Antiviral, nucleoside analogue
Brand names: Zostex
Updated · Methodology
First line
Brivudine is -approved for herpes zoster in immunocompetent adults. Comparative trials show it more effective than aciclovir for pain resolution. Once-daily for 7 days. Main limitation – strict incompatibility with 5-FU/capecitabine: 4-week washout required between brivudine and chemotherapy start.
ICD-10: J00 · ICD-11: CA00
In cells infected by herpes simplex and varicella zoster, activated to triphosphate by viral thymidine kinase. Active metabolite competes with dGTP for viral DNA polymerase and incorporates into viral DNA, terminating its synthesis. The main clinically dangerous effect: the main metabolite (bromovinyluracil) irreversibly inhibits dihydropyrimidine dehydrogenase (DPD) for 18+ days – strictly contraindicated with 5-FU/capecitabine.
Limited data. EMA recommends avoiding in pregnancy.
Breastfeeding not recommended.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
2 pairs found. Sorted from critical to minor.
Mechanism
Capecitabine is a 5-FU prodrug, same fatal mechanism via brivudine DPD inhibition.
Symptoms
Severe myelosuppression, grade III hand-foot syndrome, mucositis, diarrhoea.
Management
Combination contraindicated. Minimum 4-week washout.
Mechanism
Brivudine irreversibly inhibits dihydropyrimidine dehydrogenase (DPD) – the enzyme degrading 5-FU. After 5-FU, toxicity escalates manifold: myelosuppression, severe mucositis, neurotoxicity. reported fatal cases. Effect persists 18+ days after brivudine withdrawal – 4-week washout required.
Symptoms
Severe myelosuppression with agranulocytosis, mucositis, diarrhoea, neurological disturbance within 5-10 days.
Management
Combination contraindicated. At least 4 weeks between brivudine and starting 5-FU/capecitabine. After accidental co-administration – uridine triacetate (Vistogard) within 96 hours as antidote.
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Brivudine is evaluated for the following indications with varying evidence strength: Common cold (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Brivudine (≥ 1 in 100): Nausea, Headache, Drowsiness. See the Safety section for uncommon and serious reactions.
Limited data. EMA recommends avoiding in pregnancy.
Breastfeeding not recommended.
Brivudine is contraindicated in: Combination with 5-FU, capecitabine, tegafur (FATAL DPD inhibition); Use within 4 weeks before starting or after stopping 5-FU-based chemotherapy; Immunodeficiency (including HIV); Pregnancy. Full list in the Safety section.
Darunavir, Efavirenz, Entecavir, Famciclovir, Kagocel, Ritonavir, Valacyclovir, Inosine pranobex