am ide ▁and ▁hydro xy fl ut am ide ▁enh ance ▁their ▁mit och ond rial ▁to x icity ; ▁b ical ut am ide , ▁in ▁contrast , ▁poss esses ▁a ▁cy ano ▁group ▁in ▁place ▁of ▁the ▁nit ro ▁mo iety , ▁greatly ▁reducing ▁the ▁potential ▁for ▁such ▁to x icity . ▁ ▁The ▁he pat ot ox icity ▁of ▁fl ut am ide ▁appears ▁to ▁depend ▁on ▁hydro ly s is ▁of ▁fl ut am ide ▁catal yz ed ▁by ▁an ▁ar y lac et am ide ▁de ac et aly se ▁en zym e . ▁This ▁is ▁analog ous ▁to ▁the ▁he pat ot ox icity ▁that ▁occurs ▁with ▁the ▁with dra wn ▁par ac et am ol ▁( ac et omin oph en )- related ▁medic ation ▁phen ac et in . ▁In ▁accord ance , ▁the ▁combination ▁of ▁par ac et am ol ▁( ac et amin oph en ) ▁and ▁fl ut am ide ▁appears ▁to ▁result ▁in ▁add itive ▁to ▁syn erg istic ▁he pat ot ox icity , ▁indicating ▁a ▁potential ▁drug ▁interaction . ▁ ▁O thers ▁Fl ut am ide ▁has ▁also ▁been ▁associated ▁with ▁inter st it ial ▁p neum on itis ▁( which ▁can ▁progress ▁to ▁pul mon ary ▁fib ros is ). ▁The ▁inc idence ▁of ▁inter st it ial ▁p neum on itis ▁with ▁fl ut am ide ▁was ▁found ▁to ▁be ▁ 0 . 0 4 % ▁( 4 ▁per ▁ 1 0 , 0 0 0 )