Medical Advisory Board: Dr. Ram Dandillaya, Clinical Chief, Cardiology, Cedars-Sinai; Dr. Antonio J. Forte, Faculty, Mayo Clinic; Dr. John J. Lee, Faculty, Harvard Medical School; Dr. Daniel Kahneman, Nobel Prize Laureate. OpenEvidence is a Mayo Clinic Platform Accelerate Company.
Answered on June 5, 2023
The appropriate timing and dosage of Fluorouracil (5-FU) for a patient undergoing hemodialysis should be carefully considered due to the altered pharmacokinetics in these patients. In a case report of a patient with gastric cancer and chronic renal failure treated with 5-FU/leucovorin (LV) infusion chemotherapy, hyperammonemia was managed by adjusting the timing of hemodialysis.[1] Initially, the patient developed symptomatic hyperammonemia and underwent emergency hemodialysis on day 3. In subsequent cycles, the 5-FU dose was reduced, but hyperammonemia persisted, requiring hemodialysis on day 3. By changing the scheduled hemodialysis from day 3 to day 2, symptomatic hyperammonemia was prevented in cycles 5-7.[1]
Although there are no set recommendations for dose adjustment of 5-FU in the presence of renal or hepatic dysfunction, it is crucial to monitor patients closely for adverse events and adjust the treatment regimen accordingly.[2] In the case report mentioned above, the 5-FU dose was reduced, and the timing of hemodialysis was adjusted to manage hyperammonemia.[1] Further studies with more cases are needed to determine the optimal dosage and timing of hemodialysis for patients with impaired renal function receiving 5-FU treatment.

References

1.Ozaki Y, Imamaki H, Ikeda A, et al. Successful Management of Hyperammonemia With Hemodialysis on Day 2 During 5-Fluorouracil Treatment in a Patient With Gastric Cancer: A Case Report With 5-Fluorouracil Metabolite Analyses. Cancer Chemotherapy and Pharmacology. 2020;86(5):693-699. doi:10.1007/s00280-020-04158-1.
2.Diasio RB, Harris BE. Clinical Pharmacology of 5-Fluorouracil. Clinical Pharmacokinetics. 1989;16(4):215-37. doi:10.2165/00003088-198916040-00002.

Share

Don′t miss our weekly email alert. Stay up to date on all the new findings that matter.

We care about your privacy. View our terms of use.

© OpenEvidence 2024. All rights reserved.

Terms of Use
Privacy Policy
Contact Us

OpenEvidence is an experimental technology demonstrator. OpenEvidence does not provide medical advice, diagnosis or treatment. User questions and other inputs on OpenEvidence are not covered by HIPAA. It is the responsibility of the user to ensure questions do not contain protected health information (PHI) or any information that violates the privacy of any person.