Names and pronunciation
(rass-burr′i-case) Elitek, Fasturtec
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Drug reference
(rass-burr′i-case) Elitek, Fasturtec
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Func. class.: Enzyme
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Chem. class.: Recombinant urate- oxidase enzyme
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ACTION: Catalyzes enzymatic oxidation of uric acid into an inactive and soluble metabolite (allantoin)
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USES: To reduce uric acid levels in patients with leukemia, lymphoma, or solid tumor malignancies who are receiving chemotherapy
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CONTRAINDICATIONS: Hyper sensitivity
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Black Box Warning: G6PD deficiency (Mediterranean, African descent), hemo- lytic reactions, methemoglobinemia reac- tions to product Precautions: Pregnancy, breastfeeding, children <2 yr, anemia, acute bronchospasm, angina, atony, African- American and Mediterranean patients, hypotension Black Box Warning: Anaphylaxis, inter- ference with uric acid measurements Black Box Warning: Interference: uric acid Black Box Warning: G6PD defi- ciency, hemolytic reactions, methemo- globinemia; these patients should not be given this product; screen patients who are at higher risk for these disorders Black Box Warning: Altered uric acid measurements: for accurate results, col- lect blood in prechilled tubes with heparin, place tubes on ice, test within 4 hr • GI symptoms: frequency of stools, cramping; if severe diarrhea occurs, fluid, electrolytes may need to be given
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SIDE EFFECTS CNS: Headache, fever CV: Chest pain, hypotension GI: Nausea, vomiting, anorexia, diar- rhea, abdominal pain, constipation, dyspepsia, mucositis HEMA: Neutropenia with fever, hemoly- sis, methemoglobinemia INTEG: Rash MISC: Edema SYST: Anaphylaxis, hemolysis, sepsis
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INTERACTIONS Increase: methemoglobinemia risk— local anesthetics Drug/Lab Test
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DOSAGE AND ROUTES • Adult/adolescent/infant: IV INFUSION 0.2 mg/kg as single daily dose × 5 days
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Available forms: Powder for inj 1.5, 7.5 mg/vial
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Administer: Intermittent IV INFUSION route • Determine number of vials that are needed based on weight, concentration required • Reconstitute with diluent provided, add 1 mL of diluent/each vial, swirl, withdraw amount needed, mix with NS to final volume of 50 mL, use within 24 hr, give over 30 min, do not use filter, use different line; if not possible, flush with ≥15 mL of saline before, after use • Chemotherapy started 4-24 hr after 1st dose
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Assess: • Blood studies: BUN, serum uric acid, urine creatinine clearance, electrolytes, CBC with differential before, during therapy • Monitor temperature; fever may indi- cate beginning infection; no rectal tem- peratures Black Box Warning: Anaphylax- is: dyspnea, urticaria, flushing, wheez- ing, swelling of lips, tongue, throat; have emergency equipment nearby
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Evaluate: • Therapeutic response: decreased uric acid levels in children when antineoplas- tics causing high uric acid levels used
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the reason for therapy, expected results • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected or if breastfeeding
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PHARMACOKINETICS Half-life 16-21 hr, duration up to 12 hr
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• Adult/adolescent/infant: IV INFUSION 0.2 mg/kg as single daily dose × 5 days
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