Names and pronunciation
(peg-loe′ti-kase) Krystexxa
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Drug reference
(peg-loe′ti-kase) Krystexxa
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Func. class.: Antigout agent
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Chem. class.: Pegylated, recombinant, mammalian urate oxidase enzyme
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ACTION: Lowers plasma uric acid con- centration by converting uric acid to allan- toin, which is readily excreted by the kidneys
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USES: Chronic gout in patients experiencing treatment failure
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CONTRAINDICATIONS:
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Black Box Warning: Hypersensitivity, G6PD deficiency Precautions: Pregnancy, breastfeeding, children/infants/neonates, African- American patients, heart failure Black Box Warning: Requires special- ized setting, experienced clinician; seri- ous hypersensitivity; methemoglobinemia Black Box Warning: Specialized care setting: use only in facility where emer- gency equipment is available, anaphy- laxis may occur Black Box Warning: Infusion reactions: monitor for reactions for ≥1 hr after use Black Box Warning: Assess for G6PD deficiency, methemoglobinemia • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; avoid breast- feeding, excretion unknown
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SIDE EFFECTS CNS: Dizziness, fatigue, fever CV: Chest pain, heart failure, hypotension GI: Nausea, vomiting, diarrhea, constipation GU: Nephrolithiasis HEMA: Anemia INTEG: Ecchymosis, erythema, pruri tus, urticaria MS: Back pain, arthralgia, muscle spasm SYST: Antibody formation, infection, ana- phylaxis, infusion-related reactions RESP: Dyspnea, upper respiratory infection
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INTERACTIONS Do not use with urate-lowering agents (allopurinol, probenecid, febuxostat, sulfinpyrazone)
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DOSAGE AND ROUTES • Adult: IV INFUSION 8 mg over 2 hr q2wk
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Available forms: Sol for inj 8 mg/mL
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Administer: Intermittent IV INFUSION route • Reconstitute: visually inspect for particulate matter, discoloration when- ever sol/container permits; use aseptic technique; withdraw 8 mg (1 mL) of product/250 mL 0.9% NaCl or 0.45% NaCl; invert several times to mix, do not shake; discard remaining product P in vial • Premedicate: with antihistamines and corticosteroids in all patients and acetaminophen if deemed necessary to prevent anaphylaxis, infusion site reactions • Infusion: if refrigerated, allow to come to room temperature; do not warm artificially; give over 120 min; do not give IV push or bolus; use infusion by gravity feed, syringe-type pump, or infusion pump; given in a specialized setting by those who can manage ana- phylaxis or inj-site reactions; monitor during and for 1 hr after infusion; if reaction occurs, slow or stop infusion, may be restarted at a slower rate; do not admix • Store diluted product in refrigerator or at room temperature for up to 4 hr; refrigerator is preferred; protect from light; do not freeze; use within 4 hr of preparation
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Assess: • Gout: pain in big toe, feet, knees, red- ness, swelling, tenderness lasting a few days to weeks; intake of alcohol, purines, if patient is overweight or taking diuretics • Obtain uric acid levels at baseline, before administration; 2 consecutive uric acid levels of >6 mg/dL may indi- cate therapy failure; greater chance of anaphylaxis; infection-related reac- tions
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Evaluate: • Therapeutic response: decrease uric acid levels; relief of pain, swelling, red- ness in toes, feet, knees
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About reason for infusion, expected results • To notify prescriber during infusion of allergic reactions or redness, swelling, pain at infusion site • That continuing follow-up exams and uric acid levels will be needed
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PHARMACOKINETICS Remains primarily in intravascular space after administration, elimination half-life 2 wk, mean nadir uric acid con- centration 24-72 hr
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• Adult: IV INFUSION 8 mg over 2 hr q2wk
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