rasburicase


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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.

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.

Watch closely for signs and symptoms of hemolysis, especially in patients of African or Mediterranean descent.

Patient teaching

Teach parents and patient (as appropriate) to recognize and immediately report adverse effects, including hypersensitivity reaction.

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.

rasburicase

an antineoplastic antimetabolite used to reduce uric acid levels in children with leukemia or lymphoma and in chemotherapy patients with solid tumor malignancies.

rasburicase

Elitek Oncology An agent used in CA Pts with ↑ uric acid due to tumor lysis

rasburicase

An enzyme used to treat hyperuricaemia and prevent kidney failure in people with widespread cancer. A brand name is Fasturtec.
References in periodicals archive ?
8) Adequate hydration and the administration of allopurinol and rasburicase are recommended, but these preventive measures might be inadequate; one case describes acute renal failure occurring despite their use.
Total quantity or scope: Cladribine inj, inj carboplatin, cyclophosphamide, cytarabine inj, aprepitant, Rasburicase inj, fludarabine, fludarabine tbl.
The principle of tumour lysis syndrome, prophylaxis/treatment includes virgous hydration, adequate diuresis, control of hyperuricemia with rasburicase or allopurinol, regulation of serum electrolytes and dialysis should be the treatment options.
Table 1: Substances that can cause Methemoglobinemia (4) Inorganic Agents Nitrates, fertilizers, chlorates, copper sulfates --fungicides Organic Agents Amyl Nitrate, Isobutyl Nitrite, Sodium Nitrite, Nitroglycerin, Nitroprusside, Nitric Oxide, Nitrogen Dioxide, Trinitrotoluene, Combustion products Drugs Local Anesthetics: Benzocaine, Lidocaine, Prilocaine Pyridium, Anti-malarials --Primaquine, Chloroquine, Rasburicase, Cyclophosphamide, Ifosfamide, flutamide, Acetaminophen, Acetanilid, Phenacetic, celecoxib, Zopiclone, Methlene Blue (high doses in G6PD-Deficient patients) Antibiotics: Sulfonamides, Nitrofurantoins, P-aminosalicylic acid, Dapsone Industrial/Household Agents Aniline Dyes, Nitrobenzene, naphthalene (moth balls), aminophenol, nitroethane (nail polish remover)
Although rasburicase lowers uric acid more than allopurinol, there is currently no evidence of clinical benefit and it is extremely expensive.
Rasburicase, a recombinant uricolytic agent, has a new indication for the initial management of plasma uric acid levels in adults with leukemia, lymphoma, and solid tumor malignancies "who are receiving [anticancer] therapy expected to result in tumor lysis and subsequent elevation of plasma uric acid.
35) It was not long before rasburicase was being explored, in a small number of refractory patients, for the treatment of gout.
Rasburicase catalyzes the oxidation of uric acid to allantoin, which is easily excreted by the kidney.
Several strategies are available for the prevention and treatment of tumor lysis syndrome, with rasburicase being the most recent.
He contributed to the worldwide registration of Oxaliplatin (Eloxatin[R]) and Rasburicase (Fasturtec[R]/Elitek[R]), as well as the Gastric and Head & Neck indications for Docetaxel (Taxotere[R]).
Supply of medicinal products: Lipegfilgrastimum, Rasburicase, Pazopanib, Everolimus.