rasburicase
rasburicase
Pharmacologic class: Recombinant urate oxidase enzyme
Therapeutic class: Antimetabolite
Pregnancy risk category C
FDA Box Warning
• Drug may cause severe hypersensitivity reactions (including anaphylaxis), severe hemolysis in patients with G6PD deficiency, and methemoglobinemia. Withdraw immediately and permanently if patient shows evidence of these problems. Before starting therapy, screen patients at higher risk for G6PD deficiency (those of African or Mediterranean ancestry).
• Drug causes spuriously low uric acid levels.
Action
Catalyzes oxidation of uric acid into an inactive soluble metabolite
Availability
Powder for injection: 1.5 mg/vial
Indications and dosages
➣ Chemotherapy-induced hyperuricemia in patients with leukemia, lymphoma, or solid-tumor cancers
Adults and children: 0.2 mg/kg by I.V. infusion over 30 minutes as a single daily dose for 5 days. Chemotherapy should begin 4 to 24 hours after first dose.
Contraindications
• Hypersensitivity to drug or its components
• History of anaphylaxis, hemolytic anemia, or methemoglobinemia as a reaction to rasburicase
• G6PD deficiency
Precautions
Use cautiously in:
• pregnant or breastfeeding patients
• children younger than age 2.
Administration
• Know that patients at high risk for G6PD deficiency (those of African or Mediterranean descent) should be screened for this disorder before therapy starts.
• Give 4 to 24 hours before first chemotherapy dose, as ordered.
• Dilute by adding 1-ml vial of diluent provided. Swirl gently; don't shake. Dilute further by injecting diluted dose into infusion bag containing appropriate volume of normal saline solution, to achieve final volume of 50 ml.
• Administer daily by I.V. infusion over 30 minutes.
See Don't give as I.V. bolus.
• Don't use I.V. filters.
• Don't mix with other drugs. Use a separate I.V. line, or flush line with 15 ml of normal saline solution before and after infusing rasburicase.
• Know that more than one course of treatment isn't recommended.
Adverse reactions
CNS: headache
GI: nausea, vomiting, diarrhea, constipation, abdominal pain
Hematologic: neutropenia, methemoglobinemia, severe hemolysis (in patients with G6PD deficiency)
Respiratory: respiratory distress
Skin: rash
Other: fever, mucositis, hypersensitivity reactions including anaphylaxis, sepsis
Interactions
Drug-diagnostic tests. Neutrophils: decreased count
Uric acid: interference with measurement (if blood is at room temperature)
Patient monitoring
• Monitor for signs and symptoms of hypersensitivity reaction.
• Assess for respiratory distress and signs and symptoms of infection.
• Monitor CBC and uric acid level frequently.
See Watch closely for signs and symptoms of hemolysis, especially in patients of African or Mediterranean descent.
Patient teaching
See Teach parents and patient (as appropriate) to recognize and immediately report adverse effects, including hypersensitivity reaction.
See Tell patient or parents (as appropriate) drug may cause sepsis. Instruct patient or parents to monitor temperature and immediately report fever and other signs and symptoms of infection.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.