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URIDINE TRIACETATE

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) ANTIDOTE: Uridine triacetate is an orally administered prodrug of uridine that is rapidly converted to uridine by deacetylation. Uridine is converted to UTP, which competes with 5-FU metabolites for incorporation into RNA; thus preventing cell death and toxicity.
    B) OROTIC ACIDURIA: Uridine triacetate, a pyrimidine analog, is given orally for uridine replacement in patients with hereditary orotic aciduria.

Specific Substances

    1) Uridine
    2) Vistonuridine
    3) 5-FU antidote
    4) Capecitabine antidote
    5) PN401
    1.2.1) MOLECULAR FORMULA
    1) C15H18N2O9

Available Forms Sources

    A) FORMS
    1) HEREDITARY OROTIC ACIDURIA
    a) Orange-flavored granules are available in single-use packet containing 2 grams of uridine triacetate in cartons of 30 packets (Prod Info XURIDEN(TM) oral granules, 2015).
    2) ANTIDOTE
    a) Orange-flavored granules are available in single-dose packets containing 10 grams of uridine triacetate for the emergency treatment of adult and pediatric patients following a fluorouracil or capecitabine overdose (Prod Info VISTOGARD(R) oral granules, 2015).
    B) USES
    1) HEREDITARY OROTIC ACIDURIA
    a) Uridine triacetate, a pyrimidine analog, is used for uridine replacement for the treatment of hereditary orotic aciduria (Prod Info XURIDEN(TM) oral granules, 2015).
    2) ANTIDOTE
    a) As of December 2015, the FDA has approved uridine triacetate as an emergency treatment of adult and pediatric patients following a fluorouracil or capecitabine overdose regardless of the presence of symptoms or in those patients that exhibit early-onset of severe or life-threatening toxicity affecting the cardiac or central nervous system, and/or early onset of unusually severe adverse effects (eg., gastrointestinal toxicity and/or neutropenia) within 96 hours following the end of fluorouracil or capecitabine administration (Prod Info VISTOGARD(R) oral granules, 2015).
    b) Formerly, uridine triacetate had orphan drug status as an antidote in 5-fluorouracil (5-FU) overdose (Bamat, Tremmel, and O'Neil, 2010; Von Borstel et al, 2009).
    3) EFFICACY
    a) Based on limited experience, uridine triacetate appears to be an effective and lifesaving antidote. All patients treated to date (more than 35 patients) with uridine triacetate following 5-FU overdose have recovered completely. Patients did not develop the anticipated gastrointestinal and hematologic toxicities following 5-FU overdose. Uridine triacetate was found to be effective after exposure to a range of doses of 5-FU; the highest dose for which a patient recovered was 10,000 mg of 5-FU infused over 3 hours. Two other patients recovered fully after receiving uridine triacetate following 5-FU doses of 8960 mg over 3 hours and 5000 mg over 17 minutes, respectively (Bamat, Tremmel, and O'Neil, 2010).
    b) Seventeen patients treated with uridine triacetate (formerly known as vistonuridine) following a 5-FU overdose were compared to data from 13 patients with similar 5-FU overdoses who received supportive care only. All patients receiving uridine triacetate began treatment within 8 to 96 hours after overdose. A full recovery was seen in all 17 patients treated with uridine triacetate, even though a fatal outcome was predicted for 13 of these patients based on 5-FU dose and rate of administration. Eleven of the 13 patients who received symptomatic care had a fatal outcome predicted by 5-FU dose and rate of administration, and death occurred in all 11 despite supportive efforts (Von Borstel et al, 2009).

