플루오로우라실

항종양제 - 피리미딘 길항제

플루오로우라실(5-FU)은 수의학에서 특정 유형의 암을 치료하는 데 사용되는 피리미딘 유사체 항종양제입니다. * **개**: 유선암(종종 독소루비신 및 시클로포스파미드와 함께 FAC 프로토콜의 일부로 사용됨), 피부 편평세포암 및 위장관 종양에 전신적으로 사용됩니다. * **말**: 편평세포암, 흑색종, 말 사코이드와 같은 피부 종양을 치료하기 위해 국소적으로 또는 병변 내 주사(종종 에피네프린과 병용)로 사용됩니다. > **매우 중요한 종간 차이**: 5-FU는 **고양이에게 절대 금기**입니다. 고양이는 이 약물을 안전하게 대사하는 데 필요한 경로가 부족하여, 아주 미량(예: 사람용 연고의 우발적 섭취)에도 심각하고 빠르게 진행되며 종종 치명적인 신경독성을 유발합니다.

작용 기전: Fluorouracil is a prodrug that acts as a cell-cycle phase-specific (S-phase) antimetabolite. It enters the cell and is converted into two primary active metabolites: * **FUMP (fluorouridine monophosphate)** → Inhibits the enzyme **thymidylate synthase**, which blocks the synthesis of deoxythymidine triphosphate (dTTP). This severely disrupts **DNA synthesis** and repair. * **FUTP (fluorouridine triphosphate)** → Falsely incorporates into **RNA**, disrupting RNA processing, function, and subsequent protein synthesis. By halting both DNA and RNA functions, the drug induces apoptosis in rapidly dividing cancer cells.

동물 종별 용량

Cats

ALL · CONTRAINDICATED · ALL · Do NOT use in any form on cats
All indications · DO NOT USE · PO/IM/IV/SC/topical · null · null · Strictly contraindicated. Causes potentially fatal neurotoxicity.

Horses

Intratumoral injection with epinephrine into certain skin neoplasms (squamous cell carcinoma, melanoma, sarcoid) · 0.3 mL of 1:1000 epinephrine is added to each mL of 5-FU solution up to a maximum of 3 mL of epinephrine per total volume of 5-FU injected. · Intratumoral · Epinephrine may result in white hair growth and can cause transient excitation, tachycardia, and shaking if absorbed systemically in sufficient quantities.

Dogs

Canine mammary carcinoma (in combination with doxorubicin and cyclophosphamide-FAC protocol), dermal squamous cell carcinoma and GI tract tumors · 150 mg/m2 IV weekly, or 5-10 mg/kg IV weekly · IV · weekly
Systemic carcinomas · 150 mg/m2 · IV · once weekly OR once every 3 weeks when combined with carboplatin · 6 weeks (if used weekly) · Reduce dose by half in patients with liver, renal, or bone marrow impairment.
Basal cell and squamous cell carcinoma · Apply to affected area · topical · q24h · As directed by oncologist · Wear gloves when applying. Prevent the dog from licking the area.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

IVIntralesionalTopical

금기

CATS (Do NOT use in any form, including topical)
Patients with known hypersensitivity to the drug
Patients in poor nutritional states
Patients with depressed or reduced bone marrow function
Patients with concurrent serious infections
Pregnancy (Known teratogen - FDA Category D)
Cats (strictly contraindicated due to fatal neurotoxicity)
Patients with severe bone marrow suppression
Patients with severe hepatic or renal impairment (unless dose is adjusted)
Pregnancy and lactation

이상반응

Dose-dependent myelosuppression (leukopenia, thrombocytopenia)
Gastrointestinal toxicity (nausea, vomiting, hemorrhagic diarrhea, GI ulceration/sloughing, stomatitis)
Neurotoxicity (ataxia, disorientation, seizures)
Fatal neurotoxicity in cats (even with topical exposure)
Anorexia
Vomiting
Stomatitis
Diarrhoea
Leucopenia (nadir between 7 and 14 days)
Thrombocytopenia
Anaemia
Alopecia
Hyperpigmentation
Dermatitis
Cerebellar ataxia
Seizures

약물 상호작용

Leucovorin · May increase the gastrointestinal toxic effects of 5-FU
Cimetidine · Inhibits the metabolism of 5-FU, potentially increasing toxicity · major
Carboplatin · Synergism in human oncology, but combination may be more toxic in small animals · major
Methotrexate · Synergistic if administered before 5-FU; antagonistic if administered afterwards · major
Vincristine · Increases the cytotoxicity of 5-FU · major

모니터링

CBCs (nadirs usually occur between days 9-14 with recovery by day 30)
Gastrointestinal adverse effects (vomiting, diarrhea, anorexia)
Central nervous system adverse effects (ataxia, seizures)
Liver enzymes (alkaline phosphatase, serum transaminase), serum bilirubin, and lactic dehydrogenase (may increase)
Tumor response/Efficacy
Complete Blood Count (CBC) to monitor for leucopenia and thrombocytopenia (nadir 7-14 days)
Renal function parameters
Hepatic function parameters
Gastrointestinal signs (vomiting, diarrhea, stomatitis)
Neurological signs

과용량

Overdoses are extremely serious and potentially fatal. * **Dogs**: The lowest reported toxic dose is 8.6 mg/kg (mild GI irritation/vomiting). Seizures and death have been reported at doses as low as 10.3 mg/kg, with survival rates potentially as low as 25%. * **Cats**: Very small ingestions (such as licking human topical creams) can cause death. **Clinical Signs**: Onset is rapid (30 minutes to 6 hours). Signs include acute nausea, vomiting, hemorrhagic diarrhea, abdominal pain, GI sloughing, ataxia, severe nonresponsive seizures, severe dose-dependent myelosuppression affecting all cell lines, metabolic acidosis, and multi-organ failure. **Treatment**: * Aggressive GI decontamination and protection if ingestion was very recent (though rapid onset may render this ineffective). * Intensive supportive care: antiemetics, fluid support, pain control, and temperature regulation. * Seizure control: Diazepam is often unrewarding; barbiturates or general anesthesia are frequently required. * Broad-spectrum antibiotics to prevent secondary infections. * Filgrastim (Neupogen®) can be considered to stimulate bone marrow stem cell proliferation in dogs. * Intensive hematologic monitoring (CBCs every 3-4 days) for at least 3-4 weeks.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.