Class: Supportive care
Generic Name: Rasburicase
Trade Name: Elitek®
How is this drug used? Rasburicase is FDA approved for the management of uric acid levels in pediatric patients with leukemia, lymphoma and solid tumor malignancies who are receiving anti-cancer therapy expected to result in tumor lysis syndrome and subsequent elevation of uric acid in the blood. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Rasburicase causes an reaction with an enzyme that turns uric acid into an inactive substance, allantoin, thereby reducing uric acid levels.
Tumor lysis syndrome (TLS) is the development of electrolyte and metabolic disturbances that may occur following the treatment of cancer and can result in life-threatening complications if not managed appropriately. Tumor lysis syndrome is caused by the sudden, rapid death of cells, particularly cancer cells in patients with leukemia or lymphoma, in response to cancer therapies. Tumor lysis syndrome may occur spontaneously, although the occurrence of this is rare. When cancer cells are killed by therapy, they may spill their inner (intracellular) contents, which accumulate in the body faster than can be eliminated. These intracellular contents cause the metabolic and electrolyte disturbances that result in TLS. Hyperuricemia is a component of TLS, and refers to excess uric acid in the blood. Uric acid is the end product of the digestion of certain proteins and is normally eliminated through the urine. When excess uric acid is present, it is converted to crystals formed of sodium urate. These crystals may deposit in the tiny tubes that are part of the kidney and cause acute kidney damage, which can ultimately lead to kidney failure.
How is rasburicase given (administered)? Rasburicase is administered into a vein (intravenous) and the dose depends on several factors, including the size of the patient, the particular treatment regimen being used, and the overall health of the patient.
How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with rasburicase. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. In addition, blood levels of electrolytes and products of digestion or metabolism will be measured frequently, to monitor the extent of TLS.
Patients will also be monitored for allergic-type reactions that may occur with treatment with rasburicase, including difficulty breathing, chest pain, rash, hives, low blood pressure, closing of the throat and lightheadedness. Allergic reactions may be severe, including shock. Patients of African or Mediterranean ancestry may be at higher risk of side effects.
What are the common (occur in 30% or more of patients) side effects of treatment with rasburicase?
What are the less common (occur in 10% to 29% of patients) side effects of treatment with rasburicase?
• Abdominal pain
• Mouth sores
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• Eat small meals frequently to help alleviate nausea.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.
Are there any special precautions patients should be aware of before starting treatment?
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
When should patients notify their physician?
• Difficulty breathing
• Closing of the throat
• Lightheadedness, dizziness
• Chest pain
• Change in heart rate or rthythm
• Vision changes
• Swelling of ankles or feet
• Sudden weight gain
• Severe headache
• Swelling, pain or redness of one extremity and not the other
• Mouth sores
• Severe abdominal pain
• Prolonged constipation or diarrhea
• Prolonged or severe nausea or vomiting
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
Copyright © 2010 CancerConnect Last updated 07/10.
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