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ANTIINFECTIVES FOR SYSTEMIC USE › ANTIMYCOTICS FOR SYSTEMIC USE › ANTIMYCOTICS FOR SYSTEMIC USE › Other antimycotics for systemic use
flucytosine
J02AX01
Adult Dosing
- Systemic fungal infections: 50 to 150 mg/kg/day divided every 6 hours
- Renal impairment adjustment required based on creatinine clearance
Pediatric Dosing
- Systemic fungal infections: 50 to 150 mg/kg/day divided every 6 hours
- Safety and efficacy in neonates not established
Indications
- Serious infections caused by susceptible strains of Candida and Cryptococcus
- Used concomitantly with amphotericin B for cryptococcal meningitis
Mechanism of Action
- Penetrates fungal cells and is converted to 5-fluorouracil by fungal cytosine deaminase
- Inhibits fungal protein and RNA synthesis via incorporation of fluorouridine triphosphate into RNA and inhibition of thymidylate synthetase
Contraindications
- Hypersensitivity to flucytosine
- Known complete dihydropyrimidine dehydrogenase (DPD) deficiency
Adverse Reactions
- Bone marrow suppression (neutropenia, thrombocytopenia, anemia)
- Hepatotoxicity (elevated liver enzymes, hepatic necrosis)
- Gastrointestinal disturbances (nausea, vomiting, diarrhea, abdominal pain)
- Central nervous system effects (confusion, hallucinations, headache)
Drug Interactions
- Amphotericin B synergistically increases flucytosine antifungal activity and toxicity
- Drugs that impair renal function can decrease flucytosine clearance, leading to toxicity
- Cytotoxic bone marrow suppressants increase risk of severe myelosuppression
Curated Content: Needs Vetting Before Put to Clinical Use