Identification
Name Floxuridine
Accession Number DB00322 (APRD00692)
Type small molecule
Description An antineoplastic antimetabolite that is metabolized to fluorouracil when administered by rapid injection. Floxuridine is available as a sterile, nonpyrogenic, lyophilized powder for reconstitution. When administered by slow, continuous, intra-arterial infusion, it is converted to floxuridine monophosphate. It has been used to treat hepatic metastases of gastrointestinal adenocarcinomas and for palliation in malignant neoplasms of the liver and gastrointestinal tract. [PubChem]
Structure
Categories (*)
Molecular Weight 246.1924
Groups approved
Monoisotopic Weight 246.065199677
Pharmacology
Indication For palliative management of gastrointestinal adenocarcinoma metastatic to the liver, when given by continuous regional intra-arterial infusion in carefully selected patients who are considered incurable by surgery or other means. Also for the palliative management of liver cancer (usually administered by hepatic intra-arterial infusion).
Mechanism of action Floxuridine is rapidly catabolized to 5-fluorouracil, which is the active form of the drug. The primary effect is interference with DNA synthesis and to a lesser extent, inhibition of RNA formation through the drug's incorporation into RNA, thus leading to the production of fraudulent RNA. Fluorouracil also inhibits uracil riboside phophorylase, which prevents the utilization of preformed uracil in RNA synthesis. As well, the monophosphate of floxuridine, 5-fluoro-2'-deoxyuridine-5'-phosphate (FUDR-MP) inhibits the enzyme thymidylate synthetase. This leads to the inhibition of methylation of deoxyuridylic acid to thymidylic acid, thus interfering with DNA synthesis.
Absorption Not Available
Protein binding Not Available
Biotransformation Hepatic.
Route of elimination The drug is excreted intact and as urea, fluorouracil, a-fluoro-bureidopropionic acid, dihydrofluorouracil, a-fluoro-b-guanidopropionic acid and a-fluoro-b-alanine in the urine; it is also expired as respiratory carbon dioxide.
Toxicity Oral, rat LD50: 215 mg/kg. Signs of overdose include nausea, vomiting, diarrhea, gastrointestinal ulceration and bleeding, and bone marrow depression (including thrombocytopenia, leukopenia and agranulocytosis).
Affected organisms
  • Humans and other mammals
Interactions
Drug Interactions
Drug Mechanism of interaction
Tamoxifen Floxuridine may reduce clearance rate of Tamoxifen. Monitor for changes in therapeutic/adverse effects of Tamoxifen if Floxiridine is initiated, discontinued or dose changed.
Tolbutamide Floxuridine, a strong CYP2C9 inhibitor, may decrease the metabolism and clearance of Tolbutamide, a CYP2C9 substrate. Consider alternate therapy or monitor for changes in Tolbutamide therapeutic and adverse effects if Floxuridine is initiated, discontinued or dose changed.
Torasemide Floxuridine, a strong CYP2C9 inhibitor, may increase the serum concentration of Torasemide, a CYP2C9 substrate, by decreasing Torasemide metabolism and clearance. Consider alternate therapy or monitor for changes in the therapeutic and adverse effects of Torasemide if Floxuridine is initiated, discontinued or dose changed.
Trastuzumab Trastuzumab may increase the risk of neutropenia and anemia. Monitor closely for signs and symptoms of adverse events.
Trimethoprim The strong CYP2C9 inhibitor, Floxuridine, may decrease the metabolism and clearance of Trimethoprim, a CYP2C9 substrate. Consider alternate therapy or monitor for changes in therapeutic and adverse effects of Trimethoprim if Floxuridine is initiated, discontinued or dose changed.
Voriconazole Floxuridine, a strong CYP2C9 inhibitor, may increase the serum concentration of voriconazole by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of voriconazole if floxuridine is initiated, discontinued or dose changed.
Warfarin Floxuridine, a strong CYP2C9 inhibitor, may decrease the metabolism of warfarin. Consider alternate therapy or monitor for changes in the therapeutic and adverse effects of warfarin if floxuridine is initiated, discontinued or dose changed.
Zafirlukast Floxuridine, a strong CYP2C9 inhibitor, may decrease the metabolism and clearance of zafirlukast. Consider alternate therapy or monitor for changes in zafirlukast therapeutic and adverse effects if floxuridine is initiated, discontinued or dose changed.
