N of hypoxanthine to xanthine to uric acid. Dosage/Administration PO
N of hypoxanthine to xanthine to uric acid. Dosage/Administration PO: 200?00 mg/m2 qd; administration of >300 mg should be given in divided doses (max, 800 mg/d); should initiate therapy 24 to 48 hours prior to chemotherapy. Adult (IV): 200?00 mg/m2/d as a single Quizartinib site infusion or divided doses (max, 600 mg/d); infuse over 15?60 minutes; final concentration no greater than 6 mg/mL. PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/27693494 Pediatric (IV): Starting dose 200 mg/m2/d. Comments Adverse events include maculopapular rash, dyspepsia, nausea/ vomiting, fever, and eosinophilia; rare reports of interstitial nephritis; decreases in serum uric acid occur in 1 to 2 days with a nadir 7 days; dosage adjustment in renal dysfunction is necessary to avoid accumulation of the active metabolite oxypurinol (alloxanthine); removed by dialysis, so administer posthemodialysis or administer 50 supplemental dose; significant drug interactions with azathioprine and 6-mercaptopurine; the dose of concomitant azathioprine or 6-mercaptopurine should be reduced to one third to one fourth of their usual dose. Adverse events include nausea/ vomiting, fever, headache, abdominal pain, constipation, diarrhea, and rash. Rare (<1 ) but serious reactions have occurred such as severe hypersensitivity reactions, including anaphylaxis, hemolysis, and methemoglobinemia. Caution is advised in patients who have atopic allergies/asthma. Contraindicated in individuals deficient in glucose-6phosphatase dehydrogenase (G6PD). Rasburicase will cause enzymatic degradation of uric acid within blood samples left at room temperature, resulting in spuriously low uric acid levels-- blood must be collected into prechilled tubes containing heparin anticoagulant and immediately immersed and maintained in an ice water bath; plasma samples must be assayed within 4 hours of sample collection. 1 g resin binds approximately 1 mEq of K+; onset is variable 2 to 24 hours; administer orally or nasogastrically with a laxative such as sorbitol to avoid fecal impaction and facilitate elimination; chilling the solution will increase palatability; enema route is usually less effective. Antagonizes the action of hyperkalemia on the heart; should be monitored closely by ECG when given; onset 1 to 2 minutes; duration is 10 to 30 minutes.RasburicaseRecombinant protein that catalyzes enzymatic oxidation of uric acid into an inactive metabolite, allantoin, that is 5 to 10 times more soluble than uric acid.Adult: 0.2 mg/kg infusion over 30 minutes once daily for up to 5 days*; no dosing adjustment required in renal or hepatic dysfunction. Pediatric: 0.15-0.2 mg/kg IV infusion over 30 minutes daily ?5 days*; no dosing adjustment required in renal or hepatic dysfunction. *Studies using single dose in the treatment of hyperuricemia has been reported [55].HyperkalemiaSodium polystyrene sulfonateRemoves potassium (K+) by exchanging sodium ions (Na+) for K+ in the intestine.Adult: 15 g PO (60 mL) 1 to 4 times per day Pediatric: 1 g/kg/dose PO q6h or q2-6h rectally.Calcium gluconateRaises threshold potential and reestablishes cardiac excitability.Adult: 1? g over 3 to 5 minutes IV push. Pediatric: 60?00 mg/kg over 3 to 5 minutes slow IV push.McBride and Westervelt Journal of Hematology Oncology 2012, 5:75 http://www.jhoonline.org/content/5/1/Page 8 ofTable 3 Pharmacologic therapies for the treatment of tumor lysis syndrome (TLS) [3] (Continued)Loop diuretics Inhibits reabsorption of Na+ and chloride, thus causing increased excretion of fluid, K+, and phosphate. Ad.
