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.

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.

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:

• Nausea and vomiting
• Diarrhea
  

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.

Dosage: How Much Vistogard Should I Take?

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.

Precautions

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.

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.

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