Synonymous with 5-FU, adrucil, carzonal,
efudez, fluoroblastin and others1, fluorouracil
is a hazardous drug belongs to the general
group known as antimetabolites and is used
to treat several types of cancer, including
colon, head and neck cancers.2
This chemotherapy agent has been used
for about 40 years. Fluorouracil works by preventing
cells from making DNA and RNA by
interfering with the synthesis of nucleic acids,
thus disrupting the growth of cancer cells. It
is typically administered intravenously by
short or continuous infusions, or by the intravenous
push method. It is also given topically
to treat superficial basal cell carcinoma, keratosis,
psoriasis and viral warts.3
Side effects to patients taking this medication
include sore mouth and taste change,
diarrhea, gritty eyes and blurred vision, blood
in urine or feces, hair loss, lowered resistance
to infection, leukopenia, and infertility in
both men and women.4 Some effects do not
occur until months or years after treatment.
The International Agency for Research on
Cancer has classified fluorouracil as a Group
3 agent defined as, “Not classifiable as to
carcinogenicity to humans.”5 It is classified
between Group 2B “possibly carcinogenic”
and Group 4 “probably not carcinogenic.” The
National Institute for Occupational Safety
and Health has included it on its list of hazardous
drugs.6
Although the long-term affects from
chronic exposures to this chemical in the
workplace are somewhat undocumented due
to the hazardous nature of the drug, several
workplace precautions are recommended.
Procedures for the safe use, storage, handling
and disposal of fluorouracil should be written
and followed. Workers should avoid all direct
contact with the chemical and wear protective
gloves, lab coats and face shields. Treatment
rooms should have adequate ventilation and
workers should follow good housekeeping
practices. Any spills or personal contaminations
should be cleaned up immediately.
As the health effects to an embryo or fetus
could be potentially most drastic due to the
mode of operation of the chemical on living
tissue, serious consideration should be given
to whether a pregnant worker or those trying
to conceive should work with this drug. At a
minimum, workplace controls should be in
place and followed closely and environmental
monitoring should be considered.
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References:
- Safety MSDS for 5 fluorouracil, http://ptcl.chem.ox.ac.uk/MSDS/FL/5-fluorouracil.html
- ACS: Cancer Drug Guide: fluorouracil, www.cancer.org/
docroot/cdg/content/cdg_fluorouracil.asp
- DermNet NZ, www.dermnetnz.org/treatments/5-fluorouracil.html
- Cancerbackup, www.cancerbackup.org
- International Agency for Research on Cancer, Agents
Reviewed by the IARC Monographs, http://monographs.iarc.fr/ENG/Classification/ListagentsCASnos.pdf
- NIOSH, Department of Health and Human Services, Centers
for Disease Control, National Institute of Occupational
Health and Safety, NIOSH Alert: Preventing occupational
exposures to antineoplastic and other hazardous drugs in
health care settings (September 2004) DHHS (NIOSH)
publication number 2004-165
