uridine triacetate (PN 401) / Wellstat - LARVOL DELTA

WHEN THE CURE BECOMES THE CRISIS: 5-FLUOROURACIL-INDUCED SEVERE CARDIOMYOPATHY REVERSED BY TIMELY URIDINE TRIACETATE ADMINISTRATION (CHEST 2026) - No abstract available

Cardiomyopathy • Cardiovascular

A Rare Case of Acute 5-Fluorouracil Cardiotoxicity with Rapid Recovery of Left Ventricular Function After Uridine Triacetate Administration (AHA 2026) - "Abstract is embargoed at this time."

Clinical • Cardiovascular

PN401. Perioperative Medication Controversies: Managing Antihypertensives, Anticoagulants, and Glycemic Agents: Using Evidence to Manage Medication Conundrums (1 CME) (ASA 2026) - "By exploring key controversies and reviewing cutting edge literature, the session will foster interdisciplinary collaboration and equip attendees with practical tools to enhance patient safety and optimize outcomes. SessionLearningObjective1: Describe current recommendations regarding perioperative management of antihypertensive agents ( ACEi, ARBs), direct acting oral anticoagulants, antiplatelet agents, and sodium glucose cotransporter 2 inhibitors.SessionLearningObjective2: Describe current recommendations regarding perioperative management of antihypertensive agents ( ACEi, ARBs), direct acting oral anticoagulants, antiplatelet agents, and Sodium glucose cotransporter 2 inhibitors.SessionLearningObjective3: Provide strategies for individual mediation management based on comorbid conditions, surgical risk, and clinical scenarios."

Fatal 5-Fluorouracil Toxicity With Hyperammonemic Encephalopathy, Lactic Acidosis, and Pneumatosis Intestinalis Despite Uridine Triacetate Rescue: A Case Report. (PubMed, Cureus) - "A 56-year-old male patient with stage III (primary tumor (T4), regional lymph nodes (cN2), distant metastasis (cM0), human papillomavirus (HPV)-16-positive) squamous cell carcinoma of the right tonsil developed intractable vomiting within 24 hours of initiating continuous 5-FU infusion as part of a TPF regimen (docetaxel, cisplatin, 5-FU). Genotyping in this patient returned negative for all tested variants, demonstrating that fatal fluoropyrimidine toxicity can occur in patients classified as normal metabolizers by current testing panels. The predisposing factor underlying this patient's sensitivity to 5-FU remains unexplained."

Journal • Acute Kidney Injury • CNS Disorders • Hematological Disorders • Metabolic Disorders • Nephrology • Oncology • Renal Disease • Squamous Cell Carcinoma • DPYD

Enhanced oral absorption and anti-colorectal cancer efficacy of trifluridine by interfering with both TPase and UPase. (PubMed, Bioorg Chem) - "Although the approved trifluridine/tipiracil (FTD/TPI) therapy protects FTD from TPase-mediated degradation, UPase remains insufficiently controlled. Uridine triacetate (TAU), a uridine prodrug, is used to sustain systemic uridine exposure and attenuate UPase-mediated FTD degradation...In colorectal cancer models, the combination markedly promoted anti-tumor efficacy through suppression of cell proliferation and induction of cell apoptosis. These findings establish a prodrug-enabled metabolic protection strategy for improving oral pharmacokinetics and therapeutic efficacy of metabolically vulnerable nucleoside anticancer drugs."

Journal • Colorectal Cancer • Oncology • Solid Tumor

Fluoropyrimidine Cardiotoxicity: Role of Uridine Triacetate and Pharmacogenomic Insights from a Case of 5-FU-Induced Cardiogenic Shock. (PubMed, J Cardiovasc Pharmacol) - "Fluoropyrimidines, including 5-fluorouracil and capecitabine, are widely used antimetabolite agents and remain central to the treatment of several solid tumors, particularly gastrointestinal malignancies...This review discusses severe fluoropyrimidine-associated cardiotoxicity through the illustrative presentation of a young woman without prior cardiovascular disease who developed acute biventricular dysfunction and cardiogenic shock shortly after first exposure to FOLFIRINOX, requiring temporary mechanical circulatory support...Expanded genomic analysis identified DPYD and TYMS variants not detected by standard pretreatment pharmacogenetic screening. We herein examine the pathophysiological mechanisms of fluoropyrimidine cardiotoxicity, the rationale for uridine triacetate in severe presentations, and the potential role of expanded pharmacogenomic profiling within a precision cardio-oncology framework."

