RASBURICASE
| RASBURICASE (ras-bur'i-case) Elitek, Fasturtec  Classifications: antigout agent; antimetabolite; Therapeutic: antigout Pregnancy Category: C |
Availability
1.5 mg/vial powder for injection
Action
A recombinant urate-oxidase enzyme produced by DNA technology from Aspergillus flavus. In humans, uric acid is the final step in the catabolic pathway of purines. Rasburicase catalyzes enzymatic oxidation of uric acid; thus it is only active at the end of the purine catabolic pathway.
Therapeutic Effect
Used to manage plasma uric acid levels in pediatric patients with leukemia, lymphoma, and solid tumor malignancies who are receiving anticancer therapy that results in tumor lysis, and therefore elevates plasma uric acid.
Uses
Initial management of increased uric acid levels secondary to tumor lysis.
Contraindications
Hypersensitivity to rasburicase; deficiency in glucose-6-phosphate dehydrogenase (G6PD); history of anaphylaxis or hypersensitivity reactions; hemolytic reactions or methemoglobinemia reactions to rasburicase; pregnancy (category C), lactation, children <1 mo.
Cautious Use
Patients at risk for G6PD deficiency (e.g., African or Mediterranean ancestry). Safety and efficacy in adults and elderly are unknown.
Route & Dosage
| Hyperuricemia Child (>1 mo): IV 0.15–0.2 mg/kg/d x 5 d starting 4–24 h before chemotherapy |
Administration
| Intravenous PREPARE: IV Infusion: Reconstitute each 1.5 mg vial with 1 mL of the provided diluent and mix by swirling very gently. Do not shake. Discard if particulate matter is visible or if product is discolored after reconstitution. Remove the predetermined dose from the reconstituted vials and inject into enough NS in an infusion bag to achieve a final total volume of 50 mL. ADMINISTER: IV Infusion: Give over 30 min. DO NOT GIVE BOLUS DOSE. Infuse through an unfiltered line used for no other medications. If a separate line is not possible, flush the line with at least 15 mL of saline solution before/after infusion of rasburicase. INCOMPATIBILITIES Do not mix or infuse with other drugs. |
- Immediately discontinue IV infusion and institute emergency measures for S&S of anaphylaxis including chest pain, dyspnea, hypotension, and/or urticaria.
Adverse Effects (≥1%)
Body as a Whole: Fever, sepsis, severe hypersensitivity reactions including anaphylaxis at any time during treatment. CNS: Headache. GI: Mucositis, vomiting, nausea, diarrhea, abdominal pain. Hematologic: Neutropenia. Skin: Rash.Diagnostic Test Interference
May give false elevations for uric acid if blood sample is left at room temperature.
Pharmacokinetics
Half-Life: 18 h.Nursing Implications
Assessment & Drug Effects
- Lab tests: Patients at higher risk for G6PD deficiency (e.g., patients of African or Mediterranean ancestry) should be screened prior to starting therapy as this deficiency is a contraindication for this drug.
- Lab test special instructions: Blood for uric acid analysis must be collected into prechilled tubes containing heparin anticoagulant and immediately immersed in an ice water bath. Plasma samples must be prepared by centrifugation in a precooled centrifuge (4° C) and plasma must be maintained in an ice water bath and analyzed for uric acid within 4 h of collection.
- Monitor closely for S&S of hypersensitivity and be prepared to institute emergency measures for anaphylaxis.
- Monitor cardiovascular, respiratory, neurological, and renal status throughout therapy.
Patient & Family Education
- Report immediately any distressing S&S to physician.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; 
Prototype drug