Drug General Information (ID: DDI2DRI13J)
Drug Name			Asparaginase Escherichia coli		Drug Info		Budesonide		Drug Info
Drug Type		Protein/peptide				Small molecule
Therapeutic Class		Antineoplastics				Antiinflammatory Agents

Mechanism of Asparaginase Escherichia coli-Budesonide Interaction (Severity Level: Moderate)
Increased risk of hyperglycemia Click to Show/Hide Mechanism Graph
Drug Name		Asparaginase Escherichia coli				Budesonide
Mechanism 1		Hyperglycemia				Hyperglycemia
Key Mechanism Factor 1
		Factor Name		Hyperglycemia
		Factor Description		Drugs can induce hyperglycemia through a variety of mechanisms, including altered insulin secretion and sensitivity, direct cytotoxic effects on pancreatic cells, and increased glucose production. Hyperglycemia may increase the risk of microvascular and macrovascular complications, infection, metabolic coma and even death.
Mechanism Description		Increased risk of hyperglycemia by the combination of Asparaginase Escherichia coli and Budesonide
Mechanism 2		Hyperglycemic effects				Hyperglycemia
Key Mechanism Factor 2
		Factor Name		Hyperglycemia
		Factor Description		Drugs can induce hyperglycemia through a variety of mechanisms, including altered insulin secretion and sensitivity, direct cytotoxic effects on pancreatic cells, and increased glucose production. Hyperglycemia may increase the risk of microvascular and macrovascular complications, infection, metabolic coma and even death.
Mechanism Description		Increased risk of hyperglycemia by the combination of Asparaginase Escherichia coli and Budesonide
Mechanism 3		Hyperglycemia				Hyperglycemic effects
Key Mechanism Factor 3
		Factor Name		Hyperglycemia
		Factor Description		Drugs can induce hyperglycemia through a variety of mechanisms, including altered insulin secretion and sensitivity, direct cytotoxic effects on pancreatic cells, and increased glucose production. Hyperglycemia may increase the risk of microvascular and macrovascular complications, infection, metabolic coma and even death.
Mechanism Description		Increased risk of hyperglycemia by the combination of Asparaginase Escherichia coli and Budesonide
Mechanism 4		Hyperglycemic effects				Hyperglycemic effects
Key Mechanism Factor 4
		Factor Name		Hyperglycemia
		Factor Description		Drugs can induce hyperglycemia through a variety of mechanisms, including altered insulin secretion and sensitivity, direct cytotoxic effects on pancreatic cells, and increased glucose production. Hyperglycemia may increase the risk of microvascular and macrovascular complications, infection, metabolic coma and even death.
Mechanism Description		Increased risk of hyperglycemia by the combination of Asparaginase Escherichia coli and Budesonide

Recommended Action
Management		Close monitoring for clinical and laboratory evidence of hyperglycemia and/or altered coagulation is also recommended at baseline and periodically throughout concurrent treatment with corticosteroids and asparaginase-derived products. Patients should be advised to promptly report any signs and symptoms of hyperglycemia, bleeding, blood clots or bone pain.

References
1	Product Information. Erwinaze (asparaginase Erwinia chrysanthemi). EUSA Pharma, Newtown, PA.
2	Product Information. Oncaspar (pegaspargase). Rhone-Poulenc Rorer, Collegeville, PA.
3	Kawedia JD, Liu C, Pei D, Cheng C, Fernandez CA, Howard SC, Campana D, Panetta JC, Bowman WP, Evans WE, Pui CH, Relling MV. Dexamethasone exposure and asparaginase antibodies affect relapse risk in acute lymphoblastic leukemia. Blood. 2012 Feb 16;119(7):1658-64.