Biomarker • Journal • Cardiovascular • Congestive Heart Failure • Heart Failure • Oncology • Pain • Solid Tumor • DPYD • TYMS

Fulminant Immune Checkpoint Inhibitor Myocarditis Requiring V-A-ECMO: Rapid Recovery with Multimodal Immunosuppression (IARS-SOCCA 2026) - " A 46-year-old male with squamous cell carcinoma of the tongue, hypothyroidism, and prior subsegmental pulmonary embolism received pembrolizumab and soon presented with tachycardia, dyspnea, malaise, and cough, initially attributed to an upper respiratory infection. Weeks later, following administration of fluorouracil (5-FU), he re-presented with acute abdominal pain, tachycardia, elevated troponin (peak 1353), and severe lactic acidosis (lactate 9.9)...Treatment included pulse-dose corticosteroids, abatacept, uridine triacetate, and a 30-day course of ruxolitinib... Fulminant ICI myocarditis is a rare but highly lethal complication of immunotherapy. This case illustrates a classic diagnostic pitfall: early cardiopulmonary symptoms after ICI infusion misattributed to infection, followed by a delayed fulminant presentation after 5-FU exposure. The profound biventricular failure, conduction abnormalities, and rapid response to immunosuppression strongly support ICI..."

Checkpoint inhibition • Cardiovascular • Cough • Endocrine Disorders • Immunology • Infectious Disease • Inflammation • Metabolic Disorders • Oncology • Oral Cancer • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases • Squamous Cell Carcinoma • Tongue Carcinoma • CTLA4

APPROVED AND EMERGING OPTIONS FOR ONCOLOGY TREATMENT-RELATED TOXICITIES: A TARGETED LITERATURE REVIEW OF THE LANDSCAPE AND REMAINING UNMET NEEDS (ISPOR 2026) - "Agents were cataloged by intended use: (a) rescue therapies for acute overdose or early severe toxicity (e.g., glucarpidase, uridine triacetate, leucovorin rescue); (b) prophylactic organ-protective agents (e.g., mesna, amifostine, dexrazoxane, sodium thiosulfate, palifermin, trilaciclib); (c) countermeasures for immune-mediated toxicities (e.g., tocilizumab for cytokine release syndrome); and (d) radiation normal-tissue protectants in development (e.g., superoxide dismutase mimetics, avasopasem [GC-4419]). Across drug classes, agents demonstrated substantial clinical benefit in narrow, time-sensitive indications (e.g., rescue for high-dose methotrexate or fluoropyrimidine toxicity; cardioprotection with dexrazoxane; otoprotection with sodium thiosulfate in pediatric cisplatin-treated patients; and reduced mucositis with palifermin in select HSCT regimens)... Timely rescue administration can improve outcomes for patients experiencing severe treatment-related toxicities...."

Review • Bone Marrow Transplantation • Cardiovascular • Inflammation • Mucositis

REFRACTORY CARDIOGENIC SHOCK SECONDARY TO 5-FLUOROURACIL THERAPY REVERSED WITH URIDINE TRIACETATE (ACC 2026) - "Received palliative pembrolizumab x 1 year along with 6 cycles of carboplatin/paclitaxel...Empirically given uridine triacetate for suspected 5-FU toxicity, in addition to methylprednisolone, abatacept and ruxolitinib for possible ICI myocarditis... The case highlights cardiogenic shock as a rare complication of 5-FU. Early recognition, management with mechanical circulatory support and administration of uridine triacetate led to recovery. The case underscores the importance of maintaining suspicion for 5-FU cardiotoxicity in similar presentations."

Cardiovascular • Congestive Heart Failure • Heart Failure • Myocardial Ischemia • Squamous Cell Carcinoma • Tongue Carcinoma

Acute Non-Ischemic Cardiomyopathy Requiring VA ECMO in the Setting of 5-Fluorouracil Chemotherapy (SCCM 2026) - "This practice is changing as uridine triacetate (UT) is being utilized in severe 5-FU toxicities...We report a patient with cardiogenic shock requiring VA-ECMO who recovered following initiation of UT.Description: A 46-year-old male with a history of tongue squamous cell carcinoma, initiated on carboplatin and 5-FU infusion for palliative measures two days prior, presented to the emergency department in cardiogenic shock with evidence of end organ dysfunction...This patient's acute cardiomyopathy was determined to be non-ischemic, and likely secondary to checkpoint inhibitor-induced myocarditis or vasospasm, given his improvement after initiation of UT. VA-ECMO served as a pertinent bridge for acute cardiac-respiratory support while the underlying cause of his shock was being addressed."

