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Flucytosine
Flucytosine, also known by its brand name Ancobon, is an antifungal medication used to treat serious fungal infections such as cryptococcosis, candidiasis, and chromomycosis. It is commonly prescribed in combination with other antifungals like amphotericin B to improve treatment efficacy and prevent the development of resistance. Flucytosine works by interfering with fungal cell reproduction and is especially effective in treating systemic fungal infections that can affect the brain, lungs, and blood.
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Frequently Asked Questions
How long does it take for Flucytosine to work?
The length of treatment varies depending on the type and severity of the infection. For serious infections like cryptococcal meningitis, treatment may last for several weeks or even months.
Can Flucytosine be used alone?
Flucytosine is typically used in combination with other antifungals, like amphotericin B, to prevent the development of drug resistance and enhance its effectiveness.
What should I do if I miss a dose?
Take the missed dose as soon as you remember, unless it's close to your next scheduled dose. Do not double up doses to make up for a missed one.
Can Flucytosine cause hair loss?
Hair loss is not a common side effect of Flucytosine. However, if you notice unusual hair loss, discuss it with your healthcare provider.
How is Flucytosine monitored?
While taking Flucytosine, your doctor will regularly check blood cell counts, liver enzymes, and kidney function to monitor for potential side effects.
Comprehensive Drug Guide
How Does Flucytosine Work?
Flucytosine works by being converted into 5-fluorouracil (5-FU) inside fungal cells. Once converted, it disrupts the production of DNA and RNA within the fungus, preventing it from multiplying. This fungistatic action (inhibiting fungal growth) is especially effective when used in combination with other antifungal agents like amphotericin B, which disrupts the fungal cell membrane, enhancing the penetration of flucytosine.
Common Dosages
- The usual dose is 50 to 150 mg per kg of body weight per day, divided into four doses, typically taken every 6 hours.
- Flucytosine is often used in combination with other antifungal agents, and the dosage may vary based on the severity and type of infection.
Typical Dosing
- For cryptococcal meningitis: A common dose is 100 mg/kg/day, divided into four doses (25 mg/kg every 6 hours).
- For candidiasis and chromomycosis: Doses typically range from 50-150 mg/kg/day, divided into four doses.
- Combination therapy: Flucytosine is frequently used alongside amphotericin B for enhanced effectiveness.
Typical Dosing
FDA Approved Indications
- Cryptococcal meningitis (caused by Cryptococcus neoformans).
- Candidiasis (systemic and invasive infections caused by Candida species).
- Chromomycosis (chronic fungal infections of the skin and subcutaneous tissue).
- Aspergillosis, when used in combination therapy.
Who Shouldn't Take Flucytosine?
- Hypersensitivity to flucytosine or any components of the formulation.
- Severe renal impairment, as the drug is primarily excreted through the kidneys and requires careful monitoring in patients with compromised kidney function.
Advice From The Pharmacist
- Take Flucytosine as prescribed, typically every 6 hours with or without food.
- Do not skip doses, as fungal infections require consistent medication to prevent resistance and ensure effective treatment.
- Monitor for side effects like nausea, vomiting, or diarrhea, which are common with flucytosine. Stay hydrated to prevent dehydration.
- Regular blood tests are required to monitor kidney function and blood cell counts, as flucytosine can cause bone marrow suppression and other serious side effects.
Side Effects of Flucytosine
Common Side Effects
- Nausea and vomiting
- Diarrhea
- Rash or itching
- Decreased appetite
Uncommon/Severe Side Effects
- Bone marrow suppression, leading to anemia, leukopenia, or thrombocytopenia (low blood cell counts).
- Liver toxicity, presenting as jaundice, dark urine, or elevated liver enzymes.
- Kidney toxicity, particularly in individuals with pre-existing kidney disease.
- Gastrointestinal bleeding or severe abdominal pain.
Risks and Warnings of Flucytosine
- Bone Marrow Suppression: Flucytosine can suppress bone marrow, leading to low blood counts (e.g., anemia, leukopenia). Regular blood tests are required to monitor for these effects.
- Renal Impairment: Since flucytosine is excreted by the kidneys, patients with renal impairment should be monitored closely, and dose adjustments may be necessary.
- Liver Function: Prolonged use of flucytosine can lead to liver damage, requiring regular monitoring of liver enzymes.
- Drug Resistance: Flucytosine is more effective when used in combination with other antifungals to prevent the development of drug resistance.
Interactions with Flucytosine
Common Drug Interactions
- Amphotericin B: Flucytosine is often used with amphotericin B for synergistic effects. Amphotericin B can increase the risk of renal toxicity, so kidney function must be closely monitored.
- Cytotoxic drugs: Combining flucytosine with other bone marrow suppressants (e.g., chemotherapy drugs) can increase the risk of bone marrow suppression.
- Antiviral medications: Certain antivirals (e.g., ganciclovir) may increase the risk of bone marrow toxicity when combined with flucytosine.
Alternatives to Flucytosine
- Amphotericin B: A strong antifungal used for serious systemic infections, often in combination with flucytosine.
- Fluconazole: An oral antifungal used to treat systemic and invasive fungal infections, particularly Candida and Cryptococcus infections.
- Itraconazole: Another oral antifungal used for various systemic fungal infections, including aspergillosis and histoplasmosis.
- Voriconazole: A broad-spectrum antifungal commonly used for invasive aspergillosis and other severe fungal infections.