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) USES: Uridine, a pyrimidine analog, is used for uridine replacement for the treatment of hereditary orotic aciduria, a rare congenital autosomal recessive disorder of pyrimidine metabolism. As of December 2015, the FDA has approved uridine triacetate as an emergency treatment of adult and pediatric patients following a fluorouracil or capecitabine overdose regardless of the presence of symptoms or in those patients that exhibit early-onset of severe or life-threatening toxicity affecting the cardiac or central nervous system, and/or early onset of unusually severe adverse effects (eg, gastrointestinal toxicity and/or neutropenia) within 96 hours following the end of fluorouracil or capecitabine administration. It had been formerly available under the emergency use Investigational New Drug provisions of the FDA.
    B) PHARMACOLOGY: USE IN HEREDITARY OROTIC ACIDURIA: Uridine triacetate is a prodrug of uridine. It delivers uridine into the circulation of patients with hereditary orotic aciduria where it can be used by essentially all cells to make uridine nucleotides to compensate for the patient's genetic deficiency. USE AS AN ANTIDOTE: Uridine triacetate is rapidly converted to uridine by deacetylation. Uridine is then converted to UTP, which competes with 5-FU metabolites for incorporation into RNA; thus preventing cell death and toxicity.
    C) EPIDEMIOLOGY: Limited experience. Exposure may occur.
    D) WITH THERAPEUTIC USE
    1) ADVERSE EFFECTS: Uridine triacetate was very well tolerated in patients with hereditary orotic aciduria. It has also been well tolerated in the setting of 5-FU overdose. Nausea, vomiting and diarrhea are the only adverse effects reported with uridine triacetate therapy.
    E) WITH POISONING/EXPOSURE
    1) OVERDOSE: No data available. Severe clinical effects are not anticipated following a minor or moderate exposure.
    0.2.20) REPRODUCTIVE
    A) There are no data on the use of uridine triacetate in pregnant or breastfeeding women. The effects, if any are unknown. Animal studies have not shown embryocidal or teratologic effects at doses about one-half the maximum recommended human dose. Due to the lack of human safety information, uridine triacetate should be used in pregnant or breastfeeding women only if the potential benefit outweighs the potential risk to the fetus.

Laboratory Monitoring

    A) Specific laboratory studies or monitoring may not be necessary following a uridine triacetate exposure.
    B) Monitor electrolytes and fluid balance in patients that develop significant vomiting and/or diarrhea.
    C) ANTIDOTE: When uridine triacetate is used in the setting of a 5-FU overdose, monitor serial CBC with differential and electrolytes. Bone marrow suppression (sometimes delayed) and fluid/electrolyte depletion are common following a 5-FU overdose.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) MANAGEMENT OF TOXICITY
    1) Based on limited data, minor adverse reactions have been reported. Monitor electrolytes and fluid status in patients that develop significant vomiting and/or diarrhea. At the time of this review, treatment is expected to be symptomatic and supportive.
    B) DECONTAMINATION
    1) Gastrointestinal decontamination is not anticipated to be necessary following exposure.
    C) AIRWAY SUPPORT
    1) Airway support is not anticipated to be necessary following uridine triacetate exposure.
    D) ANTIDOTE
    1) None.
    E) PATIENT DISPOSITION
    1) HOME CRITERIA: Patients that are asymptomatic can be monitored at home. However, patients with an underlying disease that were receiving 5-FU treatment may need to be monitored in a healthcare setting.
    2) OBSERVATION CRITERIA: Symptomatic adults or children with more than mild symptoms may need to be treated and monitored for several hours.
    3) ADMISSION CRITERIA: Inpatient admission is not anticipated to be necessary due to uridine triacetate exposure. Patients may require admission depending on their underlying disease state and/or condition.
    4) CONSULT CRITERIA: Consult a regional poison center or medical toxicologist for assistance in managing patients with severe toxicity or in whom the diagnosis is not clear.
    F) PHARMACOKINETICS
    1) Maximum plasma concentrations usually occur within 2 to 3 hours, and the half-life ranges from approximately 2 to 2.5 hours. Uridine does cross the blood-brain barrier. It is excreted by the kidneys and is also metabolized by normal pyrimidine catabolic pathways present in most tissues.

Range Of Toxicity

    A) TOXICITY: A toxic dose has not been established. An adult received uridine triacetate 11 g every 6 hours orally for a total of 20 doses about 18 hours after an inadvertent 5-FU overdose. No clinical symptoms or laboratory abnormalities developed. There have been reports of minor adverse reactions (ie, nausea, vomiting, and diarrhea) following administration of uridine triacetate when used as an antidote.
    B) THERAPEUTIC DOSE: USE IN HEREDITARY OROTIC ACIDURIA: The initial dose is 60 mg/kg orally once daily. May increase to 120 mg/kg daily based on clinical response. Maximum: 8 g/day. USE AS AN ANTIDOTE: ADULT: 10 grams orally every 6 hours for 20 doses. PEDIATRIC: 6.2 grams/m(2) of body surface area (not to exceed 10 g/dose) orally every 6 hours for 20 doses. Treatment should be initiated as soon as possible following a 5-FU or capecitabine overdose. The doses should be given without regard to meals.

