Floxuridine – FUDR®

Floxuridine - FUDR®

Usual Diluents

Dilution Data

Each vial must be reconstituted with 5 mL of sterile Water for Injection to yield a solution containing approximately 100 mg of floxuridine /mL. The calculated daily dose(s) of the drug is then diluted with 5% dextrose or 0.9% sodium chloride injection to a volume appropriate for the infusion apparatus to be used. The administration of FUDR is best achieved with the use of an appropriate pump to overcome pressure in large arteries and to ensure a uniform rate of infusion.1

HOW SUPPLIED
NDC 61703-331-09 - 500 mg Sterile FUDR (floxuridine) powder in a 5 mL vial packaged individually.
This is to be reconstituted with 5 mL sterile water for injection. The sterile powder should be stored at 15°C to 30°C (59°F to 86°F). Reconstituted vials should be stored under refrigeration 2°C to 8°C (36°F to 46°F) for not more than 2 weeks.   Further dilute in 500-1000 mL D5W or NS for I.V. infusion 2.

FOR INTRA-ARTERIAL INFUSION ONLY

DESCRIPTION
Sterile FUDR (floxuridine), an antineoplastic antimetabolite, is available as a sterile, nonpyrogenic, lyophilized powder for reconstitution. Each vial contains 500 mg of floxuridine which is to be reconstituted with 5 mL of sterile Water for Injection. An appropriate amount of reconstituted solution is then diluted with a parenteral solution for intra-arterial infusion (see DOSAGE AND ADMINISTRATION section).

Floxuridine is a fluorinated pyrimidine. Chemically, floxuridine is 2’-deoxy-5-fluorouridine with an empirical formula of C9H11FN2O5. It is a white to off-white odorless solid which is freely soluble in water.

CLINICAL PHARMACOLOGY
When FUDR is given by rapid intra-arterial injection it is apparently rapidly catabolized to 5-fluorouracil. Thus, rapid injection of FUDR produces the same toxic and antimetabolic effects as does 5-fluorouracil. The primary effect is to interfere with the synthesis of deoxyribonucleic acid (DNA) and to a lesser extent inhibit the formation of ribonucleic acid (RNA). However, when FUDR is given by continuous intra-arterial infusion its direct anabolism to FUDR-monophosphate is enhanced, thus increasing the inhibition of DNA.

Floxuridine is metabolized in the liver. The drug is excreted intact and as urea, fluorouracil, a-fluoro-bureidopropionic acid, dihydrofluorouracil, a-fluoro-b-guanidopropionic acid and a-fluoro-b-alanine in the urine; it is also expired as respiratory carbon dioxide. Pharmacokinetic data on intra-arterial infusion of FUDR are not available.

INDICATIONS AND USAGE
FUDR is effective in the palliative management of gastrointestinal adenocarcinoma metastatic to the liver, when given by continuous regional intra-arterial infusion in carefully selected patients who are considered incurable by surgery or other means. Patients with known disease extending beyond an area capable of infusion via a single artery should, except in unusual circumstances, be considered for systemic therapy with other chemotherapeutic agents.

CONTRAINDICATIONS
FUDR therapy is contraindicated for patients in a poor nutritional state, those with depressed bone marrow function or those with potentially serious infections.

WARNINGS
BECAUSE OF THE POSSIBILITY OF SEVERE TOXIC REACTIONS, ALL PATIENTS SHOULD BE HOSPITALIZED FOR THE FIRST COURSE OF THERAPY.

FUDR should be used with extreme caution in poor risk patients with impaired hepatic or renal function or a history of high-dose pelvic irradiation or previous use of alkylating agents. The drug is not intended as an adjuvant to surgery.

FUDR may cause fetal harm when administered to a pregnant woman. It has been shown to be teratogenic in the chick embryo, mouse (at doses of 2.5 to 100 mg/kg) and rat (at doses of 75 to 150 mg/kg). Malformations included cleft palates; skeletal defects; and deformed appendages, paws and tails. The dosages which were teratogenic in animals are 4.2 to 125 times the recommended human therapeutic dose.

