CriticalAntiviral, nucleoside analogue×Antineoplastic, pyrimidine analogue (5-FU)
Updated · Methodology
Mechanism
Brivudine irreversibly inhibits dihydropyrimidine dehydrogenase (DPD) – the enzyme degrading 5-FU. After 5-FU, toxicity escalates manifold: myelosuppression, severe mucositis, neurotoxicity. EMA 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.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
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Sources
- AEMPS: Ficha tecnica de Brivudina (2023)– AEMPS CIMA, 2023