Home Drug Guide Pegaspargase

Drug Guide

Generic Name

Pegaspargase

Brand Names Oncaspar

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Enzyme, L-asparaginase

FDA Approved Indications

  • Acute lymphoblastic leukemia (ALL) in patients who have received prior therapy including asparaginase

Mechanism of Action

Pegaspargase depletes asparagine, an amino acid necessary for the survival of leukemia cells; it catalyzes the hydrolysis of asparagine to aspartic acid and ammonia, depriving cancer cells of an essential amino acid.

Dosage and Administration

Adult: Dose varies; typically 2,500 units/m^2 once every 14 days, administered intravenously or intramuscularly.

Pediatric: Dose varies based on body surface area; administered every 14 days.

Geriatric: Use with caution; no specific dose adjustments established.

Renal Impairment: No specific adjustments; monitor closely.

Hepatic Impairment: Use with caution; no specific adjustments established.

Pharmacokinetics

Absorption: Administered parenterally; absorption data not applicable.

Distribution: Widely distributed, including into cerebrospinal fluid and tissues.

Metabolism: Metabolized in the blood and tissues; cleared via hepatic routes.

Excretion: Excreted primarily through the hepatic system.

Half Life: Approximately 5.7 days (variable).

Contraindications

  • History of severe hypersensitivity to pegaspargase or other asparaginases

Precautions

  • Risk of allergic reactions, including anaphylaxis
  • Pancreatitis, hepatotoxicity, thrombosis, bleeding, and coagulopathy
  • Monitor for hypersensitivity reactions especially during and after infusion

Adverse Reactions - Common

  • Nausea, vomiting (Common)
  • hypersensitivity reactions, including anaphylaxis (Uncommon)
  • Pancreatitis (Uncommon)

Adverse Reactions - Serious

  • Hypersensitivity reactions including anaphylaxis (Rare)
  • Pancreatitis leading to severe complications (Rare)
  • Hepatotoxicity with liver failure (Rare)
  • Thrombosis and coagulopathy (Rare)
  • Neurotoxicity (Rare)

Drug-Drug Interactions

  • Other chemotherapeutic agents, especially methotrexate, potentially increasing toxicity

Drug-Food Interactions

  • No significant food interactions reported

Drug-Herb Interactions

  • No well-established interactions

Nursing Implications

Assessment: Monitor for hypersensitivity reactions, signs of bleeding, signs of pancreatitis, liver function, coagulation parameters.

Diagnoses:

  • Risk for allergic reaction, Risk for bleeding, Risk for pancreatitis

Implementation: Administer as ordered; premedicate if necessary; monitor vital signs during infusion; have emergency equipment available.

Evaluation: Assess for adverse reactions, treatment response, and signs of toxicity.

Patient/Family Teaching

  • Report any allergic reactions, difficulty breathing, swelling, or rash immediately.
  • Inform about possible side effects such as nausea, pancreatitis symptoms, and signs of bleeding.
  • Follow schedule for doses and attend all follow-up appointments.

Special Considerations

Black Box Warnings:

  • Serious allergic reactions including anaphylaxis, serum sickness, and severe hypersensitivity
  • Pancreatitis leading to death or severe long-term sequelae

Genetic Factors: No specific genetic testing recommended before use.

Lab Test Interference: May interfere with blood clotting tests, causing false readings.

Overdose Management

Signs/Symptoms: Allergic reactions, hypersensitivity, pancreatitis, bleeding disorders.

Treatment: Discontinue drug immediately; provide supportive care including antihistamines, corticosteroids, fluids; manage adverse effects as required.

Storage and Handling

Storage: Store at 2°C to 8°C (36°F to 46°F). Do not freeze.

Stability: Stable when refrigerated; protect from light.

🛡️ 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.