Home Drug Guide Asparaginase

Drug Guide

Generic Name

Asparaginase

Brand Names Elspar

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Enzyme (L-asparaginase)

FDA Approved Indications

  • Acute lymphoblastic leukemia (ALL) in combination with other chemotherapeutic agents

Mechanism of Action

Depletes asparagine, an amino acid necessary for tumor cell survival, by hydrolyzing it to aspartic acid and ammonia, thereby inhibiting protein synthesis in leukemic cells.

Dosage and Administration

Adult: Typically 10,000 IU/m² intravenously or intramuscularly daily, adjusted based on response and tolerability.

Pediatric: Usually 25,000 IU/m² IV/IM three times weekly, with adjustments for response and side effects.

Geriatric: Use cautiously; no specific dosage modifications established due to limited data.

Renal Impairment: No specific adjustments; monitor closely as pharmacokinetics may be altered.

Hepatic Impairment: Use with caution; hepatic function should be monitored.

Pharmacokinetics

Absorption: Rapidly absorbed when administered IM or IV.

Distribution: Widely distributed; crosses the blood-brain barrier to some extent.

Metabolism: Metabolized by the reticuloendothelial system and possibly by other enzymatic pathways.

Excretion: Excreted primarily via the reticuloendothelial system; specific pathways not well-defined.

Half Life: Approx. 8-30 hours, depending on dosing and individual patient factors.

Contraindications

  • History of hypersensitivity to E. coli derived asparaginase or any component of the formulation.

Precautions

  • Risk of hypersensitivity reactions, pancreatitis, coagulopathy, hepatic dysfunction, and allergic reactions. Use caution in patients with pre-existing hepatic or pancreatic conditions.

Adverse Reactions - Common

  • Hypersensitivity reactions (including anaphylaxis) (Common)
  • Pancreatitis (Uncommon)
  • Hepatotoxicity (elevated liver enzymes, hepatomegaly) (Uncommon)
  • Coagulopathies (bleeding or thrombosis) (Common)

Adverse Reactions - Serious

  • Severe allergic reactions/anaphylaxis (Rare)
  • Severe pancreatitis (Rare)
  • CNS effects (leukemia cutis, seizures) (Rare)

Drug-Drug Interactions

  • Corticosteroids may increase risk of hypersensitivity.
  • Other chemotherapeutic agents may enhance toxicity.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of allergic reactions, pancreatitis, hepatic dysfunction, bleeding, and thrombosis. Check baseline blood counts, liver function tests, and coagulation profile.

Diagnoses:

  • Risk for bleeding related to coagulopathy
  • Ineffective tissue perfusion related to thrombosis or bleeding
  • Risk for hypersensitivity reactions

Implementation: Administer as prescribed; premedicate with antihistamines if hypersensitivity history exists. Monitor vital signs and laboratory parameters frequently during treatment.

Evaluation: Assess for resolution of disease indicators, tolerability of therapy, and absence of adverse reactions.

Patient/Family Teaching

  • Report any allergic reactions immediately.
  • Be aware of signs of pancreatitis (severe abdominal pain, nausea).
  • Follow scheduled lab tests to monitor for toxicities.
  • Avoid vaccinations without consulting healthcare provider.

Special Considerations

Black Box Warnings:

  • Severe hypersensitivity reactions, including anaphylaxis, which can be life-threatening.

Genetic Factors: Patients with known hypersensitivity to E. coli derived products should not receive this medication.

Lab Test Interference: May affect coagulation tests and liver function tests, necessitating careful interpretation.

Overdose Management

Signs/Symptoms: Allergic reactions, hypersensitivity, hypotension, bronchospasm.

Treatment: Discontinue drug immediately; provide symptomatic and supportive care, including antihistamines, corticosteroids, and emergency interventions as needed.

Storage and Handling

Storage: Store refrigerated at 2-8°C, protected from light.

Stability: Stable until expiration date when refrigerated; avoid freezing.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.