Asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)

How to Take Asparaginase Erwinia Chrysanthemi (recombinant)-rywn 

This medication is an injection given into a big muscle (called intramuscular or IM). It can be given alone or in combination with other medications. Asparaginase can be given in various dosing schedules, depending on the regimen and the type of asparaginase being used. You will be given medication like diphenhydramine (Benedryl) and famotidine to lower your risk of a reaction to the injection.

Possible Side Effects

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

Liver Toxicity

This medication can cause liver toxicity, or liver problems, which your provider may monitor for with blood tests called liver function tests. Symptoms may be:

• Yellowing of your skin or eyes.
• Dark or brown urine.
• Pain in your abdomen (belly).

Tell your provider if you have any of these symptoms.

Muscle or Joint Pain/Aches and Headache

You may have joint or muscle pain/aches and headaches while taking this medication. Your provider can recommend medications and other ways to help relieve your pain.

Nausea and/or Vomiting

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse like heavy or greasy/fatty, spicy, or acidic foods like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.

Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

Fatigue

Fatigue can cause exhaustion, feeling worn out, and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.

Infection and Low White Blood Cell Count (Leukopenia or Neutropenia)

This medication can cause serious infections, with or without a decrease in white blood cell counts.

White blood cells (WBC) help your body fight infection. While you have cancer treatment, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or if someone you live with has these symptoms).
• When working outside, wear clothes that protect you, like long pants and gloves.
• Do not handle pet waste.
• Keep all cuts and scratches clean.
• Shower or bathe daily.
• Brush your teeth at least twice a day.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your providers before scheduling dental appointments or procedures.
• Ask your providers before you or someone you live with has any vaccines.

Fever

This medication may cause a fever. Ask your provider what temperature to watch for and when to call.

Bleeding

If you notice you are bleeding more easily or for no reason, especially new bleeding from your gums or nose, call your provider right away. You may also bruise more easily.

If you have bright red or dark, tarry stool, blood in your vomit, vomit that looks like coffee grounds, or have any signs of stroke (severe headache, trouble talking, weakness on one side, confusion), call 911 right away.

Mouth Sores (Mucositis)

This medication can cause sores or soreness in your mouth and/or throat, called mucositis. Tell your providers if your mouth, tongue, inside of your cheek, or throat becomes white, has ulcers, or is painful. Medications can be used to manage pain. Regular mouth care can help prevent or manage mouth sores. Some things you can do are:

• Brush with a soft-bristle toothbrush or cotton swab twice a day.
• Avoid mouthwashes that contain alcohol. A baking soda and/or salt with warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon of salt in an eight-ounce glass of warm water) can be used a few times each day.
• If your mouth gets dry, eat moist foods, drink plenty of fluids (6 to 8 glasses), and suck on sugarless hard candy.
• Avoid smoking and chewing tobacco, and drinking alcoholic beverages and citrus juices.

Decrease in Appetite or Taste Changes

Nutrition is an important part of your care. Cancer treatment can affect your appetite and make it hard to eat. Ask your provider about nutrition counseling services. Some tips you can follow are:

• Try to eat five or six small meals or snacks during the day, instead of 3 larger meals.
• Nutritional supplements may help if you are not eating enough.
• You may have a metallic taste or find that food has no taste. You may dislike foods or beverages that you liked before cancer treatment. These symptoms can last for months or longer after treatment ends.
• Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products, and fish without a strong smell. Sometimes cold food has less of an odor.
• Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce, or dressings.
• Use seasonings like basil, oregano, or rosemary to add flavor.

Infusion-Related Side Effects

Some people may have a reaction during infusion of this medication. Symptoms can be:

• Chills.
• Fever.
• Low blood pressure.
• Nausea.
• Vomiting.

Your provider will monitor you for symptoms of infusion-related reactions. 

High Blood Sugar

This medication can cause high blood sugar in patients with and without diabetes. Symptoms can be:

• Feeling more thirsty.
• More frequent urination.
• Feeling hungrier.
• Blurry vision.
• Headaches.
• Breath smelling like fruit.

You will have your blood sugar checked with blood tests. If you have diabetes and your blood sugars are higher than normal, talk to your provider. Tell your provider if you have any of these symptoms.

Reproductive Concerns

There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy.

If you can become pregnant, you will need to use effective birth control for 3 months after the last dose of this medication, even if your menstrual cycle has stopped or changed.

You should not breastfeed during treatment and for 1 week after the last dose of this medication.