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| Interactions: | Cimetidine
Adverse Effect: An increased risk of fluorouracil toxicity
Clinical Management: Monitor patients who have received long-term (four or more weeks) therapy with cimetidine for an increased incidence of adverse effects to fluorouracil. If possible, discontinue the cimetidine prior to the administration of fluorouracil. An alternative H-2 antagonist could also be substituted for cimetidine.
Leucoverin
Adverse Effect: fluorouracil toxicity (myelosuppression, stomatitis, GI toxicity)
Clinical Management: Fluorouracil plus leucovorin is routinely used therapeutically in the treatment of cancer. Monitor patients, especially the elderly, for increased toxicity (myelosuppression, stomatitis, GI toxicity).
Levamisole
Adverse Effect: hepatotoxicity
Clinical Management: Monitor patients for mild and asymptomatic hepatotoxicity, specifically, elevated alkaline phosphatase accompanied by increased transaminases or serum bilirubin. This hepatotoxicity is usually reversible.
Metronidazole
Adverse Effect: increased fluorouracil serum concentrations and fluorouracil toxicity (granulocytopenia, anemia, thrombocytopenia, stomatitis, vomiting)
Clinical Management: Avoid concurrent administration of fluorouracil and metronidazole, if possible.
Tamoxifen
Adverse Effect: an increased risk of thromboembolism
Clinical Management: In patients undergoing therapy with tamoxifen for breast cancer, the risks of adding fluorouracil should be weighed against the potential benefits.
Warfarin
Adverse Effect: an increased risk of bleeding
Clinical Management:Adjustments of the warfarin dose may be necessary in order to maintain the desired level of anticoagulation. |
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