Flucytosine (Ancotil)

How does it work?

Ancotil infusion contains the active ingredient flucytosine, which is an antifungal medicine. It is used to treat infections caused by fungi.

Flucytosine works by affecting the metabolism of fungal cells. It is thought to work by being incorporated into the fungal cells' genetic material, DNA and RNA. Both DNA and RNA are needed for the fungi to grow, repair themselves and multiply. Flucytosine causes problems with the production of DNA and RNA in the fungal cells and this causes them to grow in an unbalanced way, causing the fungi to die.

Flucytosine is only effective against some types of fungal infections, for example cryptococcosis, candidiasis and chromomycosis. It may be used in combination with other antifungal drugs such as amphotericin or fluconazole.

What is it used for?

  • Widespread fungal or yeast infections affecting multiple organs, systems or tissues, or the entire body (systemic fungal infection). These infections include cryptococcosis, cryptococcal meningitis, candidiasis, chromomycosis and infections due to torulopsis glabrata and hansenula.

In the treatment of cryptococcal meningitis and severe systemic candidiasis Ancotil is usually given in combination with amphotericin-B. Amphotericin-B may also be given in combination with Ancotil in severe or long-standing infections due to other organisms.

How is this treatment given?

  • Ancotil infusion is administered by a drip into a vein (intravenous infusion) over 20 to 40 minutes. The required daily dose is usually divided into four doses. This means that you will have an infusion four times a day. Treatment is not usually given for more than seven days, although for cryptococcal meningitis two weeks of treatment may be needed.

Warning!

  • This medicine can decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you will need regular blood tests to monitor your blood cells before and during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
  • You will also need regular blood tests to monitor your kidney and liver function while you are receiving treatment with this medicine.

Use with caution in

  • Elderly people.
  • People with severely decreased production of blood cells by the bone marrow (myelosuppression), resulting in very low levels of white blood cells or platelets in the blood (for example due to radiotherapy or chemotherapy treatment).
  • People with other disturbances in the normal numbers of blood cells in the blood.
  • People with decreased kidney function.
  • People with decreased liver function.
  • People with reduced activity or deficiency of an enzyme in the body called dihydropyrimidine dehydrogenase (DPD).
  • People on a low sodium diet.

Not to be used in

  • People who are taking medicines known as antiviral nucleosides, such as brivudine or sorivudine, used for the treatment of shingles and chickenpox.
  • Breastfeeding.

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • The safety of this medicine for use during pregnancy has not been established. As it could potentially be harmful to a developing baby, it should only be used to treat pregnant women if the potential benefits of the treatment outweigh the possible risks. Ask your doctor for more information.
  • It is not known if this medicine passes into breast milk. Mothers who need treatment with this medicine should not breastfeed. Seek further medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

  • Feeling or being sick.
  • Diarrhoea.
  • Skin rashes.
  • Problems with the heart.
  • Confusion.
  • Seizures (convulsions).
  • Hallucinations.
  • Spinning sensation (vertigo).
  • Sleepiness.
  • Headache.
  • Alteration in results of liver function tests.
  • Problems with the liver, such as hepatitis.
  • Decrease in the number of white blood cells, red blood cells or platelets in the blood (leukopenia and neutropenia, anaemia and thrombocytopenia) - see warning section above.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you or your child are already taking, including those bought without a prescription and herbal medicines, before treatment with this medicine is started. Similarly, check with your doctor or pharmacist before taking any new medicines during treatment with this one, to make sure that the combination is safe.

Fluorouracil, which is produced from flucytosine, is broken down in the body by an enzyme called dihydropyrimidine dehydrogenase (DPD). The action of DPD is inhibited by medicines known as antiviral nucleosides, such as brivudine and sorivudine. These medicines may increase the risk of side effects from fluorouracil and should not be used in people treated with flucytosine, or within four weeks of treatment with flucytosine.

If you are taking phenytoin for epilepsy your doctor will monitor the levels of phenytoin closely whilst you are having treatment with Ancotil. This medicine can increase the amount of phenytoin in the blood.

If you are having this medicine in combination with cytarabine treatment your doctor may want to monitor the levels of both medicines in your blood.

Other medicines containing the same active ingredient

There are currently no other medicines available in the UK that contain flucytosine as the active ingredient.