Cardiomyopathy • Cardiovascular • Coronary Artery Disease • Squamous Cell Carcinoma • Tongue Carcinoma

CHEMOTHERAPY CONFUSION: 5-FU-INDUCED HYPERAMMONEMIC ENCEPHALOPATHY REQUIRING CRRT AND URIDINE TRIACETATE (CHEST 2025) - "Two days prior to admission, the patient underwent chemotherapy treatment with a regimen of folinic acid, fluorouracil, oxaliplatin (FOLFOX) and nivolumab...Uridine triacetate was promptly administered as an antidote and a bowel regimen with lactulose and rifaximin was initiated to facilitate ammonia clearance... This case underscores the importance of early recognition of hyperammonemic encephalopathy in oncologic patients receiving 5-FU therapy. Timely intervention with renal replacement therapy and uridine triacetate can be lifesaving. Critical care clinicians should maintain a high index of suspicion for this rare but severe adverse event to optimize patient outcomes."

Acute Kidney Injury • CNS Disorders • Colorectal Cancer • Epilepsy • Esophageal Cancer • Esophageal Squamous Cell Carcinoma • Fibrosis • Hepatology • Immunology • Infectious Disease • Liver Failure • Nephrology • Renal Disease • Solid Tumor • Squamous Cell Carcinoma

PN401. Making the TEAM: Using Quality Data to Demonstrate Your Value to Hospital Administration in CMS' New Bundled Payment Model (1 CME) (ASA 2025) - "This session will describe the program and delineate how anesthesiologists may highlight their contribution to quality outcomes and high-value care. SessionLearningObjective1: Understand the clinical quality and payment framework of the CMS mandatory Transforming Episode Accountability Model (TEAM) set to start Jan 1, 2026.SessionLearningObjective2: Examine how various anesthesiologist-led perioperative workflows such as perioperative optimization clinics, acute pain services, and early-recovery programs fit into the objectives and clinical focus of TEAM.SessionLearningObjective3: Describe your contribution (utilizing data and metrics) to hospital administrators (CFO, CMO, COO, and CEO) in language that enhances their understanding of the cross-functional nature of the anesthesiologist's role and the nuances of reimbursement for anesthesia care."

Clinical • Anesthesia • Musculoskeletal Diseases • Orthopedics

Altered Mental Status in Patients Undergoing 5-Fluorouracil Based Chemotherapy: Think of the Zebras (ERA 2025) - "The day prior to presentation he had been initiated on a chemotherapy regimen of 5-FU (via continuous pump), as well as pembrolizumab, leucovorin, and oxaliplatin...In addition, 5-FU pump was removed and lactulose, rifaximin, and uridine triacetate (a specific antidote for 5-FU toxicity) were initiated... Severe hyperammonemia is a rare but potentially life-threatening adverse effect of 5-FU therapy. Our case illustrates the importance of high index of suspicion to facilitate early diagnosis and intervention with dialysis to improve outcomes. It is postulated that fluoroacetate, a catabolite of 5-FU suppresses Kreb's cycle causing dysfunction of ATP- dependent urea cycle, thus preventing conversion of ammonia into urea resulting in hyperammonemia."

Clinical • CNS Disorders • Esophageal Cancer • Esophageal Squamous Cell Carcinoma • Gastrointestinal Cancer • Hepatology • Lung Cancer • Metabolic Disorders • Non Small Cell Lung Cancer • Oncology • Solid Tumor • Squamous Cell Carcinoma

Cost analysis of pre-treatment dihydropyrimidine dehydrogenase (DPYD) genotyping to reduce hospitalizations at a cancer center in the United States (U.S.). (ASCO 2025) - "Additional savings are expected if costs for outpatient management of AEs and use of uridine triacetate in the inpatient setting are included in the model... Pre-treatment DPYD genotyping led to cost savings by reducing AE related hospitalizations among variant carriers. Cancer centers should adopt pre-treatment DPYD genotyping to reduce severe AEs, hospitalizations, and costs. Model inputs.HCUP; Healthcare Cost and Utilization Project, NC, North Carolina; CMS, Centers for Medicare and Medicaid Services."

