Drug Facts
Composition & Profile
Identifiers & Packaging
HOW SUPPLIED Flucytosine Capsules USP, 250 mg are size 2 hard gelatin capsule with blue opaque cap and grey opaque body imprinted with "NL771" on the cap with black ink and "250" on the body with red ink filled with white to off white powder. Bottles of 30 (NDC 43386-771-03) Bottles of 100 (NDC 43386-771-01). Flucytosine Capsules USP, 500 mg are size 0 hard gelatin capsule with grey opaque cap and white opaque body imprinted "NL770" on the cap with black ink and "500" on the body with red ink, filled with white to off white powder. Bottles of 30 (NDC 43386-770-03) Bottles of 100 (NDC 43386-770-01). Store at 25°C (77°F); excursions permitted to 15°C - 30°C (59°F - 86°F). LUPIN and the are registered trademarks of Lupin Pharmaceuticals, Inc. Manufactured by: Novel Laboratories, Inc. Somerset, NJ 08873 Manufactured for: Lupin Pharmaceuticals, Inc. Naples, FL 34108 SAP code: 276392 Rev: 10/2024 Image; PACKAGE LABEL.PRINCIPAL DISPLAY PANEL Flucytosine Capsules USP, 250 mg 30 Capsules Flucytosine Capsules USP, 500 mg 100 Capsules 250-30 500-100
- HOW SUPPLIED Flucytosine Capsules USP, 250 mg are size 2 hard gelatin capsule with blue opaque cap and grey opaque body imprinted with "NL771" on the cap with black ink and "250" on the body with red ink filled with white to off white powder. Bottles of 30 (NDC 43386-771-03) Bottles of 100 (NDC 43386-771-01). Flucytosine Capsules USP, 500 mg are size 0 hard gelatin capsule with grey opaque cap and white opaque body imprinted "NL770" on the cap with black ink and "500" on the body with red ink, filled with white to off white powder. Bottles of 30 (NDC 43386-770-03) Bottles of 100 (NDC 43386-770-01). Store at 25°C (77°F); excursions permitted to 15°C - 30°C (59°F - 86°F). LUPIN and the are registered trademarks of Lupin Pharmaceuticals, Inc. Manufactured by: Novel Laboratories, Inc. Somerset, NJ 08873 Manufactured for: Lupin Pharmaceuticals, Inc. Naples, FL 34108 SAP code: 276392 Rev: 10/2024 Image
- PACKAGE LABEL.PRINCIPAL DISPLAY PANEL Flucytosine Capsules USP, 250 mg 30 Capsules Flucytosine Capsules USP, 500 mg 100 Capsules 250-30 500-100
Overview
Flucytosine Capsules USP, an antifungal agent, is available as 250 mg and 500 mg capsules for oral administration. In addition to the active ingredient of flucytosine, each capsule contains lactose monohydrate, colloidal silicon dioxide, talc, sodium starch glycolate, magnesium stearate and hard gelatin capsule shell which contains gelatin, purified water, black iron oxide, FD&C Blue No.1, titanium dioxide and sodium lauryl sulfate for 250 mg strength; gelatin, purified water, black iron oxide and titanium dioxide for 500 mg strength. The imprinting ink contains black iron oxide, shellac, potassium hydroxide, titanium dioxide, povidone, sodium hydroxide and FD &C Red No. 40 aluminum lake for 250 mg and 500 mg strengths. Chemically, flucytosine is 5-fluorocytosine, a fluorinated pyrimidine which is related to fluorouracil and floxuridine. It is a white or almost white, crystalline powder with a molecular weight of 129.09 and the following structural formula: Click to Zoom In
Indications & Usage
Flucytosine Capsules USP is indicated only in the treatment of serious infections caused by susceptible strains of Candida and/or Cryptococcus . Candida: Septicemia, endocarditis and urinary system infections have been effectively treated with flucytosine. Limited trials in pulmonary infections justify the use of flucytosine. Cryptococcus: Meningitis and pulmonary infections have been treated effectively. Studies in septicemias and urinary tract infections are limited, but good responses have been reported. Flucytosine Capsules USP should be used in combination with amphotericin B for the treatment of systemic candidiasis and cryptococcosis because of the emergence of resistance to Flucytosine Capsules USP (See MICROBIOLOGY ).
