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Introduction to the disorders of purine and pyrimidine metabolism
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Methodology, such as high-pressure liquid chromatography tandem mass spectrometry, has facilitated the diagnosis and the differential diagnosis of disorders of pyrimidine metabolism. Inherited disorders remain rare. In a study of 450 children with nonspecific neurologic manifestations, such as seizures and delayed development, two were found to excrete elevated amounts of uracil and thymine and were diagnosed as having dihydropyrimidine dehydrogenase deficiency [1].
Pharmacotherapeutic considerations for elderly patients with colorectal cancer
Published in Expert Opinion on Pharmacotherapy, 2019
5-FU reports exclusively in the elderly are available in several evaluations, and infusional 5-FU is considered beneficial and generally well tolerated in the elderly [41,70,71]. We feel 5-FU is a safe option for most elderly patients with some considerations, as those with a significant cardiovascular history should have a cardiology clearance prior to therapy. Patients identified as frail should receive a dose reduction upfront, frequent AE monitoring, and consideration dihydropyrimidine dehydrogenase deficiency testing to avoid extreme toxicity. Capecitabine in the elderly shows similar efficacy with more dose-dependent AEs (diarrhea; hand-foot syndrome) particularly in those oldest in age and unfit [41,70]. We consider the same cautions with 5-FU for capecitabine elderly use but additionally recommend avoidance in patients on warfarin or who have poor renal function. These patients should be given 5-FU when a fluoropyrimidine is needed. Patients with complex medication lists (≥8–10 medications) or any cognitive decline that limit adherence should avoid capecitabine use given that an intravenous alternative exists and would eliminate these concerns.
Ectropion following topical 5-fluorouracil treatment
Published in Baylor University Medical Center Proceedings, 2023
Emma Villamaria, Nicole Dacy, Allie Preston, Chad Housewright
The package insert advises patients to use caution on ulcerated or inflamed skin. Avoidance of sun exposure is also recommended, as topical 5-fluorouracil can increase sensitivity to sunlight. Furthermore, if applied with the bare hands or gloves, the hands should be washed immediately following application. In addition, it should not be applied on the eyelids or directly into the eyes, nose, or mouth, as irritation will likely occur.7 Lastly, topical 5-fluoruracil should be used with caution in patients with dihydropyrimidine dehydrogenase deficiency, as these patients are at an increased risk of toxicity and reactions such as allergic contact dermatitis and inflammatory colitis.8
Long-term outcomes after bladder-preserving tri-modality therapy for patients with muscle-invasive bladder cancer
Published in Acta Oncologica, 2021
Emmanuelle Fabiano, Catherine Durdux, Bertrand Dufour, Arnaud Mejean, Nicolas Thiounn, Yves Chrétien, Jean-Emmanuel Bibault, Philippe Giraud, Sarah Kreps, Antoine Smulevici, Safia Maraadji, Martin Housset
There was no death related to chemoradiotherapy. Treatment was well tolerated even in older pts. Grade 3 or greater acute toxicities were exclusively hematologic. One patient had a severe life-threatening grade 4 hematologic toxicity, probably related to a dihydropyrimidine dehydrogenase deficiency.