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Included as part of the PRECAUTIONS section.


Anaphylaxis and Serious Allergic Reactions

Serious allergic reactions can occur in patients receiving Elspar. The risk of serious allergic reactions is higher in patients with prior exposure to Elspar or other Escherichia coli-derived Lasparaginases. Observe patients for one hour after administration of Elspar in a setting with resuscitation equipment and other agents necessary to treat anaphylaxis (for example, epinephrine, oxygen, intravenous steroids, antihistamines). Discontinue Elspar in patients with serious allergic reactions.


Serious thrombotic events, including sagittal sinus thrombosis can occur in patients receiving Elspar. Discontinue Elspar in patients with serious thrombotic events.


Pancreatitis, in some cases fulminant or fatal, can occur in patients receiving Elspar. Evaluate patients with abdominal pain for evidence of pancreatitis. Discontinue Elspar in patients with pancreatitis.

Glucose Intolerence

Glucose intolerance can occur in patients receiving Elspar. In some cases, glucose intolerance is irreversible. Cases of diabetic ketoacidosis have been reported. Monitor serum glucose.


Increased prothrombin time, increased partial thromboplastin time, and hypofibrinogenemia can occur in patients receiving Elspar. CNS hemorrhages have been observed. Monitor coagulation parameters at baseline and periodically during and after treatment. Initiate treatment with fresh-frozen plasma to replace coagulation factors in patients with severe or symptomatic coagulopathy.

Hepatotoxicity and Abnormal Liver Function

Fulminant hepatic failure occurs. Hepatotoxicity and abnormal liver function, including elevations of AST (SGOT), ALT (SGPT), alkaline phosphatase, bilirubin (direct and indirect), and depression of serum albumin, and plasma fibrinogen can occur. Fatty changes in the liver have been documented on biopsy. Evaluate hepatic enzymes and bilirubin pretreatment and periodically during treatment.


Patients treated with Elspar, in a combination with other chemotherapeutic agents, have been reported to develop posterior reversible encephalopathy syndrome (PRES). PRES is a neurological disorder with clinical symptoms of headache, seizures, visual disturbances, altered mental status, and hypertension. Symptoms can be nonspecific, and diagnosis requires confirmation by radiological procedures. Interrupt use of Elspar if PRES is suspected or diagnosed. Control blood pressure promptly and monitor closely for seizure activity.

Risk of Medication Errors

Medication errors involving Elspar have occurred. In particular, different formulations and routes of administration (intramuscular and intravenous) of asparaginase have been interchanged inappropriately, which may result in subtherapeutic blood levels of asparaginase or additional toxicity related to an overdose. Confirm the formulation of asparaginase prior to administration. Do not interchange Elspar with Erwinia asparaginase or pegylated E. coliasparaginase [polyethylene glycol (PEG) asparaginase].

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility

No long-term carcinogenicity studies in animals have been performed with Elspar. No relevant studies addressing mutagenic potential have been conducted. Elspar did not exhibit a mutagenic effect when tested against Salmonella typhimurium strains in the Ames assay. No studies have been performed on impairment of fertility.

Use In Specific Populations


Pregnancy Category C

In mice and rats Elspar has been shown to retard the weight gain of mothers and fetuses when given in doses of more than 1000 International Units/kg (approximately equivalent to the recommended human dose, when adjusted for total body surface area). Resorptions, gross abnormalities and skeletal abnormalities were observed. The intravenous administration of 50 or 100 International Units/kg (approximately equivalent to 10 to 20% of the recommended human dose, when adjusted for total body surface area) to pregnant rabbits on Day 8 and 9 of gestation resulted in dose dependent embryotoxicity and gross abnormalities. There are no adequate and well-controlled studies in pregnant women. Elspar should be given to a pregnant woman only if clearly needed.

Nursing Mothers

It is not known whether Elspar is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from ELSPAR, a decision should be made to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

[See Clinical Studies]

Geriatric Use

Clinical studies of Elspar did not include sufficient numbers of subjects aged 65 and older to determine whether they respond differently from younger subjects.

This monograph has been modified to include the generic and brand name in many instances.

Last reviewed on RxList: 7/26/2013


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