Recombinant carboxypeptidase G2
Glucarpidase
Brand names: Voraxaze
Adult dose
Dose: 50 units/kg IV single dose for severe methotrexate-induced toxicity
Route: IV
Frequency: single
Clinical pearls
- Methotrexate toxicity with delayed elimination (level >1 micromol/L at 42h or beyond) and renal impairment
- Continue folinic acid; do not measure MTX by immunoassay for ≥48h after glucarpidase
Contraindications
- Hypersensitivity
Side effects
- Paraesthesia
- Headache
- Flushing
- Hypersensitivity
Interactions
- Folinic acid (separate by ≥2h before/after — glucarpidase metabolises folinic)
Monitoring
- Methotrexate level (HPLC)
- U&E
- FBC
- LFTs
Reference: BNF; UKHCDO/UK Children's Cancer SG MTX toxicity guideline; SmPC; https://bnf.nice.org.uk/drugs/glucarpidase/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109
- Acute Chest Pain · NICE CG95; ESC 2023 ACS Guidelines