Glucarpidase
VORAXAZE
Pronunciation: gloo-KAR-pi-dayz
What it isRecombinant carboxypeptidase cleaving methotrexate; toxic methotrexate levels with renal impairment.
Why this oneIt clears methotrexate within minutes when the kidney cannot, where dialysis is slow and incomplete.
What limits itIt does not replace leucovorin, which must continue. Immunoassays overestimate methotrexate afterwards; extreme cost.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Toxic plasma methotrexate concentration (delayed clearance from renal impairment) | Adults & peds | 50 Units/kg single IV over 5 min | 50 Units/kg single dose |
Renal Undefined
Hepatic Undefined
Single dose; leucovorin must be separated by ≥2 hours
Instructions
- Single IV injection over 5 minutes; flush IV line before and after
- Give leucovorin at least 2 hours before or after VORAXAZE; continue per methotrexate levels
- Measure methotrexate by a chromatographic method within 48 h (immunoassays unreliable)
Available strengths
- inj 1000 [usp'u]/1
Cautions
- Serious hypersensitivity reactions
- Immunoassay interference from DAMPA metabolite for up to 48 h (overestimates methotrexate)
Adverse reactions
- Paresthesia
- Flushing
- Nausea/vomiting
- Hypotension
- Headache
Pregnancy No data; given with methotrexate, which can cause embryo-fetal harm — refer to methotrexate labeling.
Lactation No data; given with methotrexate — refer to methotrexate labeling.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 1000 [usp'u]/1 | inj | per unit | not offered |
NO BOXED WARNINGS
Principal riskIt does not replace leucovorin; extreme cost
Classes and tags
Clinical profile
Defining liabilityHypersensitivity and interference with leucovorin rescue or methotrexate assays