5fu during infusion

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We have a new order that asks for 5FU to be given at 60 minutes after Irinotecan and LV has been running. It would be along with the 2 drugs. It is written as a modified ILV. Please respond soon if you have given it, thanks. I cant find anything about compatibility.

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We use Micromedex to check compatability (or we just call the hospital pharmacy.) Here's what Micromedex has to say about running the following meds on a Y-port:

Fluorouracil-Irinotecan hydrochloride: Not Tested

Fluorouracil-Leucovorin calcium: Compatible

Irinotecan hydrochloride-Leucovorin calcium: Not Tested

(5FU=Flourouracil)

In the hospital where I work, we are conservative, so if something is not tested, we assume it is incompatible (unless pharmacy gives us other info from a different source). So, to hang these three chemos at the same time, I would run my 5FU & LV (Leucovorin) together on one line, and I'd run my irinotecan in another line.

I also might ask the docs for a double or triple lumen PICC placement (especially if IV access was bad....) (And of course, if the person had a double-lumen port like many of our folks, I'd be all set.)

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Thanks so much for the reply. We also use Micromedix but feel it is not to up to date because it says it is not tested for LV and Irinotecan and they are run together all the time. We confirmed with the doc that yes indeed he did want the 5FU at one hour during the infusion of IRIN LV. We stopped it at one hr and gave the bolus thru the primary saline and then continued the pump with the rest. I just cant find any reasoning for the anywhere. Do you know why you would do this?

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I have no idea why it would be run that way-- I just haven't encountered it, sorry! Maybe it's something new. If you do find out why the chemo is administered that way, I'd love to hear, just for curiosity's sake.

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Leucovorin is given in these regimens to interact with the fluoruracil. Think of it as "conditioning the cells" or preparing them to make them more vulnerable to the fluorouracil by putting them into the most vulnerable stage of mitosis.

In some other regimens the fluorouracil is given in the middle of a two-hour leucovorin infusion.

On the compatability issue it is interesting to me that Micromedix now states they are compatible. I was trained that they are not compatable and there is a risk for precipitation.

David Finke, RN, OCN

Hennepin Comprehensive Cancer Center

Hennepin County Medical Center

Minneapolis, MN

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