rasburicase

Therapeutic Classification: antigout agents, antihyperuricemics

Pharmacologic Classification: enzymes

Indications ⬆ ⬇

REMS

Initial management of increased uric acid levels in patients with leukemia, lymphoma, or other malignancies who are being treated with antineoplastics, which are expected to produce hyperuricemia.

Action ⬆ ⬇

An enzyme that promotes the conversion of uric acid to allantoin, an inactive water-soluble compound.
Produced by recombinant DNA technology.

Therapeutic effects:

Decreased sequelae of hyperuricemia (nephropathy, arthropathy).

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Unknown.

Half-Life: 18 hr.

Time/Action Profile ⬆ ⬇

(↓ in uric acid)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	unknown	4–24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Glucose-6-phosphate dehydrogenase (G6PD) deficiency (↑ risk of severe hemolysis);
Previous allergic reaction, hemolysis, or methemoglobinemia from rasburicase;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

None reported.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rash

GI: abdominal pain, constipation, diarrhea, mucositis, nausea, vomiting

Hemat: HEMOLYSIS, METHEMOGLOBINEMIA, neutropenia

Neuro: headache

Resp: respiratory distress

Misc: fever, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), sepsis

Interactions ⬆ ⬇

Drug-drug:

None reported.

Route/Dosage ⬆ ⬇

IV (Adults and Children ): 0.2 mg/kg once daily for 5 days.

Availability ⬆ ⬇

Lyophilized powder for injection: 1.5 mg/vial; 7.5 mg/vial

Assessment ⬆ ⬇

Monitor for hypersensitivity reaction (chest pain, dyspnea, hypotension, urticaria). If severe reaction occurs, permanently discontinue rasburicase.

Lab Test Considerations:

Monitor patients for hemolysis. Screen patients at higher risk for G6PD deficiency (patients of African or Mediterranean ancestry) prior to therapy. If hemolysis occurs, permanently discontinue rasburicase.
- May cause methemoglobinemia. If methemoglobinemia confirmed, permanently discontinue rasburicase.
- May cause spuriously low uric acid levels in blood samples left at room temperature. Collect blood for uric acid levels in prechilled tubes containing heparin and immediately immerse and maintain in an ice water bath. Uric acid must be analyzed in plasma. Plasma samples must be assayed within 4 hr of collection.

Implementation ⬆ ⬇

Chemotherapy is initiated 4–24 hr after 1st dose of rasburicase.

IV Administration:

Intermittent Infusion: Reconstitution: Add 1 mL of diluent provided to each vial and mix by swirling gently. Do not shake or vortex. Reconstitute 7.5 mg vial with 5 mL of diluent. Solution should be clear and colorless. Do not use solution if discolored or contains particulates. Diluent: Remove dose from reconstituted vials and inject into infusion bag of 0.9% NaCl for a final total volume of 50 mL. Administer within 24 hr of reconstitution. Store reconstituted or diluted solution in refrigerator for up to 24 hr.
Rate: Administer over 30 min. Do not administer as a bolus. Infuse through a separate line. Do not use a filter with infusion. If separate line is not possible, flush line with ≥15 mL of 0.9% NaCl prior to infusion.
Y-Site Incompatibility:
- blinatumomab

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
Instruct patient to notify health care provider immediately if difficulty breathing, chest pain, or hives occur.
Rep: May cause fetal harm. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected and to avoid breastfeeding during and for 2 wk after last dose.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