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asparaginase (Elspar)
Pharmacology:
Indications:
1) acute lymphocytic leukemia
2) lymphoma
3) acute myeloid leukemia [3]
Contraindications:
1) pancreatitis
2) hypersensitivity to E. coli asparaginase or component
- investigational preparation from Erwinia is available
Dosage:
1) reconstitute lyophylized powder with sterile water or normal saline for IV use or normal saline for IM use
2) shake well but not too vigorously
3) use 5 um in line filter
4) refrigerate reconstituted solutions: discard after 8 hours
5) injection 10,000 units
6) IM injections:
a) use 2 sites for IM injections > 2 mL
b) do not filter
7) be prepared to treat anaphylaxis
a) IV access should be established
b) be prepared for endotracheal intubation to maintain airway
c) antihistamine, epinephrine, oxygen, corticosteroids should be available Lyophylized powder: should be refrigerated
Adverse effects:
1) common (> 10%)
- immediate effects: fever/chills & nausea/vomiting in 50-60% of patients
- hepatotoxicity
- pancreatitis
- allergic reaction
- hyperammonemia
- thrombosis
2) less common (1-10%)
- hyperuricemia, mouth sores
3) uncommon (1-10%)
- leg vein thrombosis, hyperthermia, seizures, leukopenia (nadir about 14 days), hypotension, drowsiness, coma, fever, rash, pruritus, urticaria, transient diabetes mellitus, azotemia, coughing, laryngeal spasm, chills, malaise, hypersensitivity reactions
Drug interactions:
1) methotrexate
2) cyclophosphamide
3) mercaptopurine
4) vincristine
5) prednisone
Test interactions:
- decreases serum thyroxine & thyroxine-binding globulin
Specific
recombinant asparaginase erwinia chrysanthemi-rywn (Rylaze)
General
L-asparaginase (L-asparagine amidohydrolase, asparaginase-like protein 1, ASRGL1, ALP, CRASH)
antineoplastic agent (chemotherapeutic agent)
bacterial protein
Database Correlations
ENZYME 3.5.1.1
References
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Department of Veterans Affairs, VA National Formulary
- Deprecated Reference