Clinical Effects

Summary Of Exposure

    A) USES: Uridine, a pyrimidine analog, is used for uridine replacement for the treatment of hereditary orotic aciduria, a rare congenital autosomal recessive disorder of pyrimidine metabolism. As of December 2015, the FDA has approved uridine triacetate as an emergency treatment of adult and pediatric patients following a fluorouracil or capecitabine overdose regardless of the presence of symptoms or in those patients that exhibit early-onset of severe or life-threatening toxicity affecting the cardiac or central nervous system, and/or early onset of unusually severe adverse effects (eg, gastrointestinal toxicity and/or neutropenia) within 96 hours following the end of fluorouracil or capecitabine administration. It had been formerly available under the emergency use Investigational New Drug provisions of the FDA.
    B) PHARMACOLOGY: USE IN HEREDITARY OROTIC ACIDURIA: Uridine triacetate is a prodrug of uridine. It delivers uridine into the circulation of patients with hereditary orotic aciduria where it can be used by essentially all cells to make uridine nucleotides to compensate for the patient's genetic deficiency. USE AS AN ANTIDOTE: Uridine triacetate is rapidly converted to uridine by deacetylation. Uridine is then converted to UTP, which competes with 5-FU metabolites for incorporation into RNA; thus preventing cell death and toxicity.
    C) EPIDEMIOLOGY: Limited experience. Exposure may occur.
    D) WITH THERAPEUTIC USE
    1) ADVERSE EFFECTS: Uridine triacetate was very well tolerated in patients with hereditary orotic aciduria. It has also been well tolerated in the setting of 5-FU overdose. Nausea, vomiting and diarrhea are the only adverse effects reported with uridine triacetate therapy.
    E) WITH POISONING/EXPOSURE
    1) OVERDOSE: No data available. Severe clinical effects are not anticipated following a minor or moderate exposure.

Gastrointestinal

    3.8.2) CLINICAL EFFECTS
    A) NAUSEA AND VOMITING
    1) WITH THERAPEUTIC USE
    a) USE AS AN ANTIDOTE: In a 2 single-arm, open-label, multi-center clinical trials, nausea occurred in 7% (n=5) and vomiting developed in 10% (n=13) of 135 patients treated with 10 grams of uridine triacetate orally every 6 hours for 20 doses or at a body surface area adjusted dosage of 6.2 grams/m(2) for 20 doses in 4 pediatric patients between 1 and 7 years of age (Prod Info VISTOGARD(R) oral granules, 2015).
    B) DIARRHEA
    1) WITH THERAPEUTIC USE
    a) USE AS AN ANTIDOTE: In a 2 single-arm, open-label, multi-center clinical trials, diarrhea occurred in 4% (n=3) of 135 patients treated with 10 grams of uridine triacetate orally every 6 hours for 20 doses or at a body surface area adjusted dosage of 6.2 grams/m(2) for 20 doses in 4 pediatric patients between 1 and 7 years of age (Prod Info VISTOGARD(R) oral granules, 2015).

