Dermatology

Mevir^®

Mevir^® is a drug indicated for the early treatment of acute herpes zoster in immunocompetent adults.¹

Mevir^® (brivudine) is a herpes zoster viral agent characterized not only by its unique compliance-promoting 1 x 1 dosing over 7 days, but also by its rapid and highly specific action.^1,2 Significantly faster vesicle arrest occurs with Mevir^® than with aciclovir² and no dose adjustment is required in elderly patients and patients with hepatic and renal insufficiency¹. The risk of developing PZN (post-zoster neuralgia) is 25% lower than with aciclovir.^1,3

Brivudine irreversibly inhibits dihydropyrimidine dehydrogenase (DPD) through its major metabolite, bromovinyluracil (BVU). DPD is an enzyme that regulates the metabolism of both natural nucleosides (e.g., thymidine) and pyrimidine derivatives, such as 5-fluorouracil (5-FU). Inhibition of the enzyme leads to accumulation and enhanced toxicity of 5-FU. There is a risk of a potentially fatal interaction.¹

Warning:¹ Brivudine should not be used in patients who have recently received, are currently receiving, or are scheduled to receive within 4 weeks cancer chemotherapy with drugs containing 5-fluorouracil (5FU), including its topical preparations, its prodrugs (e.g., capecitabine, tegafur), and combination drugs containing any of these agents or other fluoropyrimidines.

Brivudine should not be used in patients who have recently received or are currently receiving antifungal therapy with flucytosine (a prodrug of 5-fluorouracil).

The interaction between brivudine and fluoropyrimidines (e.g., capecitabine, 5-FU, tegafur, flucytosine, etc.) is potentially fatal. Deaths have been reported due to this interaction. Therefore, a waiting period of at least 4 weeks must be observed between the end of treatment with brivudine and the start of therapy with fluoropyrimidine-containing drugs (e.g., capecitabine, 5-FU, tegafur, flucytosine, etc.).

In the event of accidental use of brivudine in patients who have recently received or are currently receiving fluoropyrimidines, all drugs must be discontinued and effective measures taken to reduce the toxicity of the fluoropyrimidines: immediate hospitalization and all measures to prevent systemic infection and dehydration. A specialized center for poisoning (e.g., Poison Control Center) must be contacted as soon as possible to determine an appropriate course of action for fluoropyrimidine toxicity.

Educational Material - Brivudin Prescriber Checklist

References: 1 Drug information Mevir^®, 2 Wassilew et al, Antiviral Res 2003,59:49-56, 3 Wassilew et al, Antiviral Res 2003,59:57-60

AT-WEB-27-10-2021