When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to pegaspargase, or if you have a history of inflammation of the pancreas (pancreatitis), bleeding problem, or blood clot formation (thrombosis) caused by taking L-asparaginase (Elspar®).

How to Use This Medicine:
Injectable

• Medicines used to treat cancer are very strong and can have many side effects. Before receiving this medicine, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.
• Your doctor will prescribe your exact dose and tell you how often it should be given. This medicine is given as a shot into a muscle or vein.
• You will receive this medicine while you are in a hospital or cancer treatment center. A nurse or other trained health professional will give you this medicine.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are taking any medicine that affects blood clotting, such as aspirin or warfarin (Coumadin®).
• This medicine may interfere with vaccines. Ask your doctor before you get a flu shot or any other vaccines.

Warnings While Using This Medicine:

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have diabetes.
• Medicines that treat cancer may lower the number of some types of blood cells in your body. Because of this, you may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.
• Some people who have used this medicine developed serious allergic reactions while receiving this medicine. Your doctor will need you to stay at the clinic or hospital for at least one hour after receiving this medicine to check you for any unwanted effects that may be caused by this medicine.
• This medicine may cause problems with your blood sugar. Check with your doctor if you experience increased thirst or hunger, or any increase in how much or how often you urinate.
• This medicine may increase your risk of developing serious blood clots. Tell your doctor right away if you develop any sudden or severe headaches, arm or leg swelling, shortness of breath, or chest pain.
• Check with your doctor right away if you start having severe stomach pain, nausea, vomiting, fever, or lightheadedness. You may be having problems with your pancreas.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Chest pain, shortness of breath, or coughing up blood.
• Increased hunger or thirst.
• Increase in how much or how often you urinate.
• Numbness or weakness in your arm or leg, or on one side of your body.
• Pain in your lower leg (calf).
• Pain, itching, burning, swelling, or a lump under your skin where the needle is placed.
• Sudden and severe stomach pain, nausea, vomiting, or lightheadedness.
• Sudden or severe headache, problems with vision, speech, or walking.
• Swelling of the arm or leg.
• Unexplained fever or chills.
• Unusual bleeding, bruising, or weakness.
• Yellowing of your skin or the whites of your eyes.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088