pegaspargase (Rx)Brand and Other Names:Oncaspar, PEG L Asparaginase

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 750 units (5 mL)
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Acute Lymphoblastic Leukemia

For use in patients with hypersensitivity to native forms of L-asparaginase

First line agent as part of multiagent chemotherapeutic regimen

2500 international units/m² IM (preferred) or IV q14Days 

Monitor CBC, serum amylase

Dosage Forms & Strengths

powder for injection

  • 750 units
more...

Acute Lymphoblastic Leukemia

2500 units/m² IM (preferred) or IV q14Days 

Off-label Dosing

  • BSA ≤ 0.6 m²: 82.5 units/kg IM or IV q14Days as part of multiagent chemotherapeutic regimen
  • BSA >0.6 m²: 2500 units/m² IM (preferred) or IV q14Days as part of multiagent chemotherapeutic regimen

Monitor

CBC, serum amylase

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Interactions

Interaction Checker

pegaspargase and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            >5%

            • Edema
            • Fever, malaise
            • Nausea, vomiting
            • Coagulopathy
            • Rash
            • ALT increased
            • Dyspnea
            • Erythema
            • Urticaria
            • Swelling
            • Chills

            1-5%

            • Anaphylaxis
            • Hypotension
            • Peripheral edema
            • Tachycardia
            • Thrombosis
            • CNS toxicity
            • Chills
            • Headache
            • Pain
            • Seizure
            • Erythema, rash, urticaria
            • Hyperglycemia, hyperuricemia, hypoglycemia, hypoproteinemia, hyperlipidemia
            • Bleeding tendency
            • LFT abnormalities, AST increased, jaundice, hyperbilirubinemia
            • Dyspnea
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            Warnings

            Contraindications

            Hypersensitivity

            History of (with prior L-asparaginase treatment): pancreatitis; hemorrhagic events; serious thrombosis

            Cautions

            No more than 2 mL should be administered at any one injection site

            Anaphylaxis or serious allergic reactions may occur, monitor patient for 1 hr after administration; discontinue with serious allergic reactions

            Glucose intolerance reported (irreversible in some cases); monitor serum glucose

            Hepatotoxicity and abnormal liver function, including elevations of AST (SGOT), ALT (SGPT), alkaline phosphatase, bilirubin (direct and indirect), and depression of serum albumin, and plasma fibrinogen may occur; monitor

            Discontinue if pancreatitis occurs; evaluate patients with abdominal pain for pancreatitis

            Serious thrombotic events, including sagittal sinus thrombosis reported; discontinue if this occurs

            Increased prothrombin time, increased PTT and hypofibrinogenemia may occur; monitor for coagulopathy

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: not known if excreted in breast milk

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Modified version of L-asparaginase depletes asparagine, the aminoacid required for protein synthesis, and in turn kills leukemic cells

            Pharmacokinetics

            Half-Life: 5-5.6 days

            Onset: Asparagine depleted within 4 days (IM)

            Duration: 21 days (IM); 2-4 weeks (IV in asparaginase naive adults)

            Vd: 1.5 L/m² (IM in children); 2.4 L/m² (IV in adults)

            Metabolism: Systemically

            Peak plasma time: 3-4 days (IM)

            Excretion: Urine (trace amounts)

            IV/IM Administration

            No need for test dose

            IM: must only be given as a deep intramuscular injection into a large muscle; limit the volume of a single injection site to 2 mL; if the volume to be administered is >2 mL, use multiple injection sites

            IV given as a 1- to 2- hr infusion; do not give IV push

            Administration

            • Have parenteral epinephrine, diphenhydramine, and hydrocortisone available at the bedside
            • Have a freely running IV in place
            • Have a physician readily accessible
            • Monitor the patients closely for 30-60 min
            • Do not filter solution
            • Have available appropriate agents for maintenance of an adequate airway and treatment of a hypersensitivity reaction (antihistamine, epinephrine, oxygen, IV corticosteroids)
            • Be prepared to treat anaphylaxis at each administration
            • Administer through an infusion that is already running

            IV/IM Preparation

            Reconstitution: Avoid excessive agitation; do not shake

            Standard IM dilution: Do not exceed 2 mL volume per injection site

            Standard IV dilution: Dose/100 mL NS or D5W

            Storage

            Refrigerate

            Do not use if cloudy or if precipitate is present

            Do not freeze

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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