Details About Generic Salt ::  Asparagi

Main Medicine Class::    

(ass-PAR-uh-jin-aze)

Elspar

Powder for injection, lyophilzed

10,000 international units

Class: Enzyme

 Indications

Adult

Combination therapy for acute lymphocytic leukemia. Do not use as the sole induction agent unless combination therapy is deemed inappropriate.

Pediatric

Acute lymphocytic leukemia. Do not use as the sole induction agent unless combination therapy is deemed inappropriate.

 Contraindications Anaphylactic reactions to asparaginase; pancreatitis or a history of pancreatitis.

 Route/Dosage

Acute Lymphocytic Leukemia

Pediatric: IV Give over 30 min through the side arm of an already running infusion of Sodium Chloride Injection or 5% Dextrose Injection. The drug has little tendency to cause phlebitis when given IV. IM Limit the volume at a single injection site to 2 mL. For a volume greater than 2 mL, use 2 injection sites.

Acute Lymphocytic Leukemia Induction Regimens

Pediatric: One of the following combination regimens is recommended for acute lymphocytic leukemia in children.

Acute Lymphocytic Leukemia Induction Regimen I

Pediatric: Prednisone: 40 mg/m²/day PO in 3 divided doses for 15 days, followed by tapering of the dosage as follows: 20 mg/m² for 2 days, 10 mg/m² for 2 days, 5 mg/m² for 2 days, 2.5 mg/m² for 2 days, and then discontinue.

Vincristine sulfate: 2 mg/m² IV once weekly on days 1, 8, and 15. The maximum single dose should not exceed 2 mg.

Asparaginase: 1000 IU/kg/day IV for 10 successive days beginning on day 22. When remission is obtained, institute appropriate maintenance therapy. Do not use asparaginase as part of a maintenance regimen. Asparaginase has been used in other combination regimens. Administering the drug IV concurrently with or immediately before a course of vincristine and prednisone may be associated with increased toxicity.

Acute Lymphocytic Leukemia Induction Regimen II

Pediatric: Predisone: 40 mg/m²/day PO in 3 divided doses for 28 days (the total daily dose to the nearest 2.5 mg), then gradual discontinuation over 14 days.

Vincristine sulfate: 1.5 mg/m² IV weekly for 4 doses, on days 1, 8, 15, and 22. The maximum single dose should not exceed 2 mg.

Asparaginase: 6000 IU/m² IM on days 4, 7, 10, 13, 16, 19, 22, 25, and 28. When remission is obtained, institute appropriate maintenance therapy. Do not use asparaginase as part of a maintenance regimen

Acute Lymphocytic Leukemia Single Agent Induction Therapy

Adult/Pediatric: IV Use asparaginase as the sole induction agent only when a combined regimen is inappropriate because of toxicity or other specific patient-related factors, or in cases refractory to other therapy. Administer 200 IU/kg/day IV for 28 days. Complete remissions are of short duration, 1 to 3 mo.

Interactions

Methotrexate

Asparaginase may diminish or abolish methotrexate’s effect on malignant cells. Do not use methotrexate with, or following asparaginase, while asparagine levels are below normal. Asparaginase may augment corticosteroid-induced hyperglycemia.

Vincristine and prednisone

IV administration may be associated with increased toxicity.

Lab Test Interferences May interfere with the interpretation of thyroid function tests by producing a rapid and marked reduction in serum concentrations of thyroxine-binding globulin within 2 days after the first dose.

 Adverse Reactions

CNS: Depression; confusion; hallucinations; headache; Parkinson-like syndrome. DERMATOLOGIC: Rashes. ENDOCRINE: Hyperglycemia. GI: Moderate potential for nausea, vomiting. Pancreatitis, sometimes fulminant, and acute hemorrhagic pancreatitis have occurred, both may be fatal; fatty changes in the liver; elevation of LFTs. HEMATOLOGIC: Hypofibrinogenemia; decreased synthesis of clotting factors and antithrombin III. HYPERSENSITIVITY: Acute anaphylactoid reactions are common; discontinuation of therapy and administration of fluids, corticosteroids, antihistamines, or pressors may be required. RENAL: Azotemia, usually prerenal; transient proteinuria. OTHER: Chills; fever; weight loss (usually mild); fatal hyperthermia; hypoglycemia.

