Anemia flucytosine

Bone marrow suppression is a recognized toxic effect of flucytosine anemia, leukopenia, and thrombocytopenia occur in about 5% of cases. The hematological effects are dose-related and occur after prolonged high blood concentrations of flucytosine (over 100 pg/ml). Hematotoxicity is seen more often in the presence of renal insufficiency and hence during the use of flucytosine in combination with amphotericin. If bone marrow reserve has already been depleted by underlying disease or by medications, the risk of hematotoxicity increases. 

Adverse Effects. Flucytosine may cause hepatotoxicity and may also impair bone marrow function, resulting in anemia, leukopenia, and several other blood dyscrasias.69 This drug may also produce severe gastrointestinal disturbances, including nausea, vomiting, diarrhea, and loss of appetite. 

Nephrotoxicity includes 4 GFR, tubular acidosis, 4 K+ and Mg2+, and anemia through 4 erythropoietin—protect by Na loading, use of liposomal amp B, or by drug combinations (e.g., + flucytosine), permitting 4 in amp B dose. 

Comparative studies In a randomized comparison, 64 HIV-positive, antiretroviral therapy-naive patients in Cape Town, with a first episode of cryptococcal meningitis, received either amphotericin 0.7 mg/kg/day plus flucytosine 25 mg/kg qds ( = 30), or amphotericin 1 mg/kg/day plus flucytosine 25 mg/ kg qds (n = 34) [9 ]. Regimens were given for 2 weeks, followed by oral fluconazole. The frequency of renal impairment did not differ between the groups. Anemia was associated with female sex and less strongly with the higher dose of amphotericin, which may have been exacerbated by reduced renal clearance of flucytosine. 

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