Drug General Information (ID: DDI1I2MR59)
Drug Name			Fluorouracil		Drug Info		Levomefolic acid		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Immunosuppressive Agents				Folate Supplements
Structure

Mechanism of Fluorouracil-Levomefolic acid Interaction (Severity Level: Major)
Potentiated the pharmacological effects (Unspecific) Click to Show/Hide Mechanism Graph
Drug Name		Fluorouracil				Levomefolic acid
Mechanism		5-Fluorouracil derivative				Potentiate the pharmacologic effects of 5-fluorouracil
Key Mechanism Factor 1
		Factor Name		Pharmacodynamics
		Factor Description		Enhanced pharmacological effects leading to increased adverse reactions.
Mechanism Description		Potentiate the pharmacologic effects by the combination of Fluorouracil and Levomefolic acid

Recommended Action
Management		Caution is advised if 5-FU or any of its prodrugs (e.g., capecitabine, tegafur) are prescribed in combination with leucovorin. A lower dosage of 5-FU or the prodrug may be required. Therapy with leucovorin and fluorouracil should not be initiated or continued in patients with symptoms of gastrointestinal toxicity until such symptoms have resolved. Closely monitor patients with diarrhea until it resolves. Monitor for other potential toxicities of 5-FU such as neutropenia, thrombocytopenia, stomatitis, cutaneous reactions, and neuropathy. Patients should be instructed to avoid taking folic acid supplementation or multivitamin preparations containing folic acid without first speaking with their physician.

References
1	EMEA. European Medicines Agency "EPARs. European Union Public Assessment Reports.".
2	Product Information. Xeloda (capecitabine). Roche Laboratories, Nutley, NJ.
3	Clippe C, Freyer G, Milano G, Trillet-Lenoir V "Lethal toxicity of capecitabine due to abusive folic acid prescription?" Clin Oncol (R Coll Radiol) 15 (2003): 299-300. [PMID: 12924465]