 Precautions

Pregnancy: Category C. Lactation: Discontinue nursing or discontinue the drug. Children: Toxicity is reported to be greater in adults than in children. Acute lymphocytic leukemia dosage adjustments: Patients who have received a course of therapy, if treated again, have an increased risk of hypersensitivity reactions. Therefore, repeat treatment only when the benefit of such therapy is weighed against the increased risk. Anaphylaxis: Be prepared to treat anaphylaxis at each administration. Hematologic: Bone marrow depression, leukopenia, thrombosis, and clotting factors depressed; increase in blood ammonia during the conversion of asparagine to asparatic acid by the enzyme.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Be prepared to treat anaphylaxis at each administration.
• Store at 2° to 8°C (36° to 46°F). Store reconstituted solution at 2° to 8°C (36° to 46°F); discard after 8 hr or sooner if cloudy.
• Administer by IV bolus injection, IV infusion, or IM injection.
• Desensitization regimen is recommended for patients with positive skin test and for retreatment.

IM

• Reconstitute by adding 2 mL Sodium Chloride Injection to the 10,000 unit vial. Use the resulting solution within 8 hr and only if clear.

IV

• Reconstitute the 10,000 unit vial with 5 mL Sterile Water for Injection or with Sodium Chloride Injection. This solution may be used for direct IV administration within 8 hr following reconstitution. For administration by infusion, dilute solutions with Sodium Chloride Injection or 5% Dextrose Injection. Infuse within 8 hr and only if clear.
• Filtration through a 5 micron filter during administration will remove the particles with no loss of potency.

 Assessment/Interventions

• The manufacturer recommends that a test dose (approximately 2 IU) be given before the first dose and anytime greater than 1 wk has elapsed between doses.
• Perform an intradermal skin test prior to initial administration and when it is given after a wk or more has elapsed between doses.
• Administer the drug only after successful desensitization.
• Anaphylactic reactions require the immediate use of epinephrine, oxygen, and IV steroids.
• Monitor leukocyte counts and serum uric acid. Take appropriate preventive measures. Monitor peripheral blood count and bone marrow frequently.
• Obtain frequent serum amylase to detect early evidence of pancreatitis. If pancreatitis occurs, discontinue therapy.
• Monitor blood sugar.

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
• Advise patient, family, or caregiver that medication will be used in combination with other agents to achieve maximum benefit possible.
• Review dosing schedule with patient, family, or caregiver.
• Advise patient, family, or caregiver that skin tests may be used prior to administration of medication.
• Advise patient, family, or caregiver to carefully follow instructions for supplemental therapies designed to protect the kidneys from excessive uric acid (eg, increased fluid intake, allopurinol, urinary alkalinizing agents).
• Advise patient, family, or caregiver to immediately report any of the following to health care provider: rash; hives; difficulty breathing; fever, chills, or other signs of infection; sore throat.
• Advise patient, family, or caregiver to report any of the following to health care provider: persistent nausea, vomiting, or appetite loss; persistent stomach pain; unusual bruising or bleeding.
• Instruct diabetic patient to monitor blood glucose more frequently when drug is started or dose is changed and to inform health care provider of significant changes in readings.
• Instruct patient not to take any prescription or OTC medications or dietary supplements unless advised to do so by health care provider.
• Instruct women of childbearing potential to notify health care provide if pregnant, planning to become pregnant, or breastfeeding.
• Advise patient that frequent follow-up visits and laboratory tests will be required to monitor therapy and to keep appointments.

