fluorouracil
Fluorouracil (Efudex) topical is an antimetabolite. It's available as 5% topical cream and solution, and as 2% solution. Both strengths can treat actinic keratosis, a precancerous skin condition caused by exposure to ultraviolet (UV) light over time. But only fluorouracil 5% is approved to treat basal cell carcinoma, a type of skin cancer. Fluorouracil (Efudex) topical is applied directly on the affected area(s) twice daily for 2 to 6 weeks, depending on what condition you're being treated for. Side effects of this medication can include skin burning, crusting, and irritation.
What is Fluorouracil (Efudex) topical?
What is Fluorouracil (Efudex) topical used for?
- Actinic (or solar) keratosis (scaly pre-cancerous spot or growth on the skin) in adults
- Basal cell carcinoma (certain type of skin cancer) in adults
How Fluorouracil (Efudex) topical works
Fluorouracil (Efudex) topical is an antimetabolite. It works by getting in the way of cells making copies of their genetic material. When applied on pre-cancerous or cancerous skin cells, fluorouracil (Efudex) topical prevents them from being able to grow.
Drug facts
Side effects of Fluorouracil (Efudex) topical
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Crusting of the skin
- Stinging or burning feeling of the skin
- Itchiness
- Soreness on the skin
- Scarring
Less Common Side Effects
- Darkening of skin color
- Skin tenderness
- Open sores on skin
- Rash
- Swelling on the skin
- Blistering
Fluorouracil (Efudex) topical serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Rare toxicity reaction: Stomach pains, bloody diarrhea, vomiting, fever, chills, skin rash, painful sores in the mouth.
The following Fluorouracil (Efudex) topical side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Redness and swelling of normal skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Burning feeling where medicine is applied
increased sensitivity of skin to sunlight
oozing
skin rash
soreness or tenderness of skin
Less common or rare
Darkening of skin
scaling
watery eyes
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Fluorouracil (Efudex) topical
Pros
- Preferred treatment option for actinic keratoses
- Up to a 90% cure rate for people with basal cell carcinoma
- Treatment might last as short as 2-3 weeks, depending on your condition
Cons
- Can cause uncomfortable skin reactions
- Need to use twice daily
- Hasn't been studied in children
- Not safe to use during pregnancy
Pharmacist tips for Fluorouracil (Efudex) topical
- Fluorouracil (Efudex) topical should be applied on your skin. But try your best to avoid putting medication near sensitive areas, such as your eyes or mouth, and on damaged skin because doing so can cause skin irritation.
- Gently massage fluorouracil (Efudex) topical into your skin. It's best to apply the medication with a nonmetal applicator or surgical gloves. But if you use your fingers to apply fluorouracil (Efudex) topical, wash your hands immediately after so that you don't accidentally get this medication on other skin areas.
- If you use gloves or other tools to apply fluorouracil (Efudex) topical, make sure to either wash them thoroughly or throw them away in a place that's out of reach of children or pets. If this medication is accidentally eaten by children or pets, it can cause serious harm.
- Don't cover the area with a dressing or bandages, unless your provider has instructed you to do so. This can raise your risk of skin reactions on normal skin that's near your skin spot or growth.
- Fluorouracil (Efudex) topical shouldn't be used in pregnant females. Make sure to let your dermatologist know if you're pregnant before starting fluorouracil (Efudex) topical. They'll likely consider a different medication for you.
- It's not known if fluorouracil (Efudex) topical can get into breastmilk. Talk to your dermatologist about the risks and benefits of breastfeeding while using fluorouracil (Efudex) topical. They might recommend you use formula at least until you finish your treatment.
- Store fluorouracil (Efudex) topical at room temperature in a dry place. Don't freeze it, since this can damage the medication.
Common questions about Fluorouracil (Efudex) topical
How long it takes for fluorouracil (Efudex) topical to work can differ from person to person, depending on your condition. In general, this medication should start to work within 2 to 4 weeks for actinic keratosis. But you might not see complete healing until 1 to 2 months after your treatment ended. Fluorouracil (Efudex) topical can start to work within 3 to 6 weeks for basal cell carcinoma. But take up to 3 months before the sores on the skin are healed. Talk to your dermatologist if you're concerned with how well fluorouracil (Efudex) topical is working for you.
Your dermatologist will let you know when to stop using fluorouracil (Efudex) topical. If you're using fluorouracil (Efudex) topical for actinic keratosis, your dermatologist will ask you to continue treatment until the skin spots or growths reach the "erosion" stage, which is when the skin becomes painful and inflamed. It might take 2 to 4 weeks before you reach this stage. If you're prescribed fluorouracil (Efudex) topical for basal cell carcinoma, your dermatologist will ask you to use this medication until the spots on the skin are gone, which might take up to 3 months. Ask your dermatologist if you're not sure when you should stop using fluorouracil (Efudex) topical.
In clinical trials, people using fluorouracil (Efudex) topical didn't report tiredness as a side effect. Tiredness might be a side effect that's linked more to fluorouracil injection, instead of topical fluorouracil. If you're noticing fatigue or tiredness after starting fluorouracil (Efudex) topical and it's getting in the way of your daily activities, talk to your dermatologist or primary care provider so they can help you figure out what might be causing it.
