UNC Health

     UNC Health IV Compendium Guideline

     System Formulary Restriction:

     Use of rasburicase injection in adult patients is restricted to patients who meet the following criteria:

• Known or highly suspected malignancy AND uric acid > 15 mg/dL

          OR

• Known or highly suspected malignancy associated with intermediate or high risk of tumor lysis syndrome (TLS) AND the following clinical criteria:

  •  

    Uric acid ≥ 8-15 mg/dL

  • SCr > 1.5 x baseline OR SCr ≥ 1.5 mg/dL if baseline unknown

  • WBC ≥ 50,000 cells/µL OR LDH ≥ 500 U/L

     Rasburicase injection adult dosing is restricted to the following:

• Uric acid < 8 mg/dL: Not indicated
• Uric acid 8-12 mg/dL: Consider no rasburicase or 1.5 mg IV once
• Uric acid > 12-15 mg/dL: 3 mg IV once
• Uric acid > 15 mg/dL: 6 mg IV once

     May consider subsequent doses 24 hours after previous dose if repeat uric acid remains elevated

     Adult Tumor Lysis Syndrome Clinical Guideline

• Lexicomp
• Micromedex
• UpToDate
• FDA Daily Med