Reproductive

    3.20.1) SUMMARY
    A) There are no data on the use of uridine triacetate in pregnant or breastfeeding women. The effects, if any are unknown. Animal studies have not shown embryocidal or teratologic effects at doses about one-half the maximum recommended human dose. Due to the lack of human safety information, uridine triacetate should be used in pregnant or breastfeeding women only if the potential benefit outweighs the potential risk to the fetus.
    3.20.2) TERATOGENICITY
    A) ANIMAL STUDIES
    1) Animal studies have not shown teratologic effects at doses about one half the maximum human dose of 40 g/day on a body surface area basis when given during periods of organogenesis (Prod Info VISTOGARD(R) oral granules, 2015).
    2) Animal studies have not shown teratologic effects at doses about 2.7 times the maximum recommended human dose of 120 mg/kg/day on a body surface area basis (Prod Info XURIDEN(TM) oral granules, 2015).
    3.20.3) EFFECTS IN PREGNANCY
    A) LACK OF INFORMATION
    1) There are limited case reports of uridine triacetate use in pregnant women; however, the information is insufficient to determine any drug associated risks (Prod Info VISTOGARD(R) oral granules, 2015).
    B) ANIMAL STUDIES
    1) Animal studies have not shown embryocidal effects at doses about one half the maximum human dose of 40 g/day on a body surface area basis when given during periods of organogenesis (Prod Info VISTOGARD(R) oral granules, 2015).
    2) No effect on maternal body weight nor effect on overall health was noted when pregnant animals were administered oral uridine triacetate doses about one-half the maximum recommended human dose (Prod Info VISTOGARD(R) oral granules, 2015).
    3.20.4) EFFECTS DURING BREAST-FEEDING
    A) LACK OF INFORMATION
    1) It is not known if uridine triacetate is excreted into human breast milk and the potential for adverse effects in the nursing infant from exposure to the drug are unknown. Weigh the benefits of breastfeeding with the potential adverse effects on the breastfed infant (Prod Info VISTOGARD(R) oral granules, 2015) and administer only if the potential benefit outweighs the potential risk to the infant (Prod Info XURIDEN(TM) oral granules, 2015).
    3.20.5) FERTILITY
    A) ANIMAL STUDIES
    1) Uridine triacetate did not affect fertility in male or female rats at doses about 2.7 times the maximum recommended human dose of 120 mg/kg/day on a body surface area basis (Prod Info XURIDEN(TM) oral granules, 2015).
    2) Fertility was not affected when male and female animals were administered oral uridine triacetate doses about one-half the maximum recommended human dose of 40 g/day on a body surface area basis (Prod Info VISTOGARD(R) oral granules, 2015).

Carcinogenicity

    3.21.4) ANIMAL STUDIES
    A) LACK OF INFORMATION
    1) At the time of this review, long-term carcinogenicity studies with uridine triacetate have not been conducted (Prod Info XURIDEN(TM) oral granules, 2015).

Genotoxicity

    A) There was no evidence of genotoxicity or mutagenicity in the following tests: Ames test, mouse lymphoma assay, and the mouse micronucleus test (Prod Info XURIDEN(TM) oral granules, 2015).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Specific laboratory studies or monitoring may not be necessary following a uridine triacetate exposure.
    B) Monitor electrolytes and fluid balance in patients that develop significant vomiting and/or diarrhea.
    C) ANTIDOTE: When uridine triacetate is used in the setting of a 5-FU overdose, monitor serial CBC with differential and electrolytes. Bone marrow suppression (sometimes delayed) and fluid/electrolyte depletion are common following a 5-FU overdose.

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.1) DISPOSITION/ORAL EXPOSURE
    6.3.1.1) ADMISSION CRITERIA/ORAL
    A) Inpatient admission is not anticipated to be necessary due to uridine triacetate exposure. Patients may require admission depending on their underlying disease state and/or condition.
    6.3.1.2) HOME CRITERIA/ORAL
    A) Patients that are asymptomatic can be monitored at home. However, patients with an underlying disease that were receiving 5-FU treatment may need to be monitored in a healthcare setting.
    6.3.1.3) CONSULT CRITERIA/ORAL
    A) Consult a regional poison center or medical toxicologist for assistance in managing patients with severe toxicity or in whom the diagnosis is not clear.
    6.3.1.5) OBSERVATION CRITERIA/ORAL
    A) Symptomatic adults or children with more than mild symptoms may need to be treated and monitored for several hours.

Monitoring

    A) Specific laboratory studies or monitoring may not be necessary following a uridine triacetate exposure.
    B) Monitor electrolytes and fluid balance in patients that develop significant vomiting and/or diarrhea.
    C) ANTIDOTE: When uridine triacetate is used in the setting of a 5-FU overdose, monitor serial CBC with differential and electrolytes. Bone marrow suppression (sometimes delayed) and fluid/electrolyte depletion are common following a 5-FU overdose.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) SUMMARY
    1) Gastrointestinal decontamination is not anticipated to be necessary following exposure.
    6.5.3) TREATMENT
    A) SUPPORT
    1) MANAGEMENT OF TOXICITY
    a) Based on limited data, minor adverse reactions have been reported. Monitor electrolytes and fluid status in patients that develop significant vomiting and/or diarrhea. At the time of this review, treatment is expected to be symptomatic and supportive.
    B) MONITORING OF PATIENT
    1) Specific laboratory studies or monitoring may not be needed following a uridine triacetate overdose.
    2) Monitor electrolytes and fluid balance in patients that develop significant vomiting and/or diarrhea.
    3) When it is used in the setting of a 5-FU overdose, monitor serial CBC with differential and electrolytes. Bone marrow suppression (sometimes delayed) and fluid/electrolyte depletion are common in 5-FU overdose.

