Home Drug Guide Pegloticase

Drug Guide

Generic Name

Pegloticase

Brand Names Krystexxa

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/A

Drug-Herb Interactions

N/A

Nursing 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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.