[Flucytosine photo]
KEY POINTS
- Flucytosine (Ancobon) is an anti fungal medication that penetrates the cells of fungi, where it is converted to fluorouracil, which then competes with uracil, thus interfering with fungal RNA and protein synthesis
- Can be used to treat infections caused by yeasts
- Main use is for cryptococcal meningitis, in combination with amphotericin B
- Can be used off-label for Candida infections, although this is not common to see in practice
- Avoid use as monotherapy due development of resistance
- Only available in an oral formulation
- Typical dose is 50 to 150 mg/kg/day split into 4 doses given every 6 hours
- Adjust doses for renal function
- Manufacturer package insert does not give dose adjustments for hepatic function
- There are many possible side effects, but in particular beware: hematologic toxicity, hepatic toxicity, renal toxicity
- US Boxed Warning exists for patients with renal impairment
- US Boxed Warning exists for close monitoring of renal function, hepatic function and hematologic status
- Can be expensive
RESOURCES
- Flucytosine Package Insert
- Opportunistic Infection Guideline (AIDSinfo.nih.gov)
- Treatment Guideline For Fungal Infections (Infectious Diseases Society of America)
- Current Concepts In Antifungal Pharmacology (2011)
- Flucytosine Review (Journal of Antimicrobial Chemotherapy 2000)
- Flucytosine Details From AIDSinfo