Flucytosine

CLINICAL USE

Antifungal agent

DOSE IN NORMAL RENAL FUNCTION

100–200 mg/kg per day in 4 divided doses

PHARMACOKINETICS

Molecular weight :129.1

%Protein binding :2–4

%Excreted unchanged in urine : 90

Volume of distribution (L/kg) :0.65–0.91

half-life – normal/ESRD (hrs) :3–6/75–200

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20–40 50 mg/kg 12 hourly

10 to 20 : 50 mg/kg 24 hourly

<10 : 50 mg/kg then dose according to levels. Dose of 0.5–1 g daily is usually adequate

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Dialysed. Give 50 mg/kg daily in 4 divided doses. Monitor levels

HD :Dialysed. Dose as in GFR

<10 : mL/min, given post dialysis. Monitor trough level pre dialysis, and reduce post-dialysis dose accordingly

HDF/high flux :Dialysed. Dose as in GFR

<10 : mL/min, given post dialysis. Monitor trough level pre dialysis, and reduce post-dialysis dose accordingly

CAV/VVHD :Dialysed. Give dose as in GFR 10 to 20 mL/min and monitor blood levels, pre dose

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsCytarabine: concentration of flucytosine possibly reduced

ADMINISTRATION

Reconstition

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Route

IV peripherally through a blood filter

Rate of Administration

20–40 minutes

Comments

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OTHER INFORMATION

Monitor blood levels 24 hours after therapy commences. Pre-dose level 25–50 mg/L is usually adequate. Do not exceed 80 mg/L250 mL intravenous flucytosine infusion contains 34.5 mmol sodiumBone marrow suppression more common in patients with renal impairmentTablets available on named patient basis onlyCan be given IP at a dose of 50 mg/L

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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