Clinical • Cost-analysis • HEOR • Gastrointestinal Cancer • Oncology • Solid Tumor • DPYD

UNMASKING 5-FLUOROURACIL CARDIOTOXICITY: A CASE OF REVERSIBLE CORONARY VASOSPASM - Avneesh Sharma (ACC 2025) - "Initial ECGs showed hyperacute T waves and later anterior ST elevations (Figure 1) concerning for ACS, which resolved with IV nitroglycerin...She was discharged on standard therapy for CAD, nitrates and nifedipine. Awareness of coronary vasospasm as a side effect of 5-FU therapy is paramount, with reported occurrence of 1-13%. Prompt discontinuation of therapy and consideration of uridine triacetate and pre-treatment regimens can mitigate cardiotoxicity without precluding the future use of fluoropyrimidines."

Clinical • Cardiovascular • Colorectal Cancer • Diabetes • Gastrointestinal Cancer • Gastrointestinal Disorder • Hypertension • Metabolic Disorders • Oncology • Pain • Rectal Cancer • Solid Tumor • Thrombosis

Economic Model of Uridine Triacetate Versus Supportive Care for the Treatment of Patients with Life-Threatening Early-Onset Severe Toxicity. (PubMed, Clin Drug Investig) - "Optimal treatment with uridine triacetate for all hospitalized patients in the USA expected to die from early-onset severe toxicity has the potential to improve inpatient survival at a minimal inpatient budget increase. The majority of the drug cost is offset by a reduction in the length of hospital stay and associated costs."

Journal • Gastrointestinal Disorder • Hematological Disorders

Dihydropyrimidine enzyme activity and its effect on chemotherapy toxicity: importance of genetic testing. (PubMed, Cancer Chemother Pharmacol) - "It is our recommendation to perform DPD deficiency in curative intent cancer treatment and this information can increasingly be obtained in standard tumor NGS profiling, a growing norm in medical oncology."

Journal • Colorectal Adenocarcinoma • Colorectal Cancer • Hematological Disorders • Neutropenia • Oncology • Pain • Rectal Adenocarcinoma • Solid Tumor • Thrombocytopenia • DPYD

Cardiotoxicity Conundrum: Distinguishing Immune Checkpoint Inhibitor Myocarditis from Fluorouracil Cardiotoxicity in Concurrent Therapy (AHA 2024) - "Case DescriptionThe patient is a 37-year-old male with metastatic gastroesophageal junction adenocarcinoma presenting with chest pain and dyspnea two days after initiation of leucovorin, fluorouracil, oxaliplatin (FOLFOX), and nivolumab therapy...Suspecting immune checkpoint inhibitor (ICI) myocarditis versus fluorouracil (5-FU) cardiotoxicity, he was treated simultaneously for both.After starting high-dose steroids and before uridine triacetate, he had improved symptoms, cardiac function, biomarkers, and invasive hemodynamics...At follow-up, he remained clinically stable, tolerating oxaliplatin and docetaxel (FLOT) initiation and nivolumab rechallenge without 5-FU.DiscussionThis case is challenging as the presentation does not conclusively identify a causative agent...Yet, his biomarkers remained normal with nivolumab rechallenge, arguing against ICI myocarditis and suggesting 5-FU as the culprit.Early recognition and differentiation of the culprit in concurrent..."

Checkpoint inhibition • IO biomarker • Cardiomyopathy • Cardiovascular • Esophageal Cancer • Gastric Cancer • Gastroesophageal Junction Adenocarcinoma • Inflammation • Oncology • Pain • Pulmonary Disease • Solid Tumor

Neutropenic Enterocolitis After Single Dose of CAPOX in Newly Diagnosed Colon Cancer (ACG 2024) - "He had received his first dose of adjuvant chemotherapy, CAPOX (capecitabine and oxaliplatin), four days after surgery...Oncology recommended Filgrastim and Uridine Triacetate, and gastroenterology advised bowel rest, an nasogastric tube, and Octreotide infusion...Early recognition and intervention are crucial to mitigate complications like septic shock. Further research is needed to reduce NE-associated morbidity and mortality."