Yes, fluorouracil (Efudex) topical can affect healthy skin. It's best to use a non-metal applicator or glove when applying fluorouracil (Efudex) topical only on the affected area(s), being careful to not touch the surrounding healthy skin. But if you need to use your fingers, make sure to wash your hands right away very well with soap and water after applying the cream.
Ask your dermatologist if you should apply bandages after fluorouracil (Efudex) topical treatment. In general, you should avoid putting bandages on areas where you've applied this medication. Doing so can cause your skin to absorb more fluorouracil, which can lead to more side effects, such as burning or rash. But if needed, your dermatologist might instruct you to cover the affected area with a porous and breathable gauze. Only use bandages made of materials approved by your dermatologist to prevent serious side effects.
Yes, fluorouracil (Efudex) topical can expire. There should be an expiration date that's written on the medication box or bottle. Don't use fluorouracil (Efudex) topical past the written expiration date because it might not work well to treat your skin problem.
Yes, fluorouracil (Efudex) topical can be considered a chemotherapy. Chemotherapy is a type of treatment that kills all fast-growing cells and is typically used to treat cancer. Fluorouracil (Efudex) topical can be used to treat basal cell carcinoma, which is a type of skin cancer.
Fluorouracil (Efudex) topical isn't FDA-approved for wrinkles. A small study suggests that this medication might help with wrinkles caused by sun damage, whereas other another study concludes that this medication doesn't improve the look of wrinkles. More research is needed to help us understand how fluorouracil (Efudex) topical might affect wrinkles.
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Risks and warnings for Fluorouracil (Efudex) topical
Fluorouracil (Efudex) topical can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Avoid sensitive skin areas
Don't apply fluorouracil (Efudex) topical to sensitive skin areas or near mucous membranes, such as near the eyes, mouth, or nose. Doing so raises the risk of skin damage in those areas.
Don't cover skin areas after application
Don't put bandages or dressing over areas where you just applied fluorouracil (Efudex) topical. Doing so will cause your skin to absorb more medication, which can lead to more skin-related side effects.
If needed, your skin care specialist might ask you to put a breathable, gauze dressing over it to protect the skin. But only do this if they told you it's safe to do so.
Sunburn
You can experience more serious skin reactions, such as painful peeling or blistering, if you're exposed to ultraviolet (UV) light while using fluorouracil (Efudex) topical. Avoid sun lamps and tanning beds during and immediately following treatment with fluorouracil (Efudex) topical. Also, try your best to stay out of the sun. If you need to be outside, ask your dermatologist about using sunscreen and wearing protective clothing (e.g., hats, long-sleeved shirts).
Harm to unborn baby
- Risk factors: Females of childbearing age
Fluorouracil (Efudex) topical can cause harm to an unborn baby, such as birth defects and miscarriage, if it's used during pregnancy. Let your dermatologist know if you're pregnant or plan to become pregnant while using fluorouracil (Efudex) topical.
Rare toxicity reaction
- Risk factors: Dihydropyrimidine dehydrogenase (DPD) deficiency
There has been one reported case of toxicity experienced by a person who used fluorouracil 5% topical cream. Symptoms included stomach pain, bloody diarrhea, vomiting, and fever. This person was found to have inflammation and sores in their month, stomach, and bowels.
This toxicity reaction is more common in people who don't have a enzyme called dihydropyrimidine dehydrogenase (DPD) in the body. Usualy, the DPD enzyme helps break down fluorouracil (Efudex) topical in your body. Without the enzyme, the medication can build up in your body, which can raise your risk of these side effects. If you have DPD deficiency, you can't use fluorouracil (Efudex) topical. Talk to your dermatologist about alternative treatments.
Fluorouracil (Efudex) topical dosage
Typical dosage for Fluorouracil (Efudex) topical
Actinic keratoses
- Fluorouracil 2% and 5%: Apply a thin layer to cover the skin spots or growths on the affected area(s) twice daily. The typical length of treatment is 2 to 4 weeks. But it can take 1 to 2 months after the end of treatment to notice complete healing of the skin. Basal cell carcinoma
- Fluorouracil 5% only: Apply a thin layer to cover the skin spots or growths on the affected area(s) twice daily. The typical length of treatment is 3 to 6 weeks, but can be extended to up to 3 months, if needed.
Interactions between Fluorouracil (Efudex) topical and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Brivudine
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Tegafur
- Varicella Virus Vaccine, Live
- Zoster Vaccine, Live
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acenocoumarol
- Adenovirus Vaccine
- Allopurinol
- Azanidazole
- Bacillus of Calmette and Guerin Vaccine, Live
- Benznidazole
- Cholera Vaccine, Live
- Cimetidine
- Dengue Tetravalent Vaccine, Live
- Influenza Virus Vaccine, Live
- Isoconazole
- Levoleucovorin
- Methotrexate
- Metronidazole
- Nimorazole
- Ornidazole
- Oxypurinol
- Phenprocoumon
- Poliovirus Vaccine, Live
- Secnidazole
- Smallpox Vaccine
- Tamoxifen
- Tinidazole
- Typhoid Vaccine, Live
- Warfarin
- Yellow Fever Vaccine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Fosphenytoin
- Leucovorin
- Levamisole
- Phenytoin
- Thiamine
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Fluorouracil (Efudex) topical contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Fluorouracil (Efudex) topical will not be safe for you to take.
- Currently pregnant
- Dihydropyrimidine dehydrogenase (DPD) deficiency
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