Fluorouracil Injection Shortage

• • Accord did not provide a reason for the shortage.
  • Fresenius Kabi did not provide a reason for the shortage.
  • Sagent had fluorouracil injection on shortage due to increased demand.
  • Teva Adrucil injection available.

• • Fluorouracil injection, Accord, 50 mg/mL, 10 mL vial, 10 count, NDC 16729-0276-68
  • Fluorouracil injection, Accord, 50 mg/mL, 100 mL vial, 1 count, NDC 16729-0276-38
  • Fluorouracil injection, Accord, 50 mg/mL, 20 mL vial, 10 count, NDC 16729-0276-67
  • Fluorouracil injection, Accord, 50 mg/mL, 50 mL vial, 1 count, NDC 16729-0276-11
  • Fluorouracil injection, Fresenius Kabi, 50 mg/mL, 10 mL vial, 10 count, NDC 63323-0117-10
  • Fluorouracil injection, Fresenius Kabi, 50 mg/mL, 100 mL vial, 1 count, NDC 63323-0117-61
  • Fluorouracil injection, Fresenius Kabi, 50 mg/mL, 20 mL vial, 10 count, NDC 63323-0117-20
  • Fluorouracil injection, Fresenius Kabi, 50 mg/mL, 50 mL vial, 1 count, NDC 63323-0117-51
  • Fluorouracil injection, Sagent, 50 mg/mL, 100 mL vial, 1 count, NDC 25021-1215-99
  • Fluorouracil injection, Sagent, 50 mg/mL, 50 mL vial, 1 count, NDC 25021-1215-98
  • Fluorouracil injection, Teva, 50 mg/mL, 10 mL vial, 10 count, NDC 00703-3015-13
  • Fluorouracil injection, Teva, 50 mg/mL, 100 mL vial, 5 count, NDC 00703-3019-12
  • Fluorouracil injection, Teva, 50 mg/mL, 50 mL vial, 5 count, NDC 00703-3018-12

Implications for Patient Care

• • Fluorouracil is an antimetabolite antineoplastic agent. Fluorouracil is labeled for the palliative management of breast, colon, rectal, pancreatic, and stomach cancers.[1-3]
  • Fluorouracil is used off-label for a variety of neoplastic diseases including ovarian, cervical, bladder, hepatic, prostate, endometrial, esophageal, head and neck, penile, and thymic cancers. It is also used off-label for the treatment of renal cell carcinoma and carcinoid tumors.[1-3]
  • Refer to national guidelines such as those from the National Comprehensive Cancer Network (www.nccn.org) or American Society of Clinical Oncology (www.asco.org) for additional information regarding therapeutic use.

Safety

• • Chemotherapy agents, such as fluorouracil, pose additional safety risks both for patients and for healthcare workers handling these agents.[1-3]
  • Use additional caution when processing orders for chemotherapy drugs, especially when switching between chemotherapy agents or when processing orders for chemotherapy agents with which staff may be unfamiliar (eg, those not normally prescribed at a specific institution).[1-3]

Alternative Agents & Management

• • The choice of an alternative agent must be patient-specific and based on renal function, liver function, and the neoplasm type and location. No single agent can be substituted for fluorouracil.[1-3]
  • Consider evaluating the health-care system's total supply of fluorouracil before beginning patients on combination chemotherapy regimens containing fluorouracil. If adequate supplies are not available, select an alternative regimen.
  • Consult a Hematology/Oncology specialist for patient- and neoplasm-specific recommendations.
  • Refer to the ASHP Guidelines on Managing Drug Product Shortages for more guidance on developing a multidisciplinary plan when the supply must be allocated. http://www.ashp.org/DocLibrary/Policy/DrugShortages/ASHP_shortage_guide09.pdf

References

• 1. Antineoplastic agents. In: McEvoy GK, ed. AHFS 2017 Drug Information. Bethesda, MD: American Society of Health-Systems Pharmacists; 2017: 926-1421.
  2. Drug Facts and Comparisons Online. St. Louis, MO: Wolters Kluwer Health Inc. (http://online.factsandcomparisons.com/index.aspx). February 2018.
  3. Lexi-Drugs Online. Lexi-Comp, Inc.; 2018.