Erwinaze (asparaginase Erwinia chrysanthemi) is used to treat acute lymphoblastic leukemia (ALL) in patients who have developed hypersensitivity to E. coli-derived asparaginase. Erwinaze is a cancer medication that interferes with the growth and spread of cancer cells. Erwinaze works by lowering the levels of asparagine in your body, a substance the cancer cells need to survive.

Erwinaze is given as an intravenous infusion or intramuscular injection and is often given as part of a multi-agent chemotherapeutic regimen. 

Erwinase vs Erwinaze

The original brand name was Erwinaze, but due to supply issues, the U.S. Food and Drug Administration (FDA) made available Erwinase (crisantaspase), the non-FDA licensed product with the U.K packaging. Erwinaze contains s 10,000 IIU/vial asparaginase Erwinia chrysanthemi, and Erwinase contains 10,000 IU/vial Crisantaspase (L-asparaginase from Erwinia chrysanthemi), 10,000 International units/vial.

Some people develop a life-threatening allergic reaction to Erwinaze. You will need to receive Erwinaze in a hospital or clinic setting to quickly treat any serious side effects that may occur.

Get emergency medical help if you have any signs of an allergic reaction to Erwinaze: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have serious side effects such as severe pain in your upper stomach, nausea, and vomiting, easy bruising or bleeding, increased thirst or urination, sudden numbness or severe headache, warmth or swelling in your legs, or sudden problems with your vision, speech, or balance.

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

You will be administered Erwimaze in a healthcare setting by a healthcare professional.

Erwinaze can be given to you into a vein (intravenous infusion) over 1 to 2 hours, or into a muscle (intramuscular injection).

Erwinaze is usually given three times a week (Monday/Wednesday/Friday) for two consecutive weeks (total six doses).

Your blood will need to be tested often, and your dose or medication schedule may be changed based on the results.

You may be given other medications to help prevent serious side effects or allergic reaction. Keep taking these medicines for as long as your doctor has prescribed.

Usual Dose of Erwinaze for Acute Lymphoblastic Leukemia:

To substitute for a dose of pegaspargase:
25,000 International Units/m2 intramuscularly three times a week (Monday/Wednesday/Friday) for six doses for each planned dose of pegaspargase.

To substitute for a dose of native E. coli asparaginase:
25,000 International Units/m2 administered intramuscularly for each scheduled dose of native E. coli asparaginase within a treatment regimen.

Comments:
-Limit the volume of reconstitution at a single injection site to 2 mL; if the reconstituted dose to be administered is greater than 2 mL, use multiple injection sites.
-If a partial vial is used, do not save or reuse the unused drug for later administration. Discard unused portions.

Use:
-Indicated as a component of a multi-agent chemotherapeutic regimen for the treatment of patients with acute lymphoblastic leukemia (ALL) who have developed hypersensitivity to E. coli-derived asparaginase.

Erwinaze should not be used in patients with a history of:

• Serious hypersensitivity reactions to Erwinaze, including anaphylaxis
• Serious pancreatitis with prior L-asparaginase therapy
• Serious thrombosis with prior L-asparaginase therapy
• Serious hemorrhagic events with prior L-asparaginase therapy

Before taking this medicine

You should not use Erwinaze if you have received any form of asparaginase in the past and it caused you to have:

• a serious allergic reaction;
• serious pancreas problems;
• a life-threatening blood clot; or
• serious bleeding problems.

To make sure Erwinaze is safe for you, tell your doctor if you have:

• problems with your liver or pancreas;
• bleeding problems;
• a blood clot; or
• diabetes.

Pregnancy

If you are pregnant, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. 

Erwinaze may harm an unborn baby. You may need a pregnancy test to make sure you are not pregnant. Use birth control while using this medicine and for at least 3 months after your last dose. Tell your doctor if you become pregnant.

Erwinaze can make hormonal birth control less effective, including birth control pills, injections, implants, skin patches, and vaginal rings. Use barrier birth control to prevent pregnancy: condom, diaphragm, cervical cap, or contraceptive sponge.

Fertility & Family planning

Potential for a decrease in male fertility cannot be ruled out.

Men should use effective contraceptive measures and be advised to not father a child while receiving asparaginase.

When appropriate both men and women should use necessary contraceptive measures before, and for at least three months after treatment with Erwinaze. Women should use a form of contraception other than oral contraceptives.

The time period following treatment with asparaginase when it is safe to become pregnant or father a child is unknown. As a precautionary measure it is recommended to wait for three months after completion of treatment. However, treatment with other chemotherapeutic agents should also be taken into consideration.

Breastfeeding

Do not breastfeed while using this medicine, and for at least 3 months after your last dose of Erwinaze.

Call your doctor for instructions if you miss a dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Common Erwinaze side effects

• liver or pancreas problems;
• bleeding or blood clots;
• high blood sugar;
• stomach pain, loss of appetite, nausea, vomiting, diarrhea;
• fever, headache, tiredness, mouth sores;
• bone pain, muscle or joint pain;
• allergic reaction, skin rash; or
• abnormal liver function tests.

Serious Erwinaze side effects

Get emergency medical help if you have signs of an allergic reaction to Erwinaze: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• easy bruising or bleeding (nosebleeds, bleeding gums);
• any bleeding that will not stop;
• blisters or ulcers in your mouth, red or swollen gums, trouble swallowing;
• signs of liver or pancreas problems - severe stomach pain (that may spread to your back), nausea or vomiting, jaundice (yellowing of the skin or eyes);
• signs of a blood clot - sudden numbness or weakness (especially on one side of the body), severe headache, chest pain, feeling short of breath, pain or swelling in an arm or leg;
• low white blood cell counts - fever, mouth sores, skin sores, sore throat, cough; or
• high blood sugar - increased thirst, increased urination, dry mouth, fruity breath odor.

Your cancer treatments may be delayed or permanently discontinued if you have certain side effects.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Other drugs may interact with asparaginase Erwinia chrysanthemi, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.