Uridine Triacetate — Drug Monograph

Brand names: Vistogard

Drug class: Supportive Care Agent

Mechanism of Action

Orally bioavailable acetylated prodrug converted to uridine in plasma. Exogenous uridine competes with 5-fluorouridine triphosphate (FUTP) for incorporation into cellular RNA, rescuing normal host tissues from fluoropyrimidine-induced cytotoxic RNA damage.

FDA Indications

• Emergency treatment of adult and pediatric patients following an overdose of 5-fluorouracil or capecitabine regardless of the presence of symptoms
• Early-onset, severe or life-threatening toxicity affecting the cardiac or central nervous system, or unusually early/severe onset of mucositis or leukopenia within 96 hours following the end of 5-FU or capecitabine administration

Common Side Effects

• Nausea
• Vomiting
• Diarrhea

Clinical Pearl

The specific emergency antidote for fluorouracil (5-FU) or capecitabine overdose, or for early-onset severe/life-threatening toxicities (severe mucositis, cardiotoxicity, neurotoxicity, neutropenia) occurring within 96 hours of administration. Acts as an acetylated prodrug of uridine that competitively rescues host RNA from 5-FU incorporation. Start within 96 hours regardless of symptoms — survival in overdose is dramatically higher with prompt administration. It is a rescue agent only and…

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