Asparaginase


Concise Prescribing Info
Indications/Uses
Acute lymphoblastic leukaemia.
Dosage/Direction for Use
Adult : Parenteral As colaspase: 5,000 IU/m2 every 3rd day. As crisantaspase: 6,000 IU/m2 3 times/wk for 3 wk. Alternatively, as substitute, 25,000 IU/m2 for each planned colaspase dose, or 25,000 IU/m2 3 times/wk for 6 doses for each planned pegaspargase dose. As pegaspargase: 2,500 IU/m2, no more frequently than every 14 days.
Dosage Details
Parenteral
Acute lymphoblastic leukaemia
Adult: As colaspase: 5,000 IU/m2 via IV infusion over 0.5-2 hr given every 3rd day. As crisantaspase: 6,000 IU/m2 (200 IU/kg) via IM, IV or SC inj 3 times wkly for 3 wk. Alternatively, when used as substitute, 25,000 IU/m2 for each planned colaspase dose, or 25,000 IU/m2 3 times wkly (Mon/Wed/Fri) for 6 doses for each planned pegaspargase dose, given via IM or IV inj. As pegaspargase: 2,500 IU/m2 via IM inj (Max 2 mL/inj site) or IV infusion over 1-2 hr, no more frequently than every 14 days.
Child: >1 yr As colaspase: Same as adult dose.
Hepatic Impairment
As colaspase: Severe: Contraindicated.
Reconstitution
Colaspase (IV infusion): Dilute w/ NaCl 0.9% inj to a final volume of 50-250 mL. Crisantaspase (IM/IV/SC): Add 1 or 2 mL of preservative-free NaCl 0.9% inj to provide a soln containing 10,000 or 5,000 IU/mL, respectively, injected slowly against the inner wall of the vial, gently mixed and swirled. Do not shake or invert. Pegaspargase (IV infusion): Dilute in 100 mL NaCl or dextrose 5% inj.
Incompatibility
Incompatible w/ rubber.
Contraindications
History of serious pancreatitis, hypersensitivity, serious thrombotic (e.g. sagittal sinus thrombosis, pulmonary embolism) and haemorrhagic events related to asparaginase therapy. Lactation. Severe hepatic impairment (as colaspase).
Special Precautions
Patient w/ mild pancreatitis, hyperglycaemia. Hepatic impairment.
Adverse Reactions
Hyperglycaemia, abnormal transaminase level, hyperbilirubinaemia, local reactions; nausea, vomiting, abdominal discomfort, diarrhoea; fever, rash, dyspnoea, bronchospasm, urticaria, hypotension, laryngeal oedema; altered blood lipids and cholesterol, hypoalbuminaemia, hyperammonaemia, uraemia, renal failure; drowsiness, depression, lethargy, confusion, dizziness, neurotoxicity, hallucination, seizure, Parkinson-like syndrome. Rarely, myalgia, reactive arthritis, transient bone-marrow depression, marked leucopenia.
Potentially Fatal: Serious hypersensitivity reactions (e.g. anaphylaxis), acute pancreatitis, hepatotoxicity, thrombosis, coagulopathy, ketoacidosis, hyperthermia.
IM/IV/Parenteral/SC: C
MonitoringParameters
Monitor CBC w/ differential, amylase, lipase, insulin, triglycerides, blood glucose, and coagulation parameters. Perform LFT regularly. For colaspase, monitor trough serum asparaginase activity 3 days after admin.
Drug Interactions
Increased risk of anaphylaxis and neurotoxicity w/ vincristine. May increase the risk of coagulation abnormality w/ corticosteroid (e.g. prednisone). May diminish the effect on malignant cells of methotrexate. May increase serum concentration of dexamethasone.
Lab Interference
Interferes w/ thyroid function tests by producing transient reduction of thyroxine-binding globulin concentration.
Action
Description: Asparaginase, an antineoplastic agent, reduces L-asparagine circulating levels by catalysing the deamidation of the amino acid to aspartic acid and ammonia. This results in inhibition of the cellular proliferation of leukemic cells, which lack asparagine synthetase and depend upon exogenous source of asparagine for survival. It is derived from E coli as colaspase (unconjugated) and as pegaspargase (conjugated w/ polyethylene glycol), or from Erwinia chrysanthemi as crisantaspase.
Pharmacokinetics:
Absorption: Time to peak plasma concentration: 1-2 hr (as crisantaspase).
Distribution: Distributed mainly w/in the intravascular space; approx 20% in the lymph.
Excretion: Via urine (in small amount). Elimination half-life: Colaspase: 14.2-44.2 hr. Crisantaspase: Approx 7.5 hr (IV); approx 16 hr (IM).
Storage
Store between 2-8°C. Protect from light.
ATC Classification
L01XX02 - asparaginase ; Belongs to the class of other antineoplastic agents. Used in the treatment of cancer.
References
Anon. Asparaginase (Erwinia). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 10/10/2016.

Buckingham R (ed). Asparaginase. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/10/2016.

Erwinaze Injection, Powder, Lyophilized, for Solution (Jazz Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 10/10/2016.

Joint Formulary Committee. Crisantaspase. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/10/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Asparaginase (Erwinia chrysanthemi). AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 10/10/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Pegaspargase. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 11/10/2016.

Oncaspar Injection, Solution (Baxalta US Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 10/10/2016.

Disclaimer: This information is independently developed by MIMS based on Asparaginase from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in