Nurses Compass
Drug Guide
Pegloticase
Classification
Therapeutic: Antigout Agent
Pharmacological: Recombinant Uricase
FDA Approved Indications
- Treatment of chronic gout in adult patients refractory to other urate-lowering therapies
Mechanism of Action
Pegloticase is a pegylated recombinant uricase enzyme that catalyzes the conversion of uric acid to allantoin, a more soluble and easily excreted compound, thereby reducing serum uric acid levels.
Dosage and Administration
Adult: 8 mg IV over at least 2 hours every 2 weeks; premedicate with antihistamines and corticosteroids to reduce infusion reactions.
Pediatric: Not approved for pediatric use.
Geriatric: Use with caution; consider renal and hepatic function.
Renal Impairment: Adjustment not typically necessary, but monitor closely.
Hepatic Impairment: Use with caution; no specific dosage adjustments established.
Pharmacokinetics
Absorption: Not applicable (intravenous administration).
Distribution: Distributes throughout the vascular and extravascular compartments.
Metabolism: Metabolized by the reticuloendothelial system; no hepatic metabolism involved.
Excretion: Eliminated primarily via the reticuloendothelial system; allantoin is excreted in urine.
Half Life: Approximately 13 days.
Contraindications
- G6PD deficiency (risk of hemolytic anemia)
Precautions
- Allergic reactions, infusion reactions, gout flares, hypersensitivity, kidney impairment
Adverse Reactions - Common
- Infusion reactions ( frequent)
- Gout flare ( common)
- Nausea ( common)
Adverse Reactions - Serious
- Anaphylaxis ( rare)
- Hemolytic anemia (in G6PD deficiency) ( rare)
- Serious allergic reactions ( rare)
Drug-Drug Interactions
- Immunosuppressants may increase infection risk
- Other biologic agents
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor serum uric acid levels, renal function, and for signs of allergic reactions or infusion reactions.
Diagnoses:
- Risk for allergic reaction
- Risk for gout flare
Implementation: Administer IV infusion slowly, premedicate as per protocol, monitor for infusion reactions, and manage gout flares as needed.
Evaluation: Assess reduction in serum uric acid and patient response.
Patient/Family Teaching
- Report any signs of allergic reactions immediately.
- Notify healthcare provider if gout symptoms worsen or do not improve.
- Maintain hydration and follow dietary recommendations for gout.
Special Considerations
Black Box Warnings:
- Anaphylaxis can occur; proper monitoring during infusion is essential.
Genetic Factors: G6PD deficiency contraindicates use due to risk of hemolytic anemia.
Lab Test Interference: None noted.
Overdose Management
Signs/Symptoms: Severe allergic or infusion reactions, hemolytic anemia in G6PD deficiency.
Treatment: Discontinue infusion, provide supportive care, manage allergic reactions appropriately.
Storage and Handling
Storage: Store refrigerated at 2°C to 8°C (36°F to 46°F).
Stability: Stable until the expiration date when refrigerated.