Tegafur and uracil combination drugs are used to treat metastatic colorectal cancer, a condition in which the cancer cells have moved to other body parts in adult patients.
Tegafur and uracil is a fixed-dose combination (1:4) used as a first-line treatment in combination with calcium folinate.
Colorectal cancer affects nearly 1 million people each year across the globe and is estimated to be more common in developed countries than in developing countries.
Tegafur and uracil combination drugs should not be used in patients-
If there is an allergy to tegafur and uracil
Pregnancy and breastfeeding
Children below 18 years of age
Undergoing treatments to correct infertility
Caution is required if tegafur and uracil is used in the following patients with-
Severe kidney disease
History of liver dysfunction
Symptoms of bowel obstruction
Dihydropyrimidine dehydrogenase deficiency
The doses of tegafur and uracil are calculated based on the body surface area taking into account the individual patients height and weight and given repeatedly for 35 days (1 treatment cycle).
The recommended daily dose of tegafur is 300 mg/m2 and uracil is 672 mg/m2 along with oral calcium folinate as 90mg (30 mg/dose) given three times daily (every 8 hours) for 28 days continuously followed by a 7-day treatment-free period.
If the dose amount of tegafur and uracil combination cannot be divided equally the highest dose can be taken in the morning followed by a low dose in the afternoon and the evening.
The doses of tegafur and uracil can be reduced if any blood-related or other types of toxicities occur during the treatment.
In case of severe side effects, the dose of tegafur-uracil can be reduced.
If a dose of tegafur and uracil is missed do not take the missed dose but continue with the following dose.
Never take a double dose of tegafur and uracil capsules to make up for the missed dose, and do not take the missed dose at the end of the treatment cycle which can be harmful.
Tegafur-uracil is available in a capsule form which should be taken by mouth at least 1 hour before or 1 hour after food three times daily for 28 days.
Do not take tegafur-uracil capsules for more than 28 days.
Never open, crush, break or chew the capsules of tegafur-uracil but swallow as a whole with sufficient quantity of water.
Calcium folinate capsules should be taken at the same time as the tegafur-uracil capsules.
If vomiting occurs after taking tegafur-uracil capsules, do not repeat the dose but continue with the next dose.
Liver function should be evaluated during the treatment with tegafur-uracil and calcium folinate. The patient should be monitored for the levels of liver enzymes and promptly treated for the symptoms and signs of liver dysfunction along with dose reduction.
Patients should be monitored for diarrhea during tegafur-uracil therapy and must be treated with fluid and electrolytes to prevent severe dehydration.
Women of reproductive potential should be tested for their pregnancy status before initiating the treatment. Tegafur-uracil therapy should be started only if the results are negative as it can harm the baby in the womb.
Tegafur-uracil can affect the fertility status and patients who wish to have a baby in the future must be advised to use the facilities of a sperm or egg bank.
Women should not breastfeed during the treatment with tegafur-uracil and even for a few months after stopping the treatment.
Patients should use effective contraceptive measures to avoid pregnancy. In case pregnancy is confirmed during the treatment patients must consult their doctor immediately.
Tegafur-uracil can reduce the count of white blood cells putting patients at a risk of developing an infection. Monitor the patients for any symptoms and signs of infection.
Platelet transfusion is recommended for some patients who have low platelet count due to the treatment with tegafur-uracil. Patients should be advised to consult the doctor if any unusual bleeding occurs.
Gastrointestinal: Diarrhea, nausea, vomiting, stomatitis, stomach pain, loss of appetite
Nervous system: Nerve pain, neuropathy, burning or prickling sensation in the hands and feet, speech disturbances
Cardiovascular: Blood clots, heart attack, chest pain
Skin: Hair loss, rashes, itching, eczema, leukoderma
Others: Bone marrow suppression, weakness, anemia, abnormal values of white blood cells and platelets, liver damage, loss of control in balance
The treatment with tegafur-uracil can be stopped temporarily and resumed once the side effects are significantly reduced and the abnormal blood cell counts return to near normal limits.
Treatment discontinuation of tegafur-uracil is usually not recommended because most of the side effects are reversible when the dose of tegafur-uracil is reduced or withheld.
Wash the skin or flush the eyes thoroughly with clean water if the capsule contents of tegafur-uracil come into contact with the skin or eyes.
There are no specific antidotes available for treating an overdose of tegafur-uracil. So, patients with such episodes must be treated appropriately for the symptoms and signs along with supportive care under the supervision of a toxicologist or a specialist.
The doctor should be informed before prescribing tegafur-uracil and calcium folinate if the patient is taking any prescription, Over-The-Counter drugs, or any herbal supplements or has a plan to take them, to prevent unwanted side effects caused by the medications when taken with tegafur-uracil and calcium folinate.
Store tegafur-uracil capsules at room temperature between 15°C and 25°C.
Protect the capsules from excess moisture and heat.
Return the unused capsules of tegafur-uracil to the pharmacy to be disposed off safely.
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