From 60% to 80% eliminated as respiratory CO2 (8-12 hr); small amount (15%) excreted unchanged in urine (1-6 hr). Highly toxic; initiate use in hospital. When used topically, the following response occurs:
• Early inflammation: erythema for several days (minimal reaction)
• Severe inflammation: burning, stinging, vesiculation
• Disintegration: erosion, ulceration, necrosis, pain, crusting, reepithe-lialization
• Healing: within 1-2 weeks with some residual erythema and temporary hyperpigmentation
Uses: Systemic: Palliative management of certain cancers of the rectum, stomach, colon, pancreas, and breast. In combination with levamisole for Dukes' stage C colon cancer after surgical resection. In combination with leucovorin for metastatic color-ectal cancer. Non-FDA Approved Uses: Cancer of the bladder, ovaries, prostate, cervix, endometrium, lung, liver, head, and neck. Also, malignant pleural, peritoneal, and pericar-dial effusions. Topical (as solution or cream): Multiple actinic or solar keratoses. Superficial basal cell carcinoma. Non-FDA Approved Uses: Condylomata acuminata (1% solution in 70% ethanol or the 5% cream).
Contraindications: Hypersensitiv-ity. Pregnancy.
Special Concerns: Safety and efficacy of topical products have not been established in children. Occlusive dressings may result in increased inflammation in adjacent normal skin when topical products are used. Side Effects: Topical: Dermatologie: Pain, pruritus, hyperpigmentation, irritation, inflammation, burning at site of application, scarring, soreness, allergic contact dermatitis, tenderness, scaling, swelling, suppuration, alopecia, photosensitivity, urticaria. CNS: Insomnia, irritability. Oral: Stomatitis, medicinal taste. Miseellane-
ous: Lacrimation, telangiectasia, toxic granulation.
Drug Interactions: None reported for topical dose form. Use caution with drugs that may cause photosen-sitivity.
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