There are no adequate and well-controlled studies with FUDR in pregnant women. If this drug is used during pregnancy or if the patient becomes pregnant while taking (receiving) this drug, the patient should be apprised of the potential hazard to the fetus. Women of childbearing potential should be advised to avoid becoming pregnant.

Combination Therapy
Any form of therapy which adds to the stress of the patient, interferes with nutrition or depresses bone marrow function will increase the toxicity of FUDR.

PRECAUTIONS
General
Sterile FUDR is a highly toxic drug with a narrow margin of safety. Therefore, patients should be carefully supervised since therapeutic response is unlikely to occur without some evidence of toxicity. Severe hematological toxicity, gastrointestinal hemorrhage and even death may result from the use of FUDR despite meticulous selection of patients and careful adjustment of dosage. Although severe toxicity is more likely in poor risk patients, fatalities may be encountered occasionally even in patients in relatively good condition.

Therapy is to be discontinued promptly whenever one of the following signs of toxicity appears:

Myocardial ischemia

Stomatitis or esophagopharyngitis, at the first visible sign

Leukopenia (WBC under 3500) or a rapidly falling white blood count

Vomiting, intractable

Diarrhea, frequent bowel movements or watery stools

Gastrointestinal ulceration and bleeding

Thrombocytopenia (platelets under 100,000)

Hemorrhage from any site

DOSAGE AND ADMINISTRATION
Each vial must be reconstituted with 5 mL of sterile Water for Injection to yield a solution containing approximately 100 mg of floxuridine /mL. The calculated daily dose(s) of the drug is then diluted with 5% dextrose or 0.9% sodium chloride injection to a volume appropriate for the infusion apparatus to be used. The administration of FUDR is best achieved with the use of an appropriate pump to overcome pressure in large arteries and to ensure a uniform rate of infusion.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.

The recommended therapeutic dosage schedule of FUDR by continuous arterial infusion is 0.1 to 0.6 mg/kg/day. The higher dosage ranges (0.4 mg to 0.6 mg) are usually employed for hepatic artery infusion because the liver metabolizes the drug, thus reducing the potential for systemic toxicity. Therapy can be given until adverse reactions appear (see PRECAUTIONS section). When these side effects have subsided, therapy may be resumed. The patient should be maintained on therapy as long as response to FUDR continues.

Procedures for proper handling and disposal of anticancer drugs should be considered. Several guidelines on this subject have been published.1-6 There is no general agreement that all of the procedures recommended in the guidelines are necessary or appropriate.

HOW SUPPLIED
NDC 61703-331-09 - 500 mg Sterile FUDR (floxuridine) powder in a 5 mL vial packaged individually.

This is to be reconstituted with 5 mL sterile water for injection. The sterile powder should be stored at 15°C to 30°C (59°F to 86°F). Reconstituted vials should be stored under refrigeration 2°C to 8°C (36°F to 46°F) for not more than 2 weeks.

2) Solimando, Dominic A. Drug Information Handbook for Oncology: A Complete Guide to Combination Chemotherapy Regimens, 8th ed. Hudson, OH: Lexi-Comp, Inc.; 2010.

Procedures for proper handling and disposal: Recommendations for the safe handling of parenteral antineoplastic drugs. Washington, DC, US Government Printing Office NIH publication 83-2621. AMA Council Report. Guidelines for handling parenteral antineoplastics. JAMA. Mar 15,1985, 253:1590-1592. National Study Commission on Cytotoxic Exposure: Recommendations for handling cytotoxic agents. Available from Louis P. Jeffrey, ScD, Director of Pharmacy Services, Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02902. Clinical Oncological Society of Australia: Guidelines and recommendations for safe handling of antineoplastic agents. Med J Aust. Apr 30 , 1983, 1:426-428. Jones, RB, Frank R, Mass T: Safe handling of chemotherapeutic agents: a report from the Mount Sinai  Medical  Center. CA. Sept-Oct, 1983, 33:258-263. ASHP American Society of Hospital Pharmacists Technical Assistance Bulletin on Handling Cytotoxic and Hazardous Drugs in Hospitals. Am J. Hosp Pharm Jan, 1985, 42:131-137