pegaspargase

pegaspargase /peg·as·par·gase/ (-as´pahr-jas) -asparaginase covalently linked to polyethylene glycol, used as an antineoplastic in the treatment of acute lymphoblastic leukemia.

---

pegaspargase (PEG-L-asparaginase) Warning - Hazardous drug!

Oncaspar

Pharmacologic class: Enzyme

Therapeutic class: Antineoplastic

Pregnancy risk category C

Action

Stimulates production of effector proteins, such as serum neopterin and 2', 5' oligodenylate synthetase; raises body temperature and reversibly lowers white blood cell and platelet counts

Availability

Injection: 750 international units/ml, 5-ml vial in phosphate-buffered saline solution

⊘Indications and dosages

➣ Acute lymphoblastic leukemia

Adults and children with body surface area (BSA) greater than 0.6 m²: 2,500 international units/m² I.M. or I.V. q 14 days

Adults and children with BSA less than 0.6 m²: 82.5 international units/m² I.M. or I.V. q 14 days

Contraindications

• Hypersensitivity or previous serious allergic reaction (such as generalized urticaria, bronchospasm, laryngeal edema, hypotension) to drug
• Pancreatitis or history of pancreatitis
• Previous hemorrhagic events related to L-asparaginase therapy

Precautions

Use cautiously in:
• renal or hepatic disease, CNS disorders
• concurrent use of hepatotoxic agents, anticoagulants, aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs)
• pregnant or breastfeeding patients.

Administration

☞ Follow facility protocol for handling, preparing, and disposing of chemotherapeutic drugs.
☞ Avoid inhaling vapors and contact with skin or mucous membranes.
☞ Keep resuscitation equipment, epinephrine, oxygen, steroids, and antihistamines readily available.
• Know that I.M. route is preferred because it's less likely to cause hepatotoxicity, coagulopathy, and GI or renal disorders. For single I.M. injection, don't exceed volume of 2 ml.
• For I.V. use, dilute in 100 ml of normal saline solution or dextrose 5% in water. Infuse over 1 to 2 hours.
☞ Don't freeze; freezing inactivates drug.

Route	Onset	Peak	Duration
I.V.	Unknown	72-96 hr	2 wk
I.M.	Unknown	Unknown	Unknown

Adverse reactions

CNS: dizziness, headache, confusion, hallucinations, emotional lability, drowsiness, neuritis, Parkinson-like syndrome, malaise, coma, seizures

CV: hypertension, hypotension, chest pain, peripheral edema, tachycardia, endocarditis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, anorexia, pancreatitis

GU: glycosuria, polyuria, urinary frequency, hematuria

Hematologic: hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia, disseminated intravascular coagulation

Hepatic: jaundice, fatty liver deposits, hepatotoxicity, hepatomegaly

Metabolic: hypoproteinemia, hyperuricemia, hyperammonemia, hyponatremia, hyperglycemia, hypoglycemia

Respiratory: dyspnea, cough, bronchospasm

Skin: rash, urticaria, pruritus, night sweats, alopecia

Other: increased appetite and thirst, weight loss, chills, fever, injection site reaction, facial or lip edema, hypersensitivity reactions including anaphylaxis, septic shock

Interactions

Drug-drug. Aspirin, dipyridamole, heparin, NSAIDs, warfarin: increased risk of bleeding or thrombosis

Methotrexate: decreased methotrexate action

Drug-diagnostic tests. Amylase, blood urea nitrogen, creatinine, lipase, uric acid: increased levels

Glucose: increased or decreased level

Liver function tests: abnormal results

Lymphoblasts: decreased count

Plasma proteins: altered levels

Patient monitoring

☞ Watch for anaphylaxis and other hypersensitivity reactions, especially during first hour of therapy.
• Monitor CBC (including platelet count); fibrinogen; prothrombin and partial thromboplastin times; International Normalized Ratio; and serum amylase, lipase, and uric acid levels.
☞ Assess neurologic status. Stay alert for decreased level of consciousness and evidence of impending seizure.
• Check for signs and symptoms of bleeding, infection, and hyperglycemia.
• Monitor heart rate, blood pressure, respiratory rate, temperature, and fluid intake and output.

Patient teaching

☞ Teach patient to recognize and immediately report signs and symptoms of hypersensitivity reactions, bleeding, infection, and other adverse reactions.
• Tell patient drug is likely to cause reversible hair loss.
• Stress importance of undergoing follow-up laboratory tests.
• Advise patient to avoid situations that increase risk for infection.
• Instruct patient to consult prescriber before taking other prescription drugs or over-the-counter preparations.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.