Parenteral Manual

Erwinia L-Asparaginase

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Erwinase
Classification: 
Antineoplastic
Original Date: 
August 2005
Revised Date: 
June 2023
Indications: 
  • Component of a multi-agent chemotherapeutic regimen for the treatment of patients with acute lymphoblastic leukemia in patients 
Reconstitution and Stability: 
  • Reconstitute vial with 1 mL 0.9% NaCl to give a 10 000 unit/mL concentration. Preservative free.  
  • Caution: vigorous shaking may result in loss of potency. To mix, direct 0.9% NaCl to the side of the vial, then gently rotate the vial.  
  • Withdraw from vial within 15 minutes of reconstitution. Filter needle must be used.  
  • Stable in syringe or a mini-bag at room temperature for 4 hours  
  • Do not refrigerate syringe  
Compatibility: 
  • 0.9% NaCl
  • Do not mix with other drugs
Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM YES, inject into a large muscle.  ***Maximum 2 mL per injection site***
IV Direct YES
IV Intermittent Infusion YES, in 100mL 0.9% NaCl over 1 hour
IV Continuous Infusion NO

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • 25 000 units/m2 , 3 times per week x 6 doses to replace each dose of Pegaspargase 
  • Dosage may differ according to protocol 
Potential hazards of parenteral administration: 

Immediate (within a few minutes to hours):

  • Anaphylaxis, other allergic reactions (6-43%) - urticaria, pruritus, respiratory distress, hypotension, chills, fever)  
  • Nausea and vomiting rare - more common with initial doses  
  • Pain/bruising at injection site (IM administration) - hold site at least 5 minutes after injection or until bleeding stops. Apply ice if platelet counts low. 

Delayed (within a few days to weeks) 

  • Hemorrhagic and thrombotic cardiovascular events - decreased fibrinogen, clotting factors, antithrombin 
  • Hepatotoxicity - hypoalbuminemia, increased transaminases   
  • Hyperglycemia - monitor urine/blood glucose; hypoglycemia possible  
  • Pancreatitis - elevated serum amylase, assess for abdominal tenderness  
  • Myelosuppression  
Notes: 
  • Have anaphylaxis kit at bedside. Outpatients should remain in the clinic for at least one hour following injection. NOTE: anaphylaxis may be delayed following IM injection.  
  • Insulin may be required for severe hyperglycemia

  • Give asparaginase AFTER methotrexate, cytarabine and vincristine NOT BEFORE  

References: 
  • Erwinase Product Monograph (EUSA/Jazz Canada) 
  • Erwinase Product Monograph (Jazz-USA) 
  • COG Memo January 2, 2015 - Approval of IV route of Erwinia asparaginase 
  • Erwinia and Pegaspargase. Children’s Oncology Group. Parenteral and oral Chemotherapy Administration Guidelines used by the Children’s Oncology Group. Version 10.1 Version Date: 05/01/2020 
  • Erwinase Product Monograph (Jazz Pharmaceuticals France). Version 30 Aug 2016 (access 23 Feb2021 via HC product database website)

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