Cardiotoxicity of 5-fluorouracil

Cardiovasc Hematol Agents Med Chem. 2006 Jan;4(1):1-5. doi: 10.2174/187152506775268785.


Cardiac side effects of the cytostatic agent 5-fluorouracil (5-FU) have an incidence of 1.2-7.6%. Potentially, arrhythmias, myocardial infarction and sudden cardiac death could occur. Life-threatening cardiotoxicity is rarely observed with a frequency <1%. Cardiotoxicity of 5-FU seems to differ from well known effects of other cytostatics, e.g., anthracyclines. Myocardial ischemia was suggested as potential mechanism due to occasionally observed ECG alterations during 5-FU administration. Experimental studies revealed potential mechanisms of cardiotoxicity ranging from direct toxic effects on vascular endothelium involving endothelial NO synthase leading to coronary spasms and endothelium independent vasoconstriction via protein kinase C. In addition, rheological side effects have to be considered. Coronary artery disease is judged to increase the risk of cardiac side effects. Despite lack of prospective trials, verapamil type calcium antagonists as well as nitrates seem to be useful for treatment of 5-FU induced coronary spasms. In addition, modification of the cytostatic regimen has to be considered in patients who had been symptomatic. It could be assumed that 5-FU toxicity is reversible in the majority of cases when acute complications, e.g., arrhythmias, are resolved.

Publication types

  • Review

MeSH terms

  • Animals
  • Antimetabolites, Antineoplastic / adverse effects*
  • Antimetabolites, Antineoplastic / therapeutic use
  • Antimetabolites, Antineoplastic / toxicity
  • Coronary Vasospasm / chemically induced
  • Coronary Vasospasm / drug therapy
  • Endothelium, Vascular / drug effects
  • Fluorouracil / adverse effects*
  • Fluorouracil / therapeutic use
  • Fluorouracil / toxicity
  • Heart / drug effects*
  • Heart Diseases / chemically induced*
  • Heart Diseases / drug therapy
  • Humans
  • Protein Kinase C / drug effects
  • Protein Kinase C / metabolism


  • Antimetabolites, Antineoplastic
  • Protein Kinase C
  • Fluorouracil