Flucytosine

Mechanism of action
After penetration of fungal cells, flucytosine is converted to
fluorouracil, which competes with uracil and interferes with
fungal RNA and protein synthesis.
Clinical use
Flucytosine is used adjunctively to treat serious systemic fungal
infections caused by susceptible strains of Candida or
Cryptococcus. It is not used alone because of rapid emergence
of resistant fungal organisms.
Adverse effects
Flucytosine has been associated with bone marrow depression
as well as elevations in hepatic enzymes and bilirubin because
of acute liver injury. Unlike most antifungals, the drug is primarily
eliminated unchanged in the urine. As a result, the dose
of flucytosine must be decreased in patients with renal dysfunction;
these patients must be monitored closely.