Range Of Toxicity

Therapeutic Dose

    7.2.1) ADULT
    A) HEREDITARY OROTIC ACIDURIA
    1) The recommended initial dose is 60 mg/kg ORALLY once daily mixed in 3 to 4 ounces of applesauce, pudding or yogurt followed by at least 4 ounces of water. May increase to 120 mg/kg orally once daily based on clinical response. MAX: 8 g/day (Prod Info XURIDEN(TM) oral granules, 2015).
    2) Do NOT chew the granules (Prod Info XURIDEN(TM) oral granules, 2015).
    B) FLUOROURACIL OR CAPECITABINE TOXICITY OR OVERDOSE
    1) ANTIDOTE: The recommended dose is 10 g every 6 hours for 20 doses ORALLY, mixed in 3 to 4 ounces of applesauce, pudding or yogurt followed by at least 4 ounces of water. The granules should NOT be chewed (Prod Info VISTOGARD(R) oral granules, 2015).
    2) Administer another dose if vomiting occurs within 2 hours of administration; give next dose at the regularly scheduled time. It can be administered via a nasogastric tube (see manufacturer instructions), if needed (Prod Info VISTOGARD(R) oral granules, 2015).
    7.2.2) PEDIATRIC
    A) HEREDITARY OROTIC ACIDURIA
    1) The recommended initial dose is 60 mg/kg orally once daily mixed in 3 to 4 ounces of applesauce, pudding or yogurt or it can be mixed with milk or infant formula for infants or toddlers (Prod Info XURIDEN(TM) oral granules, 2015).
    a) The dose levels by body-weight are as follows using a scale (grams) (Prod Info XURIDEN(TM) oral granules, 2015):
    1) Up to 5 kg: 0.4 g
    2) 6 to 10 kg: 0.4 to 0.6
    3) 11 to 15 kg: 0.7 to 0.9
    4) 16 to 20 kg: 1 to 1.2
    5) 21 to 25 kg: 1.3 to 1.5
    6) 26 to 30 kg: 1.6 to 1.8
    7) 31 to 35 kg: 1.9 to 2.1 (may use 1 entire 2 gram packet without weighing)
    8) 36 to 40 kg: 2.2 to 2.4
    9) 41 to 45 kg: 2.5 to 2.7
    10) 46 to 50 kg: 2.8 to 3
    11) 51 to 55 kg: 3.1 to 3.3
    12) 56 to 60 kg: 3.4 to 3.6
    13) 61 to 65 kg: 3.7 to 3.9 (may use 2 entire 2 gram packets without weighing)
    14) 66 to 70 kg: 4 to 4.2 (may use 2 entire 2 gram packets without weighing)
    15) 71 to 75 kg: 4.3 to 4.5
    16) Above 75 kg: 6 (may use 3 entire 2 gram packets without weighing)
    B) FLUOROURACIL OR CAPECITABINE TOXICITY OR OVERDOSE
    1) ANTIDOTE: The recommended dose is 6.2 g/m(2) of body surface area ORALLY every 6 hours for 20 doses, mixed in 3 to 4 ounces of applesauce, pudding or yogurt followed by at least 4 ounces of water; MAX 10 g per dose. The granules should NOT be chewed (Prod Info VISTOGARD(R) oral granules, 2015).
    2) Administer another dose if vomiting occurs within 2 hours of administration; give next dose at the regularly scheduled time. It can be administered via a nasogastric tube (see manufacturer instructions), if needed (Prod Info VISTOGARD(R) oral granules, 2015).
    3) Dose levels by body surface area are as follows (Prod Info VISTOGARD(R) oral granules, 2015):
    1) 0.34 to 0.44 m(2): 2.1 to 2.7 g (1 teaspoon (tsp))
    2) 0.45 to 0.55 m(2): 2.8 to 3.4 g (1.25 tsp)
    3) 0.56 to 0.66 m(2): 3.5 to 4.1 g (1.5 tsp)
    4) 0.67 to 0.77 m(2): 4.2 to 4.8 g (1.75 tsp)
    5) 0.78 to 0.88 m(2): 4.9 to 5.4 g (2 tsp)
    6) 0.89 to 0.99 m(2): 5.5 to 6.1 g (2.25 tsp)
    7) 1.00 to 1.10 m(2): 6.2 to 6.8 g (2.5 tsp)
    8) 1.11 to 1.21 m(2): 6.9 to 7.5 g (2.75 tsp)
    9) 1.22 to 1.32 m(2): 7.6 to 8.1 g (3 tsp)
    10) 1.33 to 1.43 m(2): 8.2 to 8.8 g (3.25 tsp)
    11) 1.44 m(2) and above: 10 g (1 full packet)

