Asparaginase

Cytostatic · Protein synthesis inhibitor

Indications

Acute Lymphocytic Leukaemia.

Dosage

Acute Lymphocytic Leukaemia: Adults & Children: 1000 IU/kg IV every day x 10 days beginning day 22 of treatment period or 6000 IU/m² IM on days 4,7,10,13,16,19,22,25, & 28.

Administration

May be administered IV, IM, or SC. IM inj should be given as a deep inj into a large muscle. IV inf in 50-250 mL of D5W or NS over at least 60 min; a small test dose (0.1 mL of dilute 20 unit/mL solution) should be given first. Compatibility: Stable in NS, D5W. Reconstitution: Lyophilized powder should be reconstituted with 1-5 mL SWFI for IV administration or NS for IM use. Stability: Store intact vial in refrigerator. The reconstituted solution should be stored under refrigeration and can be used within 8 hours as long as the solution is clear. If the solution becomes turbid, it should be discarded.

Adverse Effects

Fatigue, fever, chills, depression, agitation, seizure, somnolence, confusion, coma, nausea, vomiting, loss of appetite, stomach cramps, acute pancreatitis, hypofibrinogenaemia, decrease in number of clotting factors, hypotension, angioedema, bronchospasm, anaphylaxis, increased bilirubin, transaminases and alkaline phosphatase, azotaemia, stomatitis, disseminated intravascular coagulation, anaemia, leucopenia, thrombocytopenia, anorexia, wt loss, hypoalbuminaemia, hyperglycaemia, hypoglycaemia, dizziness, thrombosis, haemorrhage, GI upset, acute pancreatitis, altered LFTs and coagulation parameters, metabolic disturbances. Reports of hyperuricaemia, hyperammonaemia, reversible posterior leukoencephalopathy syndrome, severe hepatic impairment.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Severe hepatic impairment, coagulopathy, pancreatitis, serious haemorrhage or serious thrombosis with previous asparaginase therapy. Precautions: May alter hepatic function; use caution with pre-existing liver impairment. Serious thrombosis; discontinue. Monitor coagulation parameters; use cautiously in patients with underlying coagulopathy. May cause serious and possibly fatal pancreatitis; discontinue if pancreatitis/severe abdominal pain develops. Philadelphia chromosome-positive patients. Elderly.

Interactions

Dexamethasone, drugs metabolised by liver, hepatotoxic drugs, immunosuppressants, vincristine, glucocorticoids, anticoagulants, methotrexate, cytarabine, live vaccines, oral contraceptives.

Advice to Patient

This medication is administered intramuscularly or intravenously. Inform prescriber immediately if you feel burning or pain at infusion or injection site, chest pain, rash, chest tightness, difficulty in breathing or swallowing, sharp back pain. Contact prescriber if there is unusual fever or chills, agitation, depression, confusion, unusual bruising or bleeding, yellowing of eyes or skin, vaginal discharge or unhealed sores. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Take small, frequent meals to maintain good nutritional status.

Pharmacokinetics

Half-life elimination: IV: 8-30 hrs. IM: 34-49 hrs. Time to peak, plasma: IM: 14-24 hrs.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.