Medicscientist Drug Facts

Drugs Class ::

Indications for Drugs ::

 Indications

Adult

Combination therapy for acute lymphocytic leukemia. Do not use as the sole induction agent unless combination therapy is deemed inappropriate.

Pediatric

Acute lymphocytic leukemia. Do not use as the sole induction agent unless combination therapy is deemed inappropriate.

Drug Dose ::

 Route/Dosage

Acute Lymphocytic Leukemia

Pediatric: IV Give over 30 min through the side arm of an already running infusion of Sodium Chloride Injection or 5% Dextrose Injection. The drug has little tendency to cause phlebitis when given IV. IM Limit the volume at a single injection site to 2 mL. For a volume greater than 2 mL, use 2 injection sites.

Acute Lymphocytic Leukemia Induction Regimens

Pediatric: One of the following combination regimens is recommended for acute lymphocytic leukemia in children.

Acute Lymphocytic Leukemia Induction Regimen I

Pediatric: Prednisone: 40 mg/m²/day PO in 3 divided doses for 15 days, followed by tapering of the dosage as follows: 20 mg/m² for 2 days, 10 mg/m² for 2 days, 5 mg/m² for 2 days, 2.5 mg/m² for 2 days, and then discontinue.

Vincristine sulfate: 2 mg/m² IV once weekly on days 1, 8, and 15. The maximum single dose should not exceed 2 mg.

Asparaginase: 1000 IU/kg/day IV for 10 successive days beginning on day 22. When remission is obtained, institute appropriate maintenance therapy. Do not use asparaginase as part of a maintenance regimen. Asparaginase has been used in other combination regimens. Administering the drug IV concurrently with or immediately before a course of vincristine and prednisone may be associated with increased toxicity.

Acute Lymphocytic Leukemia Induction Regimen II

Pediatric: Predisone: 40 mg/m²/day PO in 3 divided doses for 28 days (the total daily dose to the nearest 2.5 mg), then gradual discontinuation over 14 days.

Vincristine sulfate: 1.5 mg/m² IV weekly for 4 doses, on days 1, 8, 15, and 22. The maximum single dose should not exceed 2 mg.

Asparaginase: 6000 IU/m² IM on days 4, 7, 10, 13, 16, 19, 22, 25, and 28. When remission is obtained, institute appropriate maintenance therapy. Do not use asparaginase as part of a maintenance regimen

Acute Lymphocytic Leukemia Single Agent Induction Therapy

Adult/Pediatric: IV Use asparaginase as the sole induction agent only when a combined regimen is inappropriate because of toxicity or other specific patient-related factors, or in cases refractory to other therapy. Administer 200 IU/kg/day IV for 28 days. Complete remissions are of short duration, 1 to 3 mo.

Contraindication ::

 Contraindications Anaphylactic reactions to asparaginase; pancreatitis or a history of pancreatitis.

Drug Precautions ::

 Precautions

Pregnancy: Category C. Lactation: Discontinue nursing or discontinue the drug. Children: Toxicity is reported to be greater in adults than in children. Acute lymphocytic leukemia dosage adjustments: Patients who have received a course of therapy, if treated again, have an increased risk of hypersensitivity reactions. Therefore, repeat treatment only when the benefit of such therapy is weighed against the increased risk. Anaphylaxis: Be prepared to treat anaphylaxis at each administration. Hematologic: Bone marrow depression, leukopenia, thrombosis, and clotting factors depressed; increase in blood ammonia during the conversion of asparagine to asparatic acid by the enzyme.

Drug Side Effects ::

 Adverse Reactions

CNS: Depression; confusion; hallucinations; headache; Parkinson-like syndrome. DERMATOLOGIC: Rashes. ENDOCRINE: Hyperglycemia. GI: Moderate potential for nausea, vomiting. Pancreatitis, sometimes fulminant, and acute hemorrhagic pancreatitis have occurred, both may be fatal; fatty changes in the liver; elevation of LFTs. HEMATOLOGIC: Hypofibrinogenemia; decreased synthesis of clotting factors and antithrombin III. HYPERSENSITIVITY: Acute anaphylactoid reactions are common; discontinuation of therapy and administration of fluids, corticosteroids, antihistamines, or pressors may be required. RENAL: Azotemia, usually prerenal; transient proteinuria. OTHER: Chills; fever; weight loss (usually mild); fatal hyperthermia; hypoglycemia.

