Interaction between capecitabine and brivudin in a patient with breast cancer.
BACKGROUND
A 66-year-old woman with metastatic mammary carcinoma, who was being treated with capecitabine, contracted a herpes zoster infection that was treated with the antiviral drug brivudin. A drug-drug interaction between brivudin and capecitabine caused medullar aplasia, serious toxic effects to the intestinal mucous membrane, hand-foot syndrome, onycholysis and dental pigmentation.


METHODS
Physical examination, blood analysis, blood cultures, chest X-ray, bone marrow aspiration and biopsy.


METHODS
Serious adverse event secondary to inhibition of dihydropyrimidine dehydrogenase by a drug-drug interaction between capecitabine and brivudin.


RESULTS
Intravenous hydration, imipenem, red blood cell and platelet transfusions, filgrastim, omeprazole, care of the mouth and feet, topical anesthetics, systemic analgesics and parenteral nutrition.
Baena-Cañada
José M
JM
Medical Oncology Unit, Puerta del Mar University Hospital, Avenida Ana de Viya 21, Cádiz, Spain. josem.baena.sspa@juntadeandalucia.es
Martínez
María J
MJ
García-Olmedo
Obdulia
O
Jiménez-Bárcenas
Reyes
R
Muriel-Cueto
Pedro
P
D000368:Aged; D000741:Anemia, Aplastic / Q000139:chemically induced*; D000964:Antimetabolites, Antineoplastic / Q000494:pharmacology* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000998:Antiviral Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D001973:Bromodeoxyuridine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000069287:Capecitabine; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D042943:Dihydrouracil Dehydrogenase (NADP) / Q000037:antagonists & inhibitors*; D004347:Drug Interactions; D017809:Fatal Outcome; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006562:Herpes Zoster / Q000188:drug therapy*; D006801:Humans; D054039:Onycholysis / Q000139:chemically induced; D010166:Palliative Care; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*; D016879:Salvage Therapy; D013280:Stomatitis / Q000139:chemically induced*; D014075:Tooth Discoloration / Q000139:chemically induced
D000964:Antimetabolites, Antineoplastic; D000998:Antiviral Agents; D003841:Deoxycytidine; C020235:brivudine; D000069287:Capecitabine; D042943:Dihydrouracil Dehydrogenase (NADP); D001973:Bromodeoxyuridine; D005472:Fluorouracil