Brivudin

Definition
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Substance from the group of virustatics.

Half-life
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12–15 h

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Indication
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Infections with varicella zoster in immunocompetent adults. Efficacy in children has not been proven.

Limited indication
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Restricted kidney function, pregnancy, lactation.

Dosage and method of use
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Adults: 125 mg p.o. once/day for 7 days.

Undesirable effects
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Nausea, vomiting, diarrhoea, abdominal pain, headache, dizziness, proteinuria, glucosuria, creatinine and transaminase increase, leukopenia and thrombopenia, loss of appetite.

Interactions
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Increase in toxicity of fluorouracil and tegafur. Also no application of 5-FU topically (e.g. for the treatment of actinic keratosis).

Contraindication
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Patients with cytostatic therapy and antifungal therapy with flucytosine, also with topical application). The interaction with 5-fluoropyrimidines can be fatal!!!

Preparations
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Zostex

Note(s)
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The rate of post-zosteric neuralgia should be reduced by the active substance.

Literature
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Dworkin RH et al (2007) Recommendations for the management of herpes zoster. Clin Infect Dis 44: 1-26
Drug Commission of the German Medical Association: (2006) "UAW - learning from mistakes": potentially fatal interaction between brivudine (Zostex®) and 5-fluoropyrimidines. Dtsch Arztebl 103: A 1922-1923
WHO Pharmaceuticals Newsletter (2018) Brivudine and 5-fluorouracil - Persistence of a fatal drug-drug interaction. WHO Pharmaceuticals Newsletter 6: 20-24
https://www.akdae.de/Arzneimittelsicherheit/DSM/Archiv/2019-11.html
https://www.aerzteblatt-sachsen-anhalt.de/ausgabe/arzneimittelkommission/3103-rote-hand-brief-zu-brivudin-potenziell-toedliche-toxizitaet-von-fluoropyrimidinen-bei-der-anwendung-kurz-vor-gleichzeitig-mit-oder-innerhalb-von-vier-wochen-nach-ende-der-behandlung-mit-brivudin.html