Rasburicase
Pronunciation: ras-BURE-i-kase
Class: Antimetabolite
Trade Names
Elitek
- Injection, lyophilized powder for solution 1.5 mg
- Injection, lyophilized powder for solution 7.5 mg
Pharmacology
Catalyzes enzymatic oxidation of poorly soluble uric acid into an inactive and soluble metabolite (allantoin).
Pharmacokinetics
Distribution
Vd is 110 to 127 mL/kg in children and 75.8 to 138 mL/kg in adults.
Elimination
Half-life ranges from 15.7 to 22.5 h.
Special Populations
Renal Function ImpairmentCrCl did not impact the pharmacokinetics of rasburicase.
Hepatic Function ImpairmentBaseline liver enzymes did not impact the pharmacokinetics of rasburicase.
RaceThe geometric mean values of body weight–normalized Cl were approximately 40% lower in Japanese than in white patients.
Indications and Usage
Initial management of plasma uric acid levels in children and 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.
Unlabeled Uses
Gout.
Contraindications
Individuals with G-6-PD deficiency; known history of anaphylaxis or hypersensitivity; hemolytic or methemoglobinemia reactions to rasburicase or any of its excipients.
Dosage and Administration
Adults and ChildrenIV 0.2 mg/kg, infused over 30 min, as a single dose for 5 days.
General Advice
- For IV infusion only. Do not administer as a bolus injection.
- Follow manufacturer's instructions for reconstituting the powder for injection and subsequent further dilution. Reconstitute with the diluent provided.
- Do not administer if particulate matter, cloudiness, or discoloration is noted.
- Infuse over 30 min through a separate line or flush line with at least 15 mL of normal saline prior to and after infusion.
- Do not use filters during reconstitution or infusion of rasburicase.
Storage/Stability
Store vials at 36° to 46°F. Do not freeze. Protect from light. Store reconstituted or diluted solution at 36° to 46°F for up to 24 h. Discard unused product solution after 24 h.
Drug Interactions
None well documented.
Laboratory Test Interactions
At room temperature, rasburicase causes enzymatic degradation of uric acid in blood/plasma/serum samples, potentially resulting in spuriously low plasma uric acid assay readings. To avoid ex vitro uric acid degradation, uric acid must be analyzed in plasma. Blood must be collected into prechilled tubes containing heparin. Samples must be immediately immersed in an ice water bath. Plasma samples must be prepared by centrifugation in a precooled centrifuge (4°C). Finally, the plasma must be maintained in an ice water bath and analyzed for uric acid within 4 h of collection.
Adverse Reactions
Cardiovascular
Ischemic coronary artery disorders, supraventricular arrhythmias (2% or more).
CNS
Headache (26%); anxiety (24%).
Dermatologic
Rash (13%).
GI
Nausea (58%); vomiting (50%); abdominal pain (22%); constipation, diarrhea (20%); mucositis (15%); abdominal and GI infections (2% or more).
Hematologic
Hemolysis; methemoglobinemia
Hypersensitivity
Severe allergic reactions including anaphylaxis (eg, bronchospasm, chest paint and tightness, dyspnea, hypoxia, hypotension, shock, and urticaria.
Metabolic
Peripheral edema (50%); hypophosphatemia (17%); hyperbilirubinemia (16%); fluid overload (12%); hyperphosphatemia (10%).
Respiratory
Pulmonary hemorrhage, respiratory failure (2% or more).
Miscellaneous
Fever (46%); pharyngolaryngeal pain (14%); sepsis (12%); antibody formation, increased ALT (11%).
Precautions
WarningsAnaphylaxisMay cause severe hypersensitivity reactions, including anaphylaxis. Immediately and permanently discontinue rasburicase in a patient who develops clinical evidence of a serious hypersensitivity reaction. HemolysisDo not administer to patients with G-6-PD deficiency. Immediately and permanently discontinue rasburicase in patients developing hemolysis. Screen patients at higher risk for G-6-PD deficiency before starting therapy. MethemoglobinemiaMay occur. Immediately and permanently discontinue rasburicase in a patient who develops methemoglobinemia. Interference with uric acid measurementsRasburicase enzymatically degrades uric acid in blood samples left at room temperature. Collect blood samples in prechilled tubes containing heparin and immediately immerse and maintain sample in an ice water bath. Assay plasma samples within 4 h of collection. |
MonitorMonitor all patients for allergic reactions (eg, bronchospasm, chest pain and tightness, dyspnea, hypoxia, hypotension, shock, urticaria), hemolysis, and methemoglobinemia. |
Pregnancy
Category C .
Lactation
Undetermined.
Overdosage
Symptoms
None well documented.
Patient Information
- Advise patient, family, or caregiver that medication will be prepared and administered by a health care provider in a medical facility.
- Advise patient or caregiver to report the following to health care provider: allergic reactions, bronchospasm, chest pain or tightness, dyspnea, hypotension, hypoxia, intolerable injection-site reactions, shock, urticaria, or any unusual symptoms.
Copyright © 2009 Wolters Kluwer Health.
More Rasburicase resources
- Rasburicase Monograph (AHFS DI)
- rasburicase Concise Consumer Information (Cerner Multum)
- rasburicase MedFacts Consumer Leaflet (Wolters Kluwer)
- rasburicase Intravenous Advanced Consumer (Micromedex) - Includes Dosage Information
- Elitek Prescribing Information (FDA)