Food Interactions Not Available
Thymidylate synthase
Name Thymidylate synthase
Gene Name TYMS
Pharmacological action yes
Actions Not Available
References
  • Ferguson PJ, Collins O, Dean NM, DeMoor J, Li CS, Vincent MD, Koropatnick J: Antisense down-regulation of thymidylate synthase to suppress growth and enhance cytotoxicity of 5-FUdR, 5-FU and Tomudex in HeLa cells. Br J Pharmacol. 1999 Aug;127(8):1777-86. - Pubmed
  • Kubota T: [Theoretical basis for low-dose CDDP/5-FU therapy] Gan To Kagaku Ryoho. 1999 Oct;26(11):1536-41. - Pubmed
  • Kuwa K, Sakamoto S, Sassa S, Yoshimura S, Maemura M, Nakayama T: Effects of long-term administration of UFT plus leucovorin on colorectal tumors induced with 1,2-dimethylhydrazine in rats. Anticancer Res. 1999 Nov-Dec;19(6B):5139-42. - Pubmed
  • Kuwa K, Sakamoto S, Mitamura T, Kudo H, Suzuki S, Fukushima M: Effects of a low dose leucovorin with 5-fluorouracil derivative on colorectal tumors induced with 1,2-dimethylhydrazine in rats. Anticancer Res. 1999 Nov-Dec;19(6B):5143-8. - Pubmed
  • Murakami Y, Kazuno H, Emura T, Tsujimoto H, Suzuki N, Fukushima M: Different mechanisms of acquired resistance to fluorinated pyrimidines in human colorectal cancer cells. Int J Oncol. 2000 Aug;17(2):277-83. - Pubmed
DTHybrid score 0.7329
Thymidine phosphorylase
Name Thymidine phosphorylase
Gene Name TYMP
Actions substrate
References
  • BIRNIE GD, KROEGER H, HEIDELBERGER C: STUDIES OF FLUORINATED PYRIMIDINES. XVIII. THE DEGRADATION OF 5-FLUORO-2'-DEOXYURIDINE AND RELATED COMPOUNDS BY NUCLEOSIDE PHOSPHORYLASE. Biochemistry. 1963 May-Jun;2:566-72. - Pubmed
  • Tsume Y, Hilfinger JM, Amidon GL: Enhanced cancer cell growth inhibition by dipeptide prodrugs of floxuridine: increased transporter affinity and metabolic stability. Mol Pharm. 2008 Sep-Oct;5(5):717-27. doi: 10.1021/mp800008c. Epub 2008 Jul 25. - Pubmed
DTHybrid score 0.709
Id Partner name Gene Name Score
24 Thymidylate synthase TMP1 0.7329
2626 Thymidylate synthase thyA 0.7329
2729 Thymidylate synthase thyA 0.7329
5352 Thymidylate synthase THYA 0.7329
3639 Thymidine phosphorylase deoA 0.709
2320 Thymidine kinase, cytosolic TK1 0.0818
338 DNA polymerase UL30 0.0801
379 DNA polymerase UL54 0.0801
697 DNA polymerase ORF28 0.0801
2482 DNA polymerase 43 0.0801
4104 DNA polymerase BALF5 0.0801
773 Folylpolyglutamate synthase, mitochondrial FPGS 0.0745
1729 Solute carrier family 22 member 6 SLC22A6 0.0706
1302 Dihydropyrimidine dehydrogenase [NADP+] DPYD 0.0617
3611 Cytidine deaminase cdd 0.061
3707 Cytidine deaminase cdd 0.061
4211 Cytidine deaminase CDA 0.061
365 Dihydrofolate reductase DHFR 0.0441
2381 Dihydrofolate reductase DFR1 0.0441
2833 Dihydrofolate reductase Not Available 0.0441
2931 Dihydrofolate reductase folA 0.0441
3544 Dihydrofolate reductase folA 0.0441
3682 Dihydrofolate reductase folA 0.0441
6642 Dihydrofolate reductase folA 0.0441
6756 Dihydrofolate reductase dfrA 0.0441
4604 Liver carboxylesterase 1 CES1 0.0339
2222 Equilibrative nucleoside transporter 1 SLC29A1 0.0332
4757 Cytochrome P450 2C9 CYP2C9 0.0319
1709 Canalicular multispecific organic anion transporter 2 ABCC3 0.0258
2164 Multidrug resistance-associated protein 4 ABCC4 0.0242
4226 Uridine phosphorylase 2 UPP2 0.0237
4225 Uridine phosphorylase 1 UPP1 0.0213
4773 Deoxycytidine kinase DCK 0.0196
413 Amidophosphoribosyltransferase PPAT 0.0186
2515 Amidophosphoribosyltransferase purF 0.0186
3714 Amidophosphoribosyltransferase purF 0.0186
1043 Trifunctional purine biosynthetic protein adenosine-3 [Includes: Phosphoribosylamine--glycine ligase GART 0.0165
2287 Bifunctional purine biosynthesis protein PURH [Includes: Phosphoribosylaminoimidazolecarboxamide formyltransferase ATIC 0.0163
3917 Methylenetetrahydrofolate reductase MTHFR 0.0154
