Home Drug Guide Asparaginase

Drug Guide

Generic Name

Asparaginase

Brand Names Elspar

Classification

Therapeutic: Antineoplastic agent

Pharmacological: Enzyme (L-asparaginase)

FDA Approved Indications

Acute lymphoblastic leukemia (ALL) in combination with other chemotherapeutic agents

Mechanism of Action

Depletes asparagine, an amino acid necessary for tumor cell survival, by hydrolyzing it to aspartic acid and ammonia, thereby inhibiting protein synthesis in leukemic cells.

Dosage and Administration

Adult: Typically 10,000 IU/m² intravenously or intramuscularly daily, adjusted based on response and tolerability.

Pediatric: Usually 25,000 IU/m² IV/IM three times weekly, with adjustments for response and side effects.

Geriatric: Use cautiously; no specific dosage modifications established due to limited data.

Renal Impairment: No specific adjustments; monitor closely as pharmacokinetics may be altered.

Hepatic Impairment: Use with caution; hepatic function should be monitored.

Pharmacokinetics

Absorption: Rapidly absorbed when administered IM or IV.

Distribution: Widely distributed; crosses the blood-brain barrier to some extent.

Metabolism: Metabolized by the reticuloendothelial system and possibly by other enzymatic pathways.

Excretion: Excreted primarily via the reticuloendothelial system; specific pathways not well-defined.

Half Life: Approx. 8-30 hours, depending on dosing and individual patient factors.

Contraindications

History of hypersensitivity to E. coli derived asparaginase or any component of the formulation.

Precautions

Risk of hypersensitivity reactions, pancreatitis, coagulopathy, hepatic dysfunction, and allergic reactions. Use caution in patients with pre-existing hepatic or pancreatic conditions.

Adverse Reactions - Common

Hypersensitivity reactions (including anaphylaxis) (Common)
Pancreatitis (Uncommon)
Hepatotoxicity (elevated liver enzymes, hepatomegaly) (Uncommon)
Coagulopathies (bleeding or thrombosis) (Common)

Adverse Reactions - Serious

Severe allergic reactions/anaphylaxis (Rare)
Severe pancreatitis (Rare)
CNS effects (leukemia cutis, seizures) (Rare)

Drug-Drug Interactions

Corticosteroids may increase risk of hypersensitivity.
Other chemotherapeutic agents may enhance toxicity.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of allergic reactions, pancreatitis, hepatic dysfunction, bleeding, and thrombosis. Check baseline blood counts, liver function tests, and coagulation profile.

Diagnoses:

Risk for bleeding related to coagulopathy
Ineffective tissue perfusion related to thrombosis or bleeding
Risk for hypersensitivity reactions

Implementation: Administer as prescribed; premedicate with antihistamines if hypersensitivity history exists. Monitor vital signs and laboratory parameters frequently during treatment.

Evaluation: Assess for resolution of disease indicators, tolerability of therapy, and absence of adverse reactions.

Patient/Family Teaching

Report any allergic reactions immediately.
Be aware of signs of pancreatitis (severe abdominal pain, nausea).
Follow scheduled lab tests to monitor for toxicities.
Avoid vaccinations without consulting healthcare provider.

Special Considerations

Black Box Warnings:

Severe hypersensitivity reactions, including anaphylaxis, which can be life-threatening.

Genetic Factors: Patients with known hypersensitivity to E. coli derived products should not receive this medication.

Lab Test Interference: May affect coagulation tests and liver function tests, necessitating careful interpretation.

Overdose Management

Signs/Symptoms: Allergic reactions, hypersensitivity, hypotension, bronchospasm.

Treatment: Discontinue drug immediately; provide symptomatic and supportive care, including antihistamines, corticosteroids, and emergency interventions as needed.

Storage and Handling

Storage: Store refrigerated at 2-8°C, protected from light.

Stability: Stable until expiration date when refrigerated; avoid freezing.