Parenteral Manual

Fluorouracil

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
5-FU, 5-FLUOROURACIL
Classification: 
Antimetabolite antineoplastic - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
August 2024
Indications: 
  • Hepatoblastoma
  • Colorectal cancer

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Supplied as a 50 mg/mL solution
  • Protect from light, freezing and prolonged high temperatures during storage
  • Stable at room temperature
  • Slight discoloration does not affect potency or safety, dark yellow or brown solutions should be discarded
  • A precipitate may form from exposure to low temperatures and may be resolubilized by heating vial slightly under hot water and shaking
  • Diluted solutions are stable for 24 hours at room temperature
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl and combinations

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: allopurinol, doxorubicin, furosemide, methotrexate, metoclopramide, heparin, hydrocortisone, leucovorin, mannitol, KCl

- Incompatible: droperidol, carboplatin, cisplatin, cytarabine, ondansetron

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

YES, certified RN's only
Usual dilution: undiluted (50 mg/mL)

Infusion time: over 5 minutes
IV Intermittent Infusion YES, doses < 800 mg/m2 only                                                                           Dilution : undiluted or dilute in 50-100 mL of D5W or NS
Infusion time: 30-60 minutes
IV Continuous Infusion YES, doses > 800 mg/m2 must be given by continuous infusion
Usual dilution: dilute in 500-1000 mL of D5W or NS
Infusion time: over 24 hours
SC Continuous Infusion YES,
Usual dilution: undiluted (50 mg/mL)
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 600 mg/m2 every 3 weeks
  • Colorectal cancer - 400 mg/ m2  bolus   followed by 2400 mg/m2 infusion
  • Dose reductions necessary for hepatic failure, severe mucositis, severe diarrhea and myelosuppression (consult individual protocol for modifications)
  • No dosage adjustment required for renal failure
  • Omit if bilirubin >85 micromol/L (see protocol for details)

** Dosage may differ according to protocol

Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours):

  • Nausea and vomiting (low to moderate emetogenic potential; dose dependent)
  • Excessive lacrimation, conjunctivitis, nasal discharge
  • NOT A VESICANT
  • If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.

Delayed (within a few days to weeks):

  • Myelosuppression: nadir 9-14 days
  • Stomatitis, esophagitis, diarrhea, anorexia
  • Hepatotoxicity
  • Alopecia
  • Acute cerebellar syndrome or encephalopathy (rare with bolus doses)
  • Increased pigmentation over veins used to administer fluorouracil, will fade with time
  • Rash
  • Photosensitivity
  • Palmar, plantar erythrodysethesia (hand-foot syndrome, pain and tenderness of palms and soles, then symmetrical swelling of hands and feet) - may be treated with oral pyridoxine (Vitamin B6)
  • Nail changes

 - Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy

Notes: 
  • May enhance radiation injury to tissues (radiation recall reaction)
  • Cimetidine can increase serum concentrations of fluorouracil
  • Metronidazole can enhance toxicity of fluorouracil
  • Leucovorin potentiates action of 5-FU

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