243 Ribosyldihydronicotinamide dehydrogenase [quinone] NQO2 0.0145
4924 Cytochrome P450 2C8 CYP2C8 0.0133
2567 Thymidylate synthase thyX thyX 0.0128
4275 PCZA361.16 Not Available 0.0128
4276 DNA polymerase III subunit epsilon dnaQ 0.0128
2410 Deoxyuridine 5'-triphosphate nucleotidohydrolase dut 0.0127
2490 Deoxyuridine 5'-triphosphate nucleotidohydrolase dut 0.0127
1735 Canalicular multispecific organic anion transporter 1 ABCC2 0.0125
6136 Multidrug resistance-associated protein 5 ABCC5 0.0118
6143 Solute carrier family 22 member 7 SLC22A7 0.0115
2555 Pol polyprotein pol 0.0114
3242 Pol polyprotein gag-pol 0.0114
3471 Pol polyprotein gag-pro-pol 0.0114
5256 Pol polyprotein pol 0.0114
6469 Pol polyprotein gag-pol 0.0114
6565 Pol polyprotein Not Available 0.0114
1353 DNA topoisomerase 1 TOP1 0.0114
3552 DNA topoisomerase 1 topA 0.0114
1588 Multidrug resistance protein 1 ABCB1 0.0107
1732 ATP-binding cassette sub-family G member 2 ABCG2 0.0099
2251 Thymidylate kinase tmk 0.0098
2254 Thymidylate kinase DTYMK 0.0098
3522 Thymidylate kinase tmk 0.0098
702 UMP-CMP kinase CMPK1 0.0098
3478 Glucose-1-phosphate thymidylyltransferase rmlA 0.0097
4277 Glucose-1-phosphate thymidylyltransferase rmlA 0.0097
587 Serum albumin ALB 0.009
6148 Multidrug resistance-associated protein 7 ABCC10 0.0088
360 Ribonucleoside-diphosphate reductase large subunit RRM1 0.0087
5718 Cytochrome P450 2A6 CYP2A6 0.0086
6171 Solute carrier family 28 member 3 SLC28A3 0.0085
509 Thymidine kinase TK 0.0085
570 Thymidine kinase TK 0.0085
2559 Thymidine kinase TK 0.0085
3430 Thymidine kinase tdk 0.0085
3518 Thymidine kinase TK 0.0085
5301 Thymidine kinase tdk 0.0085
5771 Thymidine kinase ORF36 0.0085
7009 Thymidine kinase ORF36 0.0085
5691 DTDP-4-DEHYDRORHAMNOSE 3,5-EPIMERASE RMLC rmlC 0.0084
3361 Serpin B5 SERPINB5 0.0084
5694 Transcription antiterminator licT licT 0.0084
4200 Cytochrome P450 1A2 CYP1A2 0.0068
56 Delta-aminolevulinic acid dehydratase ALAD 0.0067
2356 Delta-aminolevulinic acid dehydratase hemB 0.0067
3613 Delta-aminolevulinic acid dehydratase hemB 0.0067
3674 Delta-aminolevulinic acid dehydratase hemB 0.0067
2286 Isocitrate dehydrogenase [NADP] icd 0.0063
2302 Isocitrate dehydrogenase [NADP] icd 0.0063
2771 Isocitrate dehydrogenase [NADP] icd 0.0063
4534 Cytohesin-2 CYTH2 0.0061
3668 Maltose-binding periplasmic protein precursor malE 0.0059
5692 Calcium/calmodulin-dependent 3',5'-cyclic nucleotide phosphodiesterase 1B PDE1B 0.0054
2592 Beta-galactosidase lacZ 0.0053
4512 Cytochrome P450 3A4 CYP3A4 0.005
315 Arginase-1 ARG1 0.005
2347 Proto-oncogene serine/threonine-protein kinase Pim-1 PIM1 0.0046
541 cAMP-specific 3',5'-cyclic phosphodiesterase 4B PDE4B 0.004
6263 cAMP-dependent protein kinase catalytic subunit alpha PRKACA 0.004
5818 Folate receptor alpha FOLR1 0.0037
293 Gamma-glutamyl hydrolase GGH 0.0032
1650 Heme carrier protein 1 SLC46A1 0.0029
6155 ATP-binding cassette transporter sub-family C member 11 ABCC11 0.0025
6040 6-phosphogluconate dehydrogenase, decarboxylating PGD 0.0023
6160 Solute carrier organic anion transporter family member 3A1 SLCO3A1 0.0023
6150 Solute carrier organic anion transporter family member 4C1 SLCO4C1 0.0022
6020 Aldehyde oxidase AOX1 0.0021
6158 Solute carrier organic anion transporter family member 1C1 SLCO1C1 0.002
738 Monocarboxylate transporter 1 SLC16A1 0.002
6157 Solute carrier organic anion transporter family member 1B3 SLCO1B3 0.0018
1024 Solute carrier family 22 member 11 SLC22A11 0.0017
862 Multidrug resistance-associated protein 1 ABCC1 0.0016
1490 Solute carrier organic anion transporter family member 1B1 SLCO1B1 0.0016
6139 Solute carrier organic anion transporter family member 1A2 SLCO1A2 0.0015
6142 Solute carrier family 22 member 8 SLC22A8 0.0015