If the overdose rate is between 2-10X intended rate (with completed delivery of greater
than 50% of the intended total 5FU dose):
o Hospitalization at discretion of medical team.
Factors to consider:
Degree of overdose – greater vigilance may be required for
overdoses between 8-10X intended rate
Patient factors which may be associated with impaired clearance
including advanced age, impaired baseline renal function (Creatinine
clearance [CrCl] < 60 mL/min) and impaired hepatic function (AST >
2.5X ULN, Bilirubin > 1.5X ULN).
Patient’s ability to return for close outpatient follow-up and monitoring
Patient’s access to home and social supports
o Initiate filgrastim (G-CSF)* at a dose of 5 mcg/kg subcutaneous daily beginning within
24 hours of overdose and continuing for a minimum of 7 days or until past nadir to
ANC > 1.0 (1,2)
o Discontinue concomitant medications which may impair clearance of 5FU: cimetidine,
metronidazole, thiazide diuretics (3)