When should allopurinol be used for tumor lysis syndrome?
Indeed, the dose of allopurinol needs to be adjusted in case of renal insufficiency. Treatment with allopurinol should be started at least 24 hours before initiation of anticancer therapy and should be continued until normalization of uric acid levels and signs of large tumor burden are absent.
What is prevention of tumor lysis syndrome?
The most important treatment for TLS is prevention. The mainstays of TLS prevention include aggressive hydration, control of hyperuricemia with allopurinol and rasburicase treatment, and close monitoring of electrolyte abnormalities.
Which of the following is a strategy to prevent tumor lysis syndrome for a patient that is at intermediate risk?
hydration is the key prevention strategy for all patients at low, intermediate, or high risk for TLS. Hydration, and the subsequent increase in urinary output, minimizes the risk of uric acid or calcium phosphate precipitation in the renal tubules.
How do you manage tumor lysis syndrome?
Conventional management of TLS consists of aggressive intravenous hydration, diuretic therapy, urinary alkalization, and inhibition of urate production by high-dose allopurinol.
Can rasburicase and allopurinol be given together?
Allopurinol must be stopped in patients who are to receive rasburicase. Never use the two drugs together because allopurinol will interfere with rasburicase activity.
What are the primary prophylactic strategies for TLS?
The best management of TLS is prevention. Prevention strategies include hydration and prophylactic rasburicase in high-risk patients, hydration plus allopurinol or rasburicase for intermediate-risk patients, and close monitoring for low-risk patients.
How do you administer rasburicase?
Rasburicase injection comes as a powder to be mixed with liquid to be injected intravenously (into a vein) by a doctor or nurse in a hospital or clinic. It is usually given over a period of 30 minutes once a day for up to 5 days. This medication is given as a single course of treatment that will not be repeated.
What labs do you monitor for TLS?
Lab work consists of a complete blood cell count, serum electrolytes, calcium, phosphorus, creatinine, uric acid, lactate dehydrogenase, and blood urea nitrogen. After the first 24 hours, lab values are monitored at least every 12 hours for several days and then daily, or as ordered.
Why is allopurinol given before chemotherapy?
Allopurinol can be given at the start of a course of chemotherapy. When chemotherapy medicines start to kill the cancer cells, uric acid is released from these cells which can crystallise causing damage to the kidneys. Allopurinol stops these crystals from forming.
Is allopurinol an immunosuppressant?
Allopurinol demonstrated to have an immunosuppressive action when given at the dose of 200 microgram daily to the mice receiving skin grafts.
How is tumor lysis syndrome (TLS) treated?
Effective treatment and prophylaxis of hyperuricemia and impaired renal function in tumor lysis syndrome with low doses of rasburicase Low doses of rasburicase are effective and cost-saving for prophylaxis and treatment of TLS.
What is the recommended dosage of rasburicase for hyperuricemia associated with tumor lysis syndrome?
Single 4.5 mg fixed-dose of rasburicase for hyperuricemia associated with tumor lysis syndrome. J Oncol Pharm Pract. 2016 Apr 15;Epub. [PubMed] [Google Scholar]
Is tumor lysis syndrome life-threatening?
Abstract Tumor lysis syndrome (TLS) is a potentially life-threatening condition that occurs in oncologic and hematologic patients with large tumor burden, either due to cytotoxic therapy or, less commonly, spontaneously because of massive tumor cell lysis.
What is the pathophysiology of hyperuricemia in TLS?
The increase in uric acid concentration in plasma is constantly present in patients with TLS; hyperuricemia may be already present at time of diagnosis or develop 2–3 days after initiation of anti-cancer treatment. A high nucleic acid content and a very active purine metabolism are characteristic of tumor cells.