Nurses Compass
Drug Guide
Rasburicase
Classification
Therapeutic: Antineoplastic, Urate-Lowering Agent
Pharmacological: Recombinant Uricase Enzyme
FDA Approved Indications
- Prevention and treatment of hyperuricemia related to tumor lysis syndrome in pediatric and adult patients with hematologic cancers
Mechanism of Action
Rasburicase catalyzes the conversion of uric acid into allantoin, which is more soluble and easily excreted by the kidneys, thereby reducing serum uric acid levels.
Dosage and Administration
Adult: Calculate dose based on body weight; administer intravenously over 30 minutes. Dose typically 0.2 mg/kg daily for up to 5 days.
Pediatric: Dosing based on body surface area or weight; administer intravenously over 30 minutes. Dosing varies; consult specific guidelines.
Geriatric: Use with caution; adjust dose if renal impairment present.
Renal Impairment: Adjust dosage based on renal function; monitor closely.
Hepatic Impairment: No specific adjustments indicated.
Pharmacokinetics
Absorption: Not applicable (administered IV).
Distribution: Distributed in extracellular fluid; high-volume distribution.
Metabolism: Metabolized by proteolytic enzymes; not renal or hepatic.
Excretion: Excreted as allantoin via urine.
Half Life: Approximately 19 hours.
Contraindications
- History of hypersensitivity to rasburicase or any component.
- G6PD deficiency.
Precautions
- Risk of hemolysis in G6PD deficiency; screen prior to administration.
- Use with caution in patients with glucose-6-phosphate dehydrogenase deficiency; may cause hemolytic anemia.
- Monitor for allergic reactions, including anaphylaxis.
Adverse Reactions - Common
- Pyrexia (Common)
- Nausea (Common)
- Headache (Common)
Adverse Reactions - Serious
- Anaphylaxis (Rare)
- Hemolytic anemia, especially in G6PD deficiency (Rare)
- Methemoglobinemia (Rare)
Drug-Drug Interactions
- None specifically noted, but caution with other drugs affecting G6PD status.
Drug-Food Interactions
- No significant interactions noted.
Drug-Herb Interactions
- Limited data; avoid unless known safe.
Nursing Implications
Assessment: Screen for G6PD deficiency before administration. Monitor serum uric acid levels, renal function, and for allergic reactions.
Diagnoses:
- Risk for Hemolytic Anemia
- Impaired renal function due to uric acid nephropathy
Implementation: Administer IV as per dosing schedule. Ensure patient is monitored during and after infusion.
Evaluation: Assess reduction in uric acid levels, renal function, and any allergic reactions.
Patient/Family Teaching
- Inform about the purpose of medication and possible side effects.
- Report signs of allergic reactions or unusual bleeding.
- Explain the importance of G6PD screening prior to administration.
Special Considerations
Black Box Warnings:
- Hemolysis risk in G6PD deficiency.
Genetic Factors: G6PD deficiency testing required before use.
Lab Test Interference: May artificially lower serum uric acid levels; interpret results with caution.
Overdose Management
Signs/Symptoms: Allergic reactions, hemolytic anemia, methemoglobinemia.
Treatment: Supportive care; discontinue drug, provide oxygen or transfusions as needed, emergency management for anaphylaxis.
Storage and Handling
Storage: Store in a refrigerator at 2°C to 8°C (36°F to 46°F).
Stability: Stable until the expiration date when stored properly.