Asparaginase 

Drug type:  Asparaginase is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.  This medication is classified as an "enzyme."  (For more detail, see "How this drug works" section below). 

What this drug is used for: 

Acute lymphocytic leukemia (ALL) 

Note:  If a drug has been approved for one use, physicians may elect  to use this same  drug for other problems if they believe it may be helpful. 

How this drug  is given: 

• Aspariginase is  given as an  injection into a large muscle (intramuscular or IM).  Depending on your dose, the medication may need to be divided into two injections. 
• Also may be given into the vein as an infusion (intravenous or IV).  This method has higher risk of allergic reaction so often  a test dose is given first. 
• There is no pill form of aspariginase. 
• The amount of aspariginase that you will receive, and how it  is given, depends on many factors, including your height and weight, your general health or  other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose and schedule. 

Side effects: 

Important things to remember about the side effects of asparaginase: 

• Most people do not experience all of the side effects listed. 
• Side effects are often predictable in terms of their onset and duration. 
• Side effects are almost always reversible and will go away after treatment is complete. 
• There are many options  to help minimize or prevent side effects. 
• There is no relationship between  the presence or severity  of side effects  and the effectiveness of the medication. 

The following side effects are common (occurring in greater than 30%) for patients taking asparaginase: 

• Fever, chills (see flu like symptoms) 
• Nausea and vomiting 
• Allergic reaction, (sudden onset of wheezing, itching, rash, face swelling, agitation, low blood pressure).  You will be monitored closely  for this reaction.  
• Poor appetite 
• Stomach cramping 
• Central neurotoxicity: excessive sleepiness, depression, hallucinations, agitation, disorientation or seizure.  Less commonly seen stupor, confusion and/or coma. 

These side effects are less common (occurring in about 10-29%) of patients receiving asparaginase: 

• Mouth sores 
• Pancreatitis (inflammation of  the pancreas) in up to 10%  of patients.  Mainly noted in blood tests that return to normal after therapy is discontinued.  Rarely may be severe causing symptoms.  Symptoms of  acute pancreatitis include: (pain in the upper abdomen that worsens with eating, swollen  and tender abdomen, nausea, vomiting, fever, and rapid pulse).   
• Blood test abnormalities (Increased blood glucose level - some refer  to this as "sugar").   
• Increases in blood tests measuring liver function.  These return to normal once treatment is discontinued (see liver problems). 
• Blood clotting disorders, increases risk  of both bleeding and clotting. 

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms. 

When to contact your doctor or health care provider: 

Contact  your health care provider immediately, day or night, if you should experience any of  the following symptoms: 

• Fever of 100.5º F (38º C)  or higher, chills (possible signs of infection). 

The following symptoms require medical attention, but are  not an emergency.  Contact your health care provider within 24 hours of noticing any of the following: 

• Nausea (interferes with ability to eat and unrelieved with prescribed medication) 
• Vomiting (vomiting more than 4-5 times in a 24 hour period) 
• Persistant upper abdominal pain or pain that worsens with eating 
• Abdominal swelling 
• Diarrhea (4-6 episodes in a 24-hour period) 
• Unusual bleeding or bruising 
• Swelling, redness and/or pain in one leg or arm  and not  the other 
• Extreme fatigue (unable  to carry on self-care activities) 
• Yellowing of  the skin or eyes 
• Unusual thirst, need to urinate frequently 
• Confusion, excessive sleepiness, hallucinations (seeing, hearing or feeling things that are not there), agitation, or disorientation (not able to recognize familiar surroundings) 

Always inform your health care provider  if you experience any unusual symptoms. 

Precautions:  

• Before starting asparaginase treatment, make sure  you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).   
• Do not  receive any kind of immunization or vaccination without your doctor's approval while taking asparaginase. 
• Asparaginase may be inadvisable if you have had  a hypersensitivity (allergic) reaction to asparaginase.  If you have had  a reaction to Elspar®, Erwinia L-asparaginase may be used with caution. 
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment.  Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). 
• For both men and women: Do not conceive  a child (get pregnant) while taking asparaginase. Barrier methods  of contraception, such as condoms, are recommended. Discuss with your  doctor when you  may safely become pregnant or conceive a child  after therapy. 
• Do not breast feed while taking this medication. 
• Those who have a history of pancreatitis (inflammation of the pancreas) should not be treated with asparaginase. 

Self-care tips: 

• Drink at least two  to three quarts of fluid every 24 hours, unless you  are instructed otherwise. 
• For flu-like symptoms, keep warm with blankets and drink plenty of liquids.  There are medications that can help reduce  the discomfort caused by chills. 
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider. 
• Wash your hands often. 
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water. 
• Use an electric razor and a soft toothbrush to minimize bleeding. 
• Avoid contact sports or activities that could cause injury. 
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.   
• Avoid driving and tasks that require being alert until your response to this drug is well understood. 
• Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing. 
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor. 
• Get plenty of rest.   
• Maintain good nutrition. 

If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems. 

Monitoring and testing: 

You will be checked regularly by your doctor while you are taking asparaginase, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC), blood clotting factors, pancreatic enzymes, blood sugar as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.    

How this drug works: 

All cells need a chemical called asparagine to stay alive. Normal cells can make this chemical for themselves, while cancer cells cannot. Asparaginase breaks down asparagine in the body. Since the cancer cells cannot make more asparagine, they die. 

When asparaginase breaks down asparagine it is broken down into 2 chemicals, aspartic acid and ammonia.  The neurologic side effects seen with asparaginase (such as, confusion, excessive sleepiness, agitation, disorientation, or coma) are related to increased levels of these chemicals circulating in the body. 

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.