Glucarpidase, also known by its brand name Voraxaze, is a medication used in cancer treatment. It is primarily indicated for the treatment of toxic plasma methotrexate concentrations (>1 μmol/L) in patients with delayed methotrexate clearance due to impaired renal function. Methotrexate is a chemotherapy drug commonly used to treat various types of cancer, including leukemia and lymphoma.

Glucarpidase works by rapidly converting methotrexate into inactive metabolites, thus lowering toxic plasma levels of methotrexate. This can be crucial in cases where high levels of m

Glucarpidase (Voraxaze) is a synthetic enzyme that inactivates methotrexate. It is used in patients with methotrexate overdose or toxicity. Methotrexate administered in high doses as in cancer patients may result in nephrotoxicity that can further impair the excretion of methotrexate. Life-threatening toxicity may occur that can be prevented by the intravenous administration of glucarpidase.

Glucarpidase (Voraxaze) Uses:

• Methotrexate toxicity:
  • In patients with acute or chronic kidney disease where elimination of methotrexate is reduced and plasma concentration greater than 1 umol/L
  • Limitations of use: Not indicated when renal function is normal or mildly deranged when clearance is not impaired
• Off Label Use of Glucarpidase in Adults:
  • Intrathecal methotrexate overdose

Glucarpidase (Voraxaze) Dose in Adults

Note:

• Leucovorin calcium and methotrexate are both drugs used in cancer treatment. Glucarpidase is another drug that helps to reduce the harmful effects of methotrexate in the body.
• However, when you're using glucarpidase, you need to be careful with the timing of leucovorin calcium. Leucovorin calcium can 'compete' with methotrexate for the same places in the body where they work. So, it's important not to give leucovorin calcium too close to when you give glucarpidase.
• To make sure they don't interfere with each other, it's recommended not to give leucovorin calcium within 2 hours before or after giving glucarpidase. This way, each drug can do its job properly without getting in each other's way.

Glucarpidase (Voraxaze) Dose in the treatment of Methotrexate toxicity:

• When treating methotrexate toxicity with glucarpidase, the typical dose given intravenously (IV) is 50 units per kilogram of body weight as a single dose.

Glucarpidase (Voraxaze) Dose in the treatment of Intrathecal methotrexate overdose (off-label route/use):

• In the treatment of intrathecal methotrexate overdose, which is an off-label route or use of glucarpidase, the typical dose is 2,000 units.
• This dose should be administered as soon as possible after the accidental overdose of methotrexate.

Glucarpidase (Voraxaze) Dose in Children

Note: Don't give leucovorin calcium too close to glucarpidase. They both work in similar ways and can compete for the same spots in the body. To avoid them getting in each other's way, wait at least 2 hours between giving leucovorin calcium and glucarpidase.

Glucarpidase (Voraxaze) Dose in the treatment of Methotrexate toxicity:

• For treating methotrexate toxicity in infants, children, and adolescents, the typical dose of glucarpidase given intravenously (IV) is 50 units per kilogram of body weight as a single dose.

Glucarpidase (Voraxaze) Dose in the treatment of Intrathecal methotrexate overdose:

• In treating intrathecal methotrexate overdose, specifically in children aged 5 years and older, as well as adolescents, the recommended dose of glucarpidase is 2,000 units.
• This should be administered as soon as possible after accidental exposure to methotrexate.

Pregnancy Risk Factor C

• The pregnancy risk factor for glucarpidase is classified as Category C.
• This means that animal reproduction studies haven't been conducted, so it's unclear what risk it poses to a developing fetus if administered to a pregnant woman.
• However, if it's necessary for the health and prognosis of the mother, it may be used, but the potential risks to the fetus should be weighed against the benefits to the mother.

Use during breastfeeding:

• It's uncertain whether glucarpidase is present in breast milk.
• Therefore, caution is advised when considering its use in breastfeeding women.
• The potential risks and benefits should be discussed with a healthcare provider before making a decision.

Dose in Kidney disease:

• No dosage adjustment is needed for glucarpidase in individuals with renal impairment.

• This means that the standard dose of glucarpidase can be given to patients with kidney problems without needing to change the amount based on their kidney function.