Maximum Tolerated Exposure

    A) A maximum toxic dose has not been established.
    B) CASE REPORT: A 55-year-old, 77.9 kg man with colon cancer inadvertently received an overdose of 5-FU due to an infusion error and was treated with uridine triacetate about 18 hours after exposure. He was premedicated with ondansetron and received uridine triacetate 11 g every 6 hours orally for a total of 20 doses. He developed no clinical symptoms and his laboratory studies remained normal (McEvilly et al, 2011).
    C) Adverse reactions have not been reported in patients with hereditary orotic aciduria treated with uridine triacetate (Prod Info XURIDEN(TM) oral granules, 2015). During clinical trials, minor adverse reactions (ie, nausea, vomiting and diarrhea) have been reported in patients that had received an overdose of fluorouracil or capecitabine and were treated with uridine triacetate (Prod Info VISTOGARD(R) oral granules, 2015).

Summary

    A) TOXICITY: A toxic dose has not been established. An adult received uridine triacetate 11 g every 6 hours orally for a total of 20 doses about 18 hours after an inadvertent 5-FU overdose. No clinical symptoms or laboratory abnormalities developed. There have been reports of minor adverse reactions (ie, nausea, vomiting, and diarrhea) following administration of uridine triacetate when used as an antidote.
    B) THERAPEUTIC DOSE: USE IN HEREDITARY OROTIC ACIDURIA: The initial dose is 60 mg/kg orally once daily. May increase to 120 mg/kg daily based on clinical response. Maximum: 8 g/day. USE AS AN ANTIDOTE: ADULT: 10 grams orally every 6 hours for 20 doses. PEDIATRIC: 6.2 grams/m(2) of body surface area (not to exceed 10 g/dose) orally every 6 hours for 20 doses. Treatment should be initiated as soon as possible following a 5-FU or capecitabine overdose. The doses should be given without regard to meals.

Pharmacology Toxicology

Pharmacologic Mechanism

    A) USE IN HEREDITARY OROTIC ACIDURIA: Uridine triacetate is a prodrug of uridine. It delivers uridine into the circulation of patients with hereditary orotic aciduria where it can be used by essentially all cells to make uridine nucleotides to compensate for the patient's genetic deficiency (Prod Info XURIDEN(TM) oral granules, 2015).
    B) USE AS AN ANTIDOTE: Uridine triacetate (formerly known as vistonuridine) is an orally administered prodrug of uridine that is rapidly converted to uridine by deacetylation. Uridine is then converted to UTP, which competes with 5-FU metabolites for incorporation into RNA; thus preventing cell death and toxicity (Von Borstel et al, 2009).

Physicochemical

Molecular Weight

    A) 370.3 (Prod Info XURIDEN(TM) oral granules, 2015)

References

General Bibliography

    1) Bamat MK; Tremmel R; and O'Neil R: Uridine triacetate: An orally administered, life-saving antidote for 5-FU overdose. American Society of Clinical Oncology. Alexandria, VA. 2010. Available from URL: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=48340. As accessed 2010-07-27.
    2) McEvilly M, Popelas C, & Tremmel B: Use of uridine triacetate for the management of fluorouracil overdose. Am J Health Syst Pharm 2011; 68(19):1806-1809.
    3) Product Information: VISTOGARD(R) oral granules, uridine triacetate oral granules. Wellstat Therapeutics Corporation (per FDA), Gaithersburg, MD, 2015.
    4) Product Information: XURIDEN(TM) oral granules, uridine triacetate oral granules. Wellstat Therapeutics Corporation (per manufacturer), Gaithersburg, MD, 2015.
    5) Von Borstel R, O'Neil J, & Bamat M: Vistonuridine: An orally administered, life-saving antidote for 5-fluorouracil (5FU) overdose. J Clin Oncol 2009; 27(15S):9616-9616.