Vistogard (Uridine Triacetate) - Oral

What Is Vistogard?

Vistogard (uridine triacetate) is an oral prescription medication used for the emergency treatment of an overdose of fluorouracil or capecitabine, two drugs that treat various types of cancer. It is a drug in the pyrimidine analog drug class.

Fluorouracil or capecitabine interfere with DNA synthesis to cause cell death, which slows down cancer growth. However, in addition to working against cancer cells, it also affects your normal cells. This is caused by a lack of uridine, one of the components of the process required to make DNA. Uridine triacetate works by replenishing the amount of uridine in your body, which stops cell death caused by fluorouracil and capecitabine.

This medication is available in oral granule form.

Drug Facts

Generic Name: Uridine triacetate

Brand Name(s): Vistogard, Xuriden

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Pyrimidine analog

Available Generically: No

Controlled Substance: No

Active Ingredient: Uridine triacetate

Dosage Form(s): Granules

What Is Vistogard Used For?

The Food and Drug Administration (FDA) approved uridine triacetate to treat an overdose of fluorouracil or capecitabine. You may be prescribed this if your prescriber has determined that you meet the criteria below:

  • Fluorouracil or capecitabine overdose, regardless of symptoms
  • Early-onset, severe reactions or symptoms that involve the heart or central nervous system or unusually severe adverse reactions, such as neutropenia (low white blood cell count), within the first 96 hours of fluorouracil or capecitabine administration

However, the agency has set limitations for Vistogard's use. Vistogard will not be prescribed:

  • For non-emergency side effects of fluorouracil or capecitabine, such as nausea or diarrhea
  • If more than 96 hours have passed since administering the cancer medications

An overdose of fluorouracil can have different symptoms, including:

  • Heart attack
  • Heart failure
  • Confusion
  • Severe diarrhea
  • Inflammation of your stomach, or mucositis
  • Hand-foot syndrome, a disorder that involves tingling, burning, or redness of your hands and feet

How to Take Vistogard

Always follow directions from your healthcare provider on how to take Vistogard. It is dispensed in granule form in single-dose packets.

To take this medication:

  • Mix your packet of granules with 3 to 4 ounces of soft, such as a cup of applesauce, pudding, or yogurt, before taking it. Do not chew the granules.
  • Take the mixture within 30 minutes of preparing it.
  • Drink a full glass of water afterward.
  • Take the full recommended course of medication, even if you are feeling well.

Storage

Store Vistogard in a cool, dry place at room temperature (77 F). Keep it protected from exposure to high humidity or moisture. Do not store it in the bathroom. These environments can impact how well medications work.

It is also important to ensure that this medication is kept away and out of reach of children and pets to prevent accidental consumption.

Off-Label Uses

Healthcare providers may prescribe uridine triacetate for off-label uses, meaning for conditions not specifically indicated by the FDA.

Uridine triacetate can also be used for a condition known as hereditary orotic aciduria. This rare disease results in changes in DNA synthesis and decreases the amount of uridine you have available. The lack of uridine may lead to low amounts of iron in the body that cannot be treated by standard methods such as iron supplementation. Vistogard treats this disease by replenishing your body's uridine, reducing the effects of orotic aciduria.

How Long Does Vistogard Take to Work?

Vistogard will take around eight hours for your uridine levels to be replenished, but it may take several days or up to three weeks to see the full maximal effects. Even if you are feeling better after you take your first dose, it is important to take the rest of your doses.

What Are the Side Effects of Vistogard?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The most common side effects of Vistogard are:

Severe Side Effects

Vistogard is a generally well-tolerated medication with no documented severe side effects.

Long-Term Side Effects

Vistogard does not have documented side effects that occur after it has been stopped.

