rasburicase: clinical use

Prescribing considerations

• Use under supervision of a clinician experienced in chemotherapy for haematological malignancy.
• Assess G6PD status where clinically feasible, particularly in populations with higher prevalence.
• Recognise established or high-risk tumour lysis syndrome as time-critical.
• Rasburicase lowers urate but does not directly correct hyperkalaemia, hyperphosphataemia or hypocalcaemia.
• Evidence is insufficient to recommend repeated treatment courses; anti-rasburicase antibodies can develop.

Contraindications and cautions

• Hypersensitivity to rasburicase or an excipient.
• G6PD deficiency.
• Other cellular metabolic disorders known to cause haemolytic anaemia.

Monitoring

• Plasma uric acid and renal function.
• Potassium, phosphate, calcium and clinical features of tumour lysis syndrome.
• Hypersensitivity, haemolysis, haemolytic anaemia and methaemoglobinaemia.
• Use pre-chilled heparin tubes and validated cold handling for urate samples.
• Record product name and batch number for biological-medicine traceability.

Clinical pharmacology

Rasburicase is a recombinant urate oxidase that converts uric acid to soluble allantoin. It is a protein degraded through peptide hydrolysis; renal elimination is a minor clearance pathway.

Formulation and product differences

• The product requires refrigeration, protection from light and must not be frozen.
• Use sodium chloride solution for further dilution; do not use glucose solution or an infusion filter.

Solution for infusion

Route: Intravenous

Strengths: 1.5 mg/mL