Dosage & Administration
The usual dosage of Flucytosine Capsules USP is 50 to 150 mg/kg/day administered in divided doses at 6-hour intervals. Nausea or vomiting may be reduced or avoided if the capsules are given a few at a time over a 15-minute period. If the BUN or the serum creatinine is elevated, or if there are other signs of renal impairment, the initial dose should be at the lower level (see WARNINGS ). Flucytosine Capsules USP should be used in combination with amphotericin B for the treatment of systemic candidiasis and cryptococcosis because of the emergence of resistance to Flucytosine Capsules USP (See MICROBIOLOGY ).
Warnings & Precautions
WARNINGS Flucytosine Capsules USP must be given with extreme caution to patients with impaired renal function. Since Flucytosine Capsules USP is excreted primarily by the kidneys, renal impairment may lead to accumulation of the drug. Flucytosine Capsules USP serum concentrations should be monitored to determine the adequacy of renal excretion in such patients. Dosage adjustments should be made in patients with renal insufficiency to prevent progressive accumulation of active drug. Flucytosine Capsules USP must be given with extreme caution to patients with bone marrow depression. Patients may be more prone to depression of bone marrow function if they: 1) have a hematologic disease, 2) are being treated with radiation or drugs which depress bone marrow, or 3) have a history of treatment with such drugs or radiation. Bone marrow toxicity can be irreversible and may lead to death in immunosuppressed patients. Frequent monitoring of hepatic function and of the hematopoietic system is indicated during therapy. 5-Fluorouracil is a metabolite of flucytosine. Dihydropyrimidine dehydrogenase is a key enzyme involved in the metabolism and elimination of 5-fluorouracil. Therefore, the risk of severe drug toxicity is increased when Flucytosine Capsules, USP is used in individuals with deficiency in DPD. Possible drug toxicities include mucositis, diarrhea, neutropenia, and neurotoxicity. Determination of DPD activity may be considered where drug toxicity is confirmed or suspected. In the event of suspected drug toxicity, consider stopping Flucytosine Capsules USP, treatment.
Boxed Warning
Use with extreme caution in patients with impaired renal function. Close monitoring of hematologic, renal and hepatic status of all patients is essential. These instructions should be thoroughly reviewed before administration of Flucytosine Capsules USP.
Contraindications
Flucytosine Capsules, USP is contraindicated in patients with a known hypersensitivity to the drug. Flucytosine Capsules, USP is contraindicated in patients with known complete dihydropyrimidine dehydrogenase (DPD) enzyme deficiency (see WARNINGS ).
Adverse Reactions
The adverse reactions which have occurred during treatment with Flucytosine Capsules USP are grouped according to organ system affected. Cardiovascular: Cardiac arrest, myocardial toxicity, ventricular dysfunction. Respiratory: Respiratory arrest, chest pain, dyspnea. Dermatologic: Rash, pruritus, urticaria, photosensitivity. Gastrointestinal: Nausea, emesis, abdominal pain, diarrhea, anorexia, dry mouth, duodenal ulcer, gastrointestinal hemorrhage, acute hepatic injury including hepatic necrosis with possible fatal outcome in debilitated patients, hepatic dysfunction, jaundice, ulcerative colitis, enterocolitis, bilirubin elevation, increased hepatic enzymes. Genitourinary: Azotemia, creatinine and BUN elevation, crystalluria, renal failure. Hematologic: Anemia, agranulocytosis, aplastic anemia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, and fatal cases of bone marrow aplasia. Neurologic: Ataxia, hearing loss, headache, paresthesia, parkinsonism, peripheral neuropathy, pyrexia, vertigo, sedation, convulsions. Psychiatric: Confusion, hallucinations, psychosis. Miscellaneous: Fatigue, hypoglycemia, hypokalemia, weakness, allergic reactions, Lyell's syndrome. To report SUSPECTED ADVERSE REACTIONS, contact Lupin Pharmaceuticals, Inc. at 1-866-403-7592 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Drug Interactions
Cytosine arabinoside, a cytostatic agent, has been reported to inactivate the antifungal activity of Flucytosine Capsules USP by competitive inhibition. Drugs which impair glomerular filtration may prolong the biological half-life of flucytosine.
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