Drug Mode of Action ::  

Drug Interactions ::

Interactions

Methotrexate

Asparaginase may diminish or abolish methotrexate’s effect on malignant cells. Do not use methotrexate with, or following asparaginase, while asparagine levels are below normal. Asparaginase may augment corticosteroid-induced hyperglycemia.

Vincristine and prednisone

IV administration may be associated with increased toxicity.

Drug Assesment ::

 Assessment/Interventions

• The manufacturer recommends that a test dose (approximately 2 IU) be given before the first dose and anytime greater than 1 wk has elapsed between doses.
• Perform an intradermal skin test prior to initial administration and when it is given after a wk or more has elapsed between doses.
• Administer the drug only after successful desensitization.
• Anaphylactic reactions require the immediate use of epinephrine, oxygen, and IV steroids.
• Monitor leukocyte counts and serum uric acid. Take appropriate preventive measures. Monitor peripheral blood count and bone marrow frequently.
• Obtain frequent serum amylase to detect early evidence of pancreatitis. If pancreatitis occurs, discontinue therapy.
• Monitor blood sugar.

Drug Storage/Management ::

 Administration/Storage

• Be prepared to treat anaphylaxis at each administration.
• Store at 2° to 8°C (36° to 46°F). Store reconstituted solution at 2° to 8°C (36° to 46°F); discard after 8 hr or sooner if cloudy.
• Administer by IV bolus injection, IV infusion, or IM injection.
• Desensitization regimen is recommended for patients with positive skin test and for retreatment.

IM

• Reconstitute by adding 2 mL Sodium Chloride Injection to the 10,000 unit vial. Use the resulting solution within 8 hr and only if clear.

IV

• Reconstitute the 10,000 unit vial with 5 mL Sterile Water for Injection or with Sodium Chloride Injection. This solution may be used for direct IV administration within 8 hr following reconstitution. For administration by infusion, dilute solutions with Sodium Chloride Injection or 5% Dextrose Injection. Infuse within 8 hr and only if clear.
• Filtration through a 5 micron filter during administration will remove the particles with no loss of potency.

Drug Notes ::

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
• Advise patient, family, or caregiver that medication will be used in combination with other agents to achieve maximum benefit possible.
• Review dosing schedule with patient, family, or caregiver.
• Advise patient, family, or caregiver that skin tests may be used prior to administration of medication.
• Advise patient, family, or caregiver to carefully follow instructions for supplemental therapies designed to protect the kidneys from excessive uric acid (eg, increased fluid intake, allopurinol, urinary alkalinizing agents).
• Advise patient, family, or caregiver to immediately report any of the following to health care provider: rash; hives; difficulty breathing; fever, chills, or other signs of infection; sore throat.
• Advise patient, family, or caregiver to report any of the following to health care provider: persistent nausea, vomiting, or appetite loss; persistent stomach pain; unusual bruising or bleeding.
• Instruct diabetic patient to monitor blood glucose more frequently when drug is started or dose is changed and to inform health care provider of significant changes in readings.
• Instruct patient not to take any prescription or OTC medications or dietary supplements unless advised to do so by health care provider.
• Instruct women of childbearing potential to notify health care provide if pregnant, planning to become pregnant, or breastfeeding.
• Advise patient that frequent follow-up visits and laboratory tests will be required to monitor therapy and to keep appointments.

Medicscientist Drug Facts

Disclaimer ::

The Information available on this site is for only Informational Purpose , before any use of this information please consult your Doctor .Price of the drugs indicated above may not match to real price due to many possible reasons may , including local taxes etc.. These are only approximate indicative prices of the drug.