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10/21/2016

Fluorouracil Injection

Reason for the Shortage

    • Accord has flourouracil available.[1]
    • Fresenius Kabi has flourouracil available.[2]
    • Teva has flourouracil available.[3]

Available Products

    • Fluorouracil injection, Accord, 50 mg/mL, 10 mL vial, 10 count, NDC 16729-0276-68
    • Fluorouracil injection, Accord, 50 mg/mL, 100 mL vial, 1 count, NDC 16729-0276-38
    • Fluorouracil injection, Accord, 50 mg/mL, 20 mL vial, 10 count, NDC 16729-0276-67
    • Fluorouracil injection, Accord, 50 mg/mL, 50 mL vial, 1 count, NDC 16729-0276-11
    • Fluorouracil injection, Fresenius Kabi, 50 mg/mL, 10 mL vial, 10 count, NDC 63323-0117-10
    • Fluorouracil injection, Fresenius Kabi, 50 mg/mL, 100 mL vial, 1 count, NDC 63323-0117-61
    • Fluorouracil injection, Fresenius Kabi, 50 mg/mL, 20 mL vial, 10 count, NDC 63323-0117-20
    • Fluorouracil injection, Fresenius Kabi, 50 mg/mL, 50 mL vial, 1 count, NDC 63323-0117-51
    • Fluorouracil injection, Teva, 50 mg/mL, 10 mL vial, 10 count, NDC 00703-3015-13
    • Fluorouracil injection, Teva, 50 mg/mL, 100 mL vial, 5 count, NDC 00703-3019-12
    • Fluorouracil injection, Teva, 50 mg/mL, 50 mL vial, 5 count, NDC 00703-3018-12

Estimated Resupply Dates

    • All marketed presentations are available.

Implications for Patient Care

    • Fluorouracil is an antimetabolite antineoplastic agent. Fluorouracil is labeled for the palliative management of breast, colon, rectal, pancreatic, and stomach cancers.[4,5,6]
    • Fluorouracil is used off-label for a variety of neoplastic diseases including ovarian, cervical, bladder, hepatic, prostate, endometrial, esophageal, head and neck, penile, and thymic cancers. It is also used off-label for the treatment of renal cell carcinoma and carcinoid tumors.[4,5,6]
    • Refer to national guidelines such as those from the National Comprehensive Cancer Network (www.nccn.org) or American Society of Clinical Oncology (www.asco.org) for additional information regarding therapeutic use.

Safety

    • Chemotherapy agents, such as fluorouracil, pose additional safety risks both for patients and for healthcare workers handling these agents.[4,5,6]
    • Use additional caution when processing orders for chemotherapy drugs, especially when switching between chemotherapy agents or when processing orders for chemotherapy agents with which staff may be unfamiliar (eg, those not normally prescribed at a specific institution).[4,5,6]

Alternative Agents & Management

    • The choice of an alternative agent must be patient-specific and based on renal function, liver function, and the neoplasm type and location. No single agent can be substituted for fluorouracil.[4,5,6]
    • Consider evaluating the health-care system's total supply of fluorouracil before beginning patients on combination chemotherapy regimens containing fluorouracil. If adequate supplies are not available, select an alternative regimen.
    • Consult a Hematology/Oncology specialist for patient- and neoplasm-specific recommendations.
    • Refer to the ASHP Guidelines on Managing Drug Product Shortages for more guidance on developing a multidisciplinary plan when the supply must be allocated. http://www.ashp.org/DocLibrary/Policy/DrugShortages/ASHP_shortage_guide09.pdf

References

    1. Accord (personal communications). January 28, February 25, March 4, 14, 22, and 28, April 6, May 3 and 16, June 2, July 19, and October 11, 2016.
    2. Fresenius Kabi (personal communications). January 28, February 25, March 4, 14, 22, and 28, April 6, May 3, 16, and 23, July 15, August 1, 3, 11, and 26, and October 17, 2016.
    3. Teva (personal communications) January 28, February 25, March 4, 14, 22, and 28, April 6, May 3 and 16, July 14, and October 21, 2016.
    4. Antineoplastic agents. In: McEvoy GK, ed. AHFS 2015 Drug Information. Bethesda, MD: American Society of Health-Systems Pharmacists; 2015: 839-1281.
    5. Drug Facts and Comparisons Online. St. Louis, MO: Wolters Kluwer Health Inc. (http://online.factsandcomparisons.com/index.aspx). March 2015.
    6. Lexi-Drugs Online. Lexi-Comp, Inc.; 2015.

Updated

Updated October 21, 2016 by Michelle Wheeler, PharmD, Drug Information Specialist. Created January 28, 2016 by Jane Chandramouli, PharmD, Drug Information Specialist. Copyright 2017, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Vizient to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Vizient, ASHP, and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Vizient, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Vizient, ASHP nor University of Utah endorses or recommends the use of any drug.

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