GI  adrenocarcenoma metastatic to the liver

Most common adverse reaction-
diarrhea, enteritis, localized erythema, nausea, stomatitis and vomiting.

Cardiovascular - Myocardial ischema

CNS - lerthargy, malaise, weakness

Dermatologic - alopecia, dermatitis, nonspecific skin toxicity, rash

GI -  abnormal pain, acalcuous cholecytitis, anorexia, bleeding, cramps, duodenal ulcer,
        duodenitis, gastritis, gastroenteritis,glossitis, pharyngitis, and possible intra- and
        extrahepatic biliary sclerosis

Lab test abnormalites-  bromosulphthalein, prothrombin, sedmentation rate, thrombopenia,    total proteins 

Local - abscees, arterial aneurysm, arterial ischemia, bleeding at catheter site, cather blocked,  displaced or leaking

Poor nutritional state, depressed bone marrow function, potentially  serioous infections.

Special Precautions/Warnings-

First course of therapy- due to possibliy of severe toxic reactions, hospitalize all patients
for the first course of therapy

Combination therapy - any form of therapy that adds stress to the patient, interferes with nutriotion or depress bone marrow will  increase the toxicity to floxurdine

Renal  function impairment  - use floxurdine with extreme caution in patients with impaired hepatic or renal function.

Special risk - use floxurdine with extreme  caution in poor risk patients with a history of high
dose pelvic irradiation or previous use of  alkylating agents

Discontinuation of therapy- therapy to be discontinued when first signs of toxicity appears

 Myocardial ischema,
 Stomatis or esophagopharyngitis
 Leukopenia WBC count under 3500 or rapidly falling blood count
 Vomiting
 Diarrhea, frequent bowel movement
 GIulceration
 Thrombocytopenia

Pregnancy- advice women of child bearing age to avoid becoming pregnant

Lactation- advice mothers not to breast feed while receiving the drug

Children- safety and efficacy in children has not been established 

Monitoring - careful monitoring of WBC and platelet count is recommended
 Haemorrhage from any site

Indication-

GI  adrenocarcenoma metastatic to the liver

Dosage-
the recommended therapeutic dose scheduleof floxrudine by continous arterial infusion is
0.1 to 0.6mg/kg/day .
Higher dose ranges from 0.4 to 0.6mg/kg/day  are usually employed for hepatic artery infusion
because the liver metabolizes the drug, thus reducing the potential for systemic toxicity.

Reconstituton- each vial must be reconstituted with 5ml of sterile water for injection to yield
a solution containing approx 100mg/ml of floxurdine

.

Pregnancy-
Advice women of child bearing age to avoid becoming pregnant

Lactation-
Advice mothers not to breast feed while receiving the drug

Children-
Safety and efficacy in children has not been established