Related Subjects:
|Hyperuricaemia
|Acute and Chronic Gout
|Allopurinol
|Rasburicase
- 📖 Always check BNF or equivalent for UpToDate prescribing advice
- 💊 Rasburicase = recombinant urate-oxidase enzyme, used to prevent/treat tumour lysis syndrome (TLS)
⚙️ Mode of Action
- 🧪 Recombinant urate-oxidase enzyme produced by genetically modified Saccharomyces cerevisiae
- 🔬 Converts uric acid → allantoin (highly soluble and easily excreted by kidneys)
- ⚡ Rapid reduction in plasma uric acid levels compared with allopurinol (which only inhibits new uric acid formation)
- 💡 Tetrameric protein, ~34 kDa subunits
📋 Indication / Dose
- 🛡️ Prophylaxis & treatment of acute hyperuricaemia in patients with haematological malignancy and high tumour burden at risk of TLS
- ⚠️ Usually initiated before chemotherapy in high-risk patients
💊 Dose Range (check BNF/datasheet)
| Name | Starting Dose | Frequency | Route |
|---|
| Rasburicase | 200 micrograms/kg | OD (for up to 7 days, guided by uric acid levels) | IV infusion over 30 min |
⚠️ Do not administer by PO route (the second blank row in your draft table can be deleted).
🔄 Interactions
- 📖 See BNF for full details
- 💡 Inactivates uric acid in vitro → avoid sending blood samples for uric acid unless collected on ice and processed immediately
⚠️ Cautions
- ⚡ Risk of haemolysis and methaemoglobinaemia in patients with G6PD deficiency → contraindicated
- 🧪 Monitor closely in patients with haematological malignancies and renal impairment
- ⚠️ Stop allopurinol if starting rasburicase (different mechanism, no benefit in combination)
🚫 Contraindications
- ❌ G6PD deficiency (risk of severe haemolysis)
- ❌ Hypersensitivity to rasburicase or excipients
- ❌ Caution in pregnancy / breastfeeding – consult specialist advice
⚡ Side Effects
- 🤢 GI upset: nausea, vomiting, diarrhoea
- 🌡️ Fever, headache
- 🩹 Rash, skin reactions
- ⚠️ Rare: anaphylaxis, haemolysis, methaemoglobinaemia
📚 References
📝 Revisions
- Added cautions, contraindications, and key clinical pearls (Aug 2025)
