful risk-benefit assessment rather than being absolute contraindications, and are discussed in Precautions and Warnings and Use in Special Populations.
Frequently Asked Questions about 5-Fluorouracil [5-FU]
What is 5-Fluorouracil [5-FU] used for?
5-Fluorouracil [5-FU] is a chemotherapy medicine. Given by injection/infusion, it is used mainly, in combination with other chemotherapy drugs, to treat colorectal, gastric (stomach), pancreatic, breast, and certain other cancers. As a topical cream or solution, it is used to treat actinic (solar) keratosis and, in selected cases, superficial basal cell carcinoma of the skin.
Why is DPD testing sometimes recommended before starting 5-Fluorouracil [5-FU]?
Some people have reduced activity of an enzyme called dihydropyrimidine dehydrogenase (DPD), which normally breaks down 5-Fluorouracil [5-FU] in the body. In these patients, systemic 5-Fluorouracil [5-FU] can build up to dangerous levels and cause severe, sometimes fatal side effects (severe low blood counts, severe mouth/gut damage, and nerve problems). Where available, DPD testing before starting treatment helps identify this risk so the dose can be adjusted or the drug avoided.
What are the main side effects of 5-Fluorouracil [5-FU]?
With systemic (injection/infusion) use, common side effects of 5-Fluorouracil [5-FU] include low blood counts (raising the risk of infection, bruising, or bleeding), nausea, vomiting, diarrhea, mouth sores, hair thinning, and hand-foot syndrome (redness/soreness of palms and soles). Rare but serious effects include severe infection, heart problems (chest pain, abnormal heart rhythm), and nerve problems. With topical use, redness, burning, crusting, and peeling of treated skin are expected and usually resolve after the course finishes.
Can 5-Fluorouracil [5-FU] be used during pregnancy or while breastfeeding?
Systemic 5-Fluorouracil [5-FU] is contraindicated in pregnancy because it can seriously harm the developing baby; effective contraception is required during treatment. Breastfeeding is not recommended during and for some time after systemic 5-Fluorouracil [5-FU] treatment. Topical 5-Fluorouracil [5-FU] should be used in pregnancy or while breastfeeding only if a physician judges it clearly necessary, as safety data are limited — always consult your physician first.
Who should not receive 5-Fluorouracil [5-FU]?
5-Fluorouracil [5-FU] should not be given to anyone with a known allergy to it, anyone with known complete DPD enzyme deficiency, anyone with severely low bone marrow function, pregnant women (systemic use), or anyone currently or recently (within about 4 weeks) treated with the antiviral drugs brivudine or sorivudine, because combining these can cause fatal toxicity.
What should be done if an overdose of 5-Fluorouracil [5-FU] is suspected?
Because 5-Fluorouracil [5-FU] is given under strict medical supervision on a fixed schedule, an overdose would usually reflect a dosing or administration error rather than something a patient does at home. If an overdose of 5-Fluorouracil [5-FU] is suspected, seek immediate medical attention or contact emergency services/poison control right away; treatment requires hospital-based monitoring and supportive care, and a specific antidote may be available in some settings if given early.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.