rasburicase


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rasburicase

Elitek, Fasturtek (UK)

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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

rasburicase

Elitek Oncology An agent used in CA Pts with ↑ uric acid due to tumor lysis
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

rasburicase

An enzyme used to treat hyperuricaemia and prevent kidney failure in people with widespread cancer. A brand name is Fasturtec.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
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References in periodicals archive ?
Since TLS is an acute emergency so early identification of high-risk patients, appropriate prophylactic interventions like hyper hydration, use of allopurinol, rasburicase and strict monitoring for its clinical complications like arrhythmia, AKI and central nervous system (CNS) manifestations in leukemic patients undergoing chemotherapy may help to decrease frequency, severity of TLS and improve outcome.2,4,5 There are number of local studies on various aspects of ALL but very few on incidences of TLS in children.
Paras Biopharmaceuticals has developed and is now offering clinical development and marketing collaboration for the following Biosimilars: Recombinant Teriparatide, Recombinant Anakinra (Kineret[R] Biosimilar), Recombinant Rasburicase and Recombinant Romiplostim (N-plate[R] Biosimilar).
Rasburicase is a recombinant preparation biosynthesized from a strain of genetically modified Saccharomyces cerevisae containing cDNA from A flavus that encodes for urate oxidase.
High-risk patients should be treated prophylactically with increased hydration along with rasburicase with the exception of patients with glucose6-phosphate dehydrogenase (G6PD) deficiency and hypersensitivity to rasburicase.
(6) There has been limited study of rasburicase, an injectable approved for tumor lysis, in the treatment of tophaceous gout.
Rasburicase, as an adjunct to aggressive hydration in order to preclude kidney injury, has been shown to effectively and safely reduce uric acid concentrations even in the neonatal period [15-17].
Uricases are enzymes, including rasburicase and pegloticase, which decompose uric acid into soluble products for excretion.
Common medications that are cited include dapsone, methylene blue, nitrofurantoin, primaquine, rasburicase, and NSAIDs [14].
For this purpose, a comprehensive search of literatures was performed using search terms like tumor lysis syndrome, incidence, hematological malignancy, risk factor, electrolyte abnormality, uric acid, allopurinol, rasburicase, febuxostat, and combination of these terms by using MEDLINE/PubMed, Hinari, the Cochrane library, and Google Scholar.
Her renal failure was treated with intravenous normal saline (her creatinine eventually trended down to 2.3 mg/dL) while her hyperuricemia was treated with rasburicase 6 mg (uric acid trended down to 7 mg/dL).
We diagnosed the tumor lysis syndrome and she was treated with furosemide and rasburicase. Anuria did not improve despite these treatments, and continuous hemodialysis was induced.