Colon Cancer • Colorectal Adenocarcinoma • Colorectal Cancer • Gastrointestinal Cancer • Gastrointestinal Disorder • Hematological Disorders • Hematological Malignancies • Infectious Disease • Leukopenia • Mucositis • Neutropenia • Oncology • Pain • Palliative care • Septic Shock • Solid Tumor • Stomatitis

Review of the fluoropyrimidine antidote uridine triacetate. (PubMed, Br J Clin Pharmacol) - "In 2015, the United States Food and Drug Administration (FDA) approved uridine triacetate to treat overdose and severe toxicity of the fluoropyrimidine chemotherapy agents 5-fluorouracil (5-FU) and its oral prodrug capecitabine. Mechanistically uridine triacetate would be expected to be effective for overdose and severe toxicity of tegafur (a 5-FU prodrug), but there are no published case reports describing this. Uridine triacetate is available internationally through an expanded access scheme and has been available in the UK since 2019 on a named patient basis."

Journal • Review • Metabolic Disorders

PN401. Anesthetic Considerations in Thoracic and Thoracoabdominal Aortic Disease (ASA 2024) - "Learning Objective 2 Utilize mitigation strategies to minimize neurologic and renal complications resulting from thoracic aortic procedures. Learning Objective 3 Employ modern evidence-based medicine to treat acquired coagulopathy from open surgical approaches to the thoracic aorta"

Anesthesia • Cardiovascular • Hematological Disorders

Nucleo(s)tide metabolism as basis for drug development; the Anne Simmonds award lecture. (PubMed, Nucleosides Nucleotides Nucleic Acids) - "This background was fundamental in our studies on how to optimize application of existing drugs (5-fluorouracil [5FU], thiopurines, antifolates such as methotrexate) but also to support development of novel drugs such as gemcitabine, novel antifolates, S-1, TAS-102 and fluorocyclopentenylcytosine. Knowledge of their metabolism helped to design rational combinations such as of gemcitabine with cisplatin, one of the most widely used drug combinations for various cancers. The combination of 5FU with uridine, led to the development of triacetyluridine registered for emergency treatment of patients with lethal 5FU toxicity...The latter actually led to the most interesting results. Investigation of (nucleoside/nucleotide) metabolism remains an exciting field of research."

Journal • Cardiovascular • Infectious Disease • Oncology • Pediatrics • Rheumatology

FLUOROPYRIMIDINE-ASSOCIATED SEVERE CARDIOTOXICITY TREATED WITH URIDINE TRIACETATE (ACC 2024) - "Background: 5-fluorouracil (5-FU) associated cardiotoxicity is infrequent and remains poorly defined...An ECG revealed lateral ST elevations, which normalized promptly after stopping 5-FU and nitroglycerin administration... It is crucial to monitor patients receiving 5-FU for any signs of cardiotoxicity, as early interventions can be critical. Uridine triacetate may play an essential role in life-threatening toxicities."

Cardiomyopathy • Cardiovascular • Colon Cancer • Colorectal Cancer • Congestive Heart Failure • Coronary Artery Disease • Gastrointestinal Cancer • Heart Failure • Myocardial Infarction • Oncology • Pain • Solid Tumor • DPYD

A CASE OF 5-FLUOROURACIL INDUCED ACUTE HEART FAILURE (ACC 2024) - "After undergoing radical appendectomy with diverting loop, patient received FOLFOX (folinic acid, fluorouracil, and oxaliplatin) therapy...Patient also received uridine triacetate for presumed 5-FU associated cardiomyopathy... 5-FU confer benefit to patients with solid tumors however with limited use due to cardiotoxicity. The above case demonstrates the need to further define cardio-protective strategies for patients receiving 5-FU."

Clinical • Appendix Cancer • Atrial Fibrillation • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Critical care • Gastrointestinal Cancer • Heart Failure • Oncology • Peritoneal Cancer • Respiratory Diseases • Solid Tumor

HEREDITARY OROTIC ACIDURIA: AN UNCOMMON PRESENTATION IN A PEDIATRIC PATIENT (ASPHO 2024) - "The patient's orotic acid level was found to be 2,986 mmol (normal: 0.7 to 5.1 mmol) The patient started uridine triacetate... A thorough work up was completed for this patient with initial symptoms of neutropenia and normocytic anemia. After preliminary testing, a diagnosis of MDS was heavily considered with the potential for a bone marrow transplant. A definitive diagnosis was found after whole exome sequencing."

Clinical • Anemia • Aplastic Anemia • Bone Marrow Transplantation • Genetic Disorders • Hematological Disorders • Hematological Malignancies • Metabolic Disorders • Myelodysplastic Syndrome • Neutropenia • Oncology • Pediatrics • Transplantation