Report Side Effects

Vistogard may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Vistogard Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (oral granules):
    • For treatment of hereditary orotic aciduria:
      • Adults and children—Dose is based on body weight and must be determined by your doctor. The starting dose is 60 milligrams (mg) per kilogram (kg) of body weight (1 to 3 packets) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per kg of body weight (2 to 4 packets) once a day.
    • For emergency treatment of patients who have an overdose of fluorouracil or capecitabine:
      • Adults—10 grams (1 packet) every 6 hours for 20 doses.
      • Children—Dose is based on body size and must be determined by your doctor. The starting dose is 6.2 grams per square meter (m[2]) of body size (not to exceed 10 grams per dose) every 6 hours for 20 doses.

Modifications

Vistogard usually does not require special dosing. It is dosed the same even if you have problems with your kidney or liver.

However, if your child needs this medication, the dose will need to be adjusted based on height and weight.

Missed Dose

If you miss a dose of Vistogard, take it as soon as you remember. If you are closer to the next dose than the missed one, then skip the missed dose and take only the next scheduled dose. You should not take more than one dose at a time.

If you miss a dose of Vistogard, your symptoms may not improve.

Overdose: What Happens If I Take Too Much Vistogard?

Vistogard is a safe medication that is well tolerated, even in large doses. There is not much data on what happens if you take too much of it, but it would likely induce side effects such as nausea, vomiting, and diarrhea.

What Happens If I Overdose on Vistogard?

If you think you or someone else may have overdosed on Vistogard, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Vistogard, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is important that your doctor check your progress at regular visits. This is to make sure that this medicine is working properly and to check for unwanted effects.

What Other Medications Interact With Vistogard?

Vistogard is intended to be used to treat overdoses related to fluorouracil and capecitabine. However, if you are not experiencing an overdose, this medication can prevent those medications from working appropriately.

What Medications Are Similar?

Other medications can be used to reverse toxicities related to chemotherapy, such as:

  • Mesnex (mesna)
  • Dexrazoxane

Mesna is commonly used with Cytoxan (cyclophosphamide) to prevent hemorrhagic cystitis, or bladder damage, which is a common side effect of Cytoxan. Similarly, dexrazoxane is used to prevent the side effects associated with Adriamycin (doxorubicin), including heart damage.

This is a list of drugs that are similar to Vistogard. It is NOT a list of drugs recommended to take with Vistogard. In fact, you should not take these drugs together. Talk to your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • How expensive is Vistogard? Is there a way to get help paying for it?

    Depending on your insurance, the price of Vistogard will vary. There may be a way to get help paying for Vistogard through prescription assistance programs. Ask your healthcare provider or pharmacist about potential cost savings.

  • Where can I get Vistogard?

    Vistogard is a specialty medication used only in certain circumstances. You may need to pick the prescription up at a specialty pharmacy.

  • How can I manage the side effects associated with Vistogard?

    The most common side effects of Vistogard are nausea, vomiting, and diarrhea. To help prevent these side effects, make sure you take it with food and drink plenty of water.

How Can I Stay Healthy While Taking Vistogard?

To stay healthy while taking Vistogard, it is important to use it exactly as prescribed to effectively treat chemotherapy toxicity. Continue to take the full course even if you start to feel better after your first dose.

Along with taking this medication as prescribed, make sure to get plenty of rest, stay hydrated and eat a healthy diet as instructed by your healthcare provider.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page

The author would like to recognize and thank Chong Yol Gacasan Kim for contributing to this article.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Vistogard label.

  2. Food and Drug Administration. Fluorouracil label.

  3. Al Absi HS, Sacharow S, Al Zein N, Al Shamsi A, Al Teneiji A. Hereditary orotic aciduria (HOA): a novel uridine-5-monophosphate synthase (UMPS) mutation. Mol Genet Metab Rep. 2021;26:100703. doi:10.1016/j.ymgmr.2020.100703

  4. Matz EL, Hsieh MH. Review of advances in uroprotective agents for cyclophosphamide- and ifosfamide-induced hemorrhagic cystitis. Urology. 2017;100:16-19. doi:10.1016/j.urology.2016.07.030

  5. Vachhani P, Shin S, Baron J, et al. Dexrazoxane for cardioprotection in older adults with acute myeloid leukemia. Leuk Res Rep. 2017;7:36-39. doi:10.1016/j.lrr.2017.04.001