imiglucerase


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imiglucerase

 [im″ĭ-gloo´ser-ās]
an analogue of the enzyme lacking in Gaucher's disease, used for treating the adult form of the disease; administered by intravenous infusion.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

imiglucerase

(i-mi-gloo-ser-ase) ,

Cerezyme

(trade name)

Classification

Therapeutic: replacement enzyme
Pregnancy Category: C

Indications

Treatment of symptomatic type 1 Gaucher’s disease.

Action

Prevents the accumulation of glucocerebrosides in cells. Replaces glucocerebrosidases that are deficient in type 1 Gaucher’s disease.

Therapeutic effects

Improvement in symptoms of Gaucher’s disease (anemia, thrombocytopenia, bone disease, splenomegaly, and hepatomegaly).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Widely distributed.
Metabolism and Excretion: Excreted mainly by the kidneys.
Half-life: 3.6–10.4 min.

Time/action profile (improvement in symptoms)

ROUTEONSETPEAKDURATION
IVunknownunknownunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: Pregnancy or lactation (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache

Cardiovascular

  • mild hypotension

Gastrointestinal

  • abdominal discomfort
  • nausea

Genitourinary

  • decreased urinary frequency

Dermatologic

  • pruritus
  • rash

Miscellaneous

  • antibody production (most frequent)
  • hypersensitivity reactions
  • fever

Interactions

Drug-Drug interaction

None significant.

Route/Dosage

Intravenous (Adults and Children) Range 2.5 units/kg 3 times weekly to 15–60 units/kg q 1–2 wk. Evaluate dosage every 6 mo for possible reduction.

Availability

Injection: 200 units/vial

Nursing implications

Nursing assessment

  • Monitor for an improvement in symptoms including hepatomegaly, splenomegaly, anemia, thrombocytopenia, bone demineralization, and increased appetite and energy level periodically throughout therapy. Assess liver and spleen size every 6 mo to determine effectiveness of therapy.
  • Monitor patient for signs of hypersensitivity reactions (pruritus, flushing, urticaria, angioedema, chest pain, dyspnea, hypotension). Pretreatment with antihistamines and decreasing rate of infusion usually allows patient to continue use.
  • Lab Test Considerations: Monitor hemoglobin and platelet count monthly to determine effectiveness of therapy. If hemoglobin is <7 g/dL or platelet count is <50,000, monitor every 2 wk; levels should increase with imiglucerase therapy.
    • Monitor serum acid phosphatase levels every 2 mo; levels should decrease with imiglucerase therapy.
    • Monitor chemistry panel every 6 mo during therapy.

Potential Nursing Diagnoses

Fatigue (Indications)
Risk for injury (Indications)

Implementation

  • On the day of use, after determining the correct amount of imiglucerase and appropriate number of vials, reconstitute each vial with 5.1 mL of sterile water for injection for a volume of 5.3 mL (40 units/mL). Withdraw 5 mL from each vial and pool with 0.9% NaCl for a final volume of 100–200 mL. Do not use a solution that is discolored or that contains particulate matter.
  • May also be administered undiluted.
  • Small dosage adjustments can be made to avoid discarding partially used bottles, as long as monthly dose remains unaltered.
  • Do not use imiglucerase after the expiration date. Does not contain a preservative. Stable for up to 12 hr at room temperature or if refrigerated.
  • Rate: Administer diluted solution over 1–2 hr or 0.5-1 unit/kg/min.
    • Undiluted solution may be administered at a rate no greater than 1 unit/kg/min.
  • Additive Incompatibility: Information unavailable. Do not admix with other drugs or solutions.

Patient/Family Teaching

  • Inform patient of the purpose of this medication and the importance of treatment at least every 4 wk. Imiglucerase helps control the symptoms but does not cure Gaucher’s disease. Lifelong therapy may be required..
  • Emphasize the importance of follow-up examinations and lab tests.

Evaluation/Desired Outcomes

  • Increasing hemoglobin and platelet counts and decreasing acid phosphatase levels, hepatomegaly, and splenomegaly. In pediatric patients, cachexia and wasting should diminish.
Drug Guide, © 2015 Farlex and Partners
References in periodicals archive ?
ET with imiglucerase has become the standard of care for treatment of significantly symptomatic Gaucher disease type 1.10,11 Eliglustat (Cerdelga) is a new oral oral glucosylceramide synthase inhibitor indicated for the long-term treatment of adult patients with Gaucher disease type 112, It is not affordable in Iraq under the financial hardship.
In 2003, due to the growing legal claims within the federal states and the difficulties for the managing bodies to meet the provision of these products, the possibility of centralised purchase of two medicines: Imiglucerase (for Gaucher's disease) and Pegylated Interferon (for hepatitis) was discussed in the TIC, as well as the demand from CONASS that the criteria for clinical inclusion of patients be revised as well as for the revision of the amounts provided by the Ministry of Health.
Specific therapy for the nonneuronopathic manifestations of Gaucher disease has been available since 1991 firstly in the form of the macrophage targeted placenta-derived glucocerebrosidase (alglucerase, Ceredase [R], Genzyme Corporation, MA) (7), and subsequently (1994 in USA and 1997 in Europe) by recombinant human enzyme, imiglucerase (Cerezyme[R], Genzyme Corporation, MA) (8).
In a recent study of patients treated with imiglucerase for 10 years, a positive effect was observed in skeletal symptoms, as well as a reduction of bone pain and crises in patients who suffer from them at baseline.
ENCORE is a multi-national, randomized, controlled, open-label, study designed to determine whether eliglustat tartrate is non-inferior to Cerezyme (imiglucerase for injection).
4.3.1 Enzyme replacement therapy (ERT): (1) imiglucerase, an analogue of human intracellular glucocerebrosidase, is the treatment of choice for types 1 and 3 Gaucher disease.
This affected production of Cerezyme (imiglucerase) for Gaucher disease and Fabrazyme (agalsidase beta) for Fabry disease.
Genzyme's patent covers novel culture processes that have been critical in enabling the company to produce Cerezyme (imiglucerase for injection) on a large scale, which has ensured that the therapy is available to patients in need throughout the world.
Since then, the Therapeutic Goods Administration has designated two biological drugs as orphans--rabies immunoglobulin and recombinant enzyme imiglucerase for replacement therapy in patients with Gaucher disease.