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Rasburicase Administration Considerations

  • Administration of rasburicase beyond 5 days is not recommended by the manufacturer. In fact, a single dose of rasburicase has been shown to rapidly reduced hyperuricemia and multiple doses are rarely needed.
  • To prevent the need for multiple doses of rasburicase, we would recommend a single dose of rasburicase followed by scheduled oral allopurinol.
  • Monitoring Tumor Lysis Syndrome (TLS) lab trends and responding to concerning trajectories is critical.
  • May be administered at diagnosis or initiation of chemotherapy.
  • Rasburicase should not be administered to patients receiving continuous dialysis.
  • Bulky disease and chemo sensitive malignancies increase the risk of TLS. These situations may require Rasburicase administration prior to the start of chemotherapy or if uric acid is rising but not > 8 mg/dL.
  • Administration of rasburicase outside of identified parameters may be warranted at the discretion of the oncology provider.

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.