Any doctors / pharmacists around?

[MangoMayhem]

I've been prescribed three weeks of Efudix for my scalp - was told it may get inflamed but I have just been reading up on it and it seems it may affect fertility?

Can anyone confirm this - nothing about fertility was mentioned, I'm mid thirties and wanting to get pregnant.

Feeling really bleurgh.

Not a medic but I have used efudix before. From what I remember it’s not a medicine you want to get pregnant on. I’m not sure how dangerous it is when only used topically, but I do remember that being on the patient leaflet.

Regarding its use, it’s generally for pre-malignant skin lesions, sometimes actinic keratoses. It did make my skin go red/crusty/oozy/bloody, but it didn’t especially hurt. I used it for a month I think.

Thanks - not planning to get pregnant when on it but want to know it won't affect my fertility going forwards.

Thanks for the info on side effects - much appreciated!

(Ex nurse)

It contains a topical chemotherapy agent and so, in theory it could affect reproductive cells and studies have found effects in mice. Hence the warning info in packets re pregnancy & breastfeeding. However, the doses are low and whilst you do absorb the chemotoxic agent through your skin, you absorb it in such low levels that it is not shown to be harmful (so long as you follow prescriber instructions to the letter). You do need to protect against pregnancy whilst using it but topical fluorouracil at 5% as found in efudix is not thought to affect long term fertility in human females according to the scientific evidence. The data suggests that male fertility is affected by topical use but that doesn’t matter in your case as it is you applying it, not him.

pubmed.ncbi.nlm.nih.gov/30085306/

www.medicines.org.uk/emc/medicine/6219#gref

Have a chat with your prescriber or pharmacist if you need to know more,

Thank you very much.

It's really weird that none of this was actually explained to me!

I seem to remember it not being mentioned at all to me either; I rather suspect that topical is really low risk. I wouldn’t get pregnant while using it, but I don’t think there can be any real risk to future fertility as it wasn’t mentioned to me either.

Remember that fluorouracil (the active ingredient) is also given intravenously as a chemotherapy agent. That is probably where the real fertility risk resides.

That is strange the risk was never mentioned to you. I remember my dermatologist was going to prescribe me something (can't remember off the top of my head what it was called), but it was aggressive treatment for acne. She went on and on about not getting pregnant while on this treatment, make sure my birth control is completely water tight, how it could affect an unborn baby etc. I decided not to go on this treatment and went for an unharmful antibiotic instead, continued taking my birth control with precision anyway. Found out I was pregnant a few weeks later! Really scares me to think what could have happened otherwise.

I don’t think it would be the same medicine though @freecuthbert. For acne you were probably discussing a retinoid which also has implications for foetal development.

Efudix contains a chemotherapy agent that absolutely is harmful to fertility when used as an intravenous infusion, I’m not sure if it’s as risky topically, and I think fertility effects unlikely too. But yep, definitely not mentioned by the doc either way.

Oh sorry, I knew it wasn't the same medication, I was just saying I'm surprised they didn't go on about the importance of birth control etc as the acne treatment suggested to me had similar risks

I think the acne treatment is quite harmful even topically, I guess the efudix might not be such a worry? Idk - but like OP I was very confused that it wasn’t mentioned. But it wasn’t even on the hospital information sheet, just the patient leaflet.

Topical efudix is also linked with birth defects as it is teratogenic (contains agents which affect developing embryo/foetus), that’s why should not get pregnant whilst using the medication. As you say @cakefanatic, low dose topical use according to strict prescribed instructions is probably unlikely to cause harm but it is a known teratogen and so it is wise to adhere to the package insert advice. It is odd that pregnancy prevention wasn’t mentioned by the prescriber or the pharmacist if you are a woman of childbearing age.