Efudex: Should you be prescribing it?

This question was submitted by a general dentist: 

When discussing sun damage to lips, a couple of patients told me that they were prescribed Efudex by their physician. There is apparently no follow-up by the physician and no indication to the patients as to what the desired outcome of the said treatment should be. Should dentists be prescribing this and what would the appropriate follow-up and regimen be for this chemotherapeutic agent?

Dr. Mark Donaldson provided this quick initial response in collaboration with Dr. Suham Alexander, Oasis Clinical Editor

Dr. Mark Donaldson is Director of Pharmaceutical Services at the Kalispell Regional Medical Center,  Clinical Professor in the Department of Pharmacy at the University of Montana, and Clinical Associate Professor in the School of Dentistry at the Oregon Health and Sciences University

Efdex is usually prescribed as a topical ointment to treat pre-cancerous and cancerous skin growths including: superficial basal cell carcinoma of the skin, roughened red patches of skin after sun exposure, and inflammation of the lips due to sun exposure, gamma rays or Xrays.

Dentists SHOULD NOT be prescribing Efudex® (topical Fluorouracil). This antineoplastic medication is a kind of topical chemotherapy with many of the same risks as its oral and intravenous counterparts. While the systemic toxicities associated with fluorouracil administration may be less with this topical formulation (i.e., neutropenia, neurotoxicity, and gastrointestinal toxicity), it has been associated with hair loss (alopecia), photosensitivity, pruritis, stomatitis, hyperpigmentation and many other adverse effects especially in patients with a genetic deficiency of dihydropyrimidine dehydrogenase (DPD). Hands should be washed immediately after applying and contact with mucous membranes should be avoided due to potential for local inflammation and ulceration.

Physicians prescribe this medication to be applied twice a day for either actinic keratosis or superficial basal cell carcinoma and the treatment course may be as long as 12 weeks. Fluorouracil is teratogenic and fetal defects and miscarriages have been reported following use of this topical product in humans. Its use is contraindicated during pregnancy.

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