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glucarpidase

glucarpidase
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Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Voraxaze POWDER FOR INJECTION, INTRAVENOUS 1,000 units      
Comments:

VORAXAZE is an antidote approved to treat toxic methotrexate concentrations in patients with reduced methotrexate clearance due to impaired renal function. The cost of one dose for a 70 kg patient is $90,000. It is classified as formulary restricted status to oncology and required order set use.

Glucarpidase Criteria For Use

Osteosarcoma patients:

  • Methotrexate level >50 micromole at hour 24, > 10 micromole at hour 36, >5 micromole at hour 48
  • OR plasma levels >2 standard deviations above the mean methotrexate elimination curve at >12 hours
  • AND SCr >2 times above pre-methotrexate baseline

 

Other patients:

  • Methotrexate level >5 micromole for >42 hours post-methotrexate initiation
  • OR plasma levels >2 standard deviations above the mean methotrexate elimination curve at >12 hours
  • AND SCr >1.5 times above pre-methotrexate baseline OR SCr >1.8 mg/dL

 

Dose: 50 units/kg IV as a single dose over 5 minutes

  • Administer within 96 hours of initiating the methotrexate infusion.
  • Do not administer leucovorin within 2 hours of glucarpidase.
  • For 48 hours after glucarpidase administration, determine the leucovorin dose based on the patient’s pre-glucarpidase methotrexate concentration.

 

Reviewed: August 28, 2012

Last updated: May. 18, 2024






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