Dose in Liver disease:

• No dosage adjustments for glucarpidase are provided in the manufacturer's labeling for individuals with hepatic impairment.
• This means that the appropriate dose remains the same regardless of any liver-related issues.
• However, it's important to note that this lack of adjustment is because the effects of hepatic impairment on glucarpidase haven't been specifically studied.

Side Effects of Glucarpidase (Voraxaze):

• Immunologic:
  • Antibody development

• Cardiovascular:
  • Flushing
  • Hypotension
• Central nervous system:
  • Headache
• Gastrointestinal:
  • Nausea/vomiting
• Neuromuscular & skeletal:
  • Paresthesia

Contraindications to Glucarpidase (Voraxaze):

• According to the manufacturer's labeling, there are no contraindications listed for glucarpidase.
• This means that there are no specific situations or conditions where the use of glucarpidase is absolutely prohibited.

Warnings and precautions

Hypersensitivity

• Hypersensitivity reactions, including serious allergic reactions, have been reported with the use of glucarpidase.
• This means that some individuals may experience severe allergic responses when receiving glucarpidase treatment.

Glucarpidase (Voraxaze): Drug Interaction

Monitoring parameters:

Serum Methotrexate Levels:

• Timing: If less than 48 hours have passed since glucarpidase administration:
  • Use a chromatographic method for measuring serum methotrexate levels.
• Reasoning: DAMPA can interfere with immunoassay results until more than 48 hours after glucarpidase administration.

Monitoring Parameters:

• Complete Blood Count (CBC) with Differential
• Bilirubin Levels
• Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) Levels
• Serum Creatinine Levels
• Signs/Symptoms Evaluation:
  • Look for any signs or symptoms of methotrexate toxicity.

How to administer Glucarpidase (Voraxaze)?

Intravenous Administration:

• Infusion Duration: Administer over 5 minutes.
• IV Line Flushing: Flush the IV line before and after glucarpidase administration.
• Caution with Leucovorin Calcium:
  • Do not give leucovorin calcium within 2 hours before or after glucarpidase to avoid competition for binding sites.

Intrathecal Administration (Off-label for Intrathecal Methotrexate Overdose):

• Timing: Glucarpidase should be given within 3 to 9 hours of accidental intrathecal methotrexate overdose.
• Administration Routes:
  • Administered over 5 minutes via lumbar route, ventriculostomy, Ommaya reservoir, or both lumbar and ventriculostomy.
• Dosage in Case Report:
  • In one case, 1,000 units were administered through the ventricular catheter over 5 minutes, followed by another 1,000 units through the lumbar catheter.

Mechanism of action of Glucarpidase (Voraxaze):

• Glucarpidase is a type of recombinant enzyme.
• Its main job is to quickly break down a specific part of methotrexate, a drug used in cancer treatment.
• By doing this, it turns methotrexate into inactive substances called DAMPA and glutamate.
• This process happens outside of the cells in the body, and it happens fast.
• One important thing to note is that this breakdown of methotrexate by glucarpidase doesn't depend on how well the kidneys are working.

Onset of Action:

• Methotrexate Toxicity:
  • Reduces methotrexate concentrations by at least 97% within 15 minutes of IV administration.

Duration:

• Methotrexate Toxicity:
  • Maintains a greater than 95% reduction of methotrexate concentrations for up to 8 days.

Distribution:

• Volume of Distribution (V):
  • IV Administration: 3.6 liters.
  • Distribution is restricted to plasma volume.

Half-life Elimination:

• IV Administration:
  • Normal Renal Function:
    • Serum glucarpidase activity levels: 5.6 hours.
    • Serum total glucarpidase: approximately 9 hours.
  • Impaired Renal Function (Creatinine Clearance <30 mL/minute):
    • Half-life: 8 to 10 hours.

International Brand Names of Glucarpidase:

• Voraxaze

Glucarpidase Brand Names in Pakistan:

No Brands Available in Pakistan.

Glucarpidase, also known by its brand name Voraxaze, is a medication used in cancer treatment. It is primarily indicated for the treatment of toxic plasma methotrexate concentrations (>1 μmol/L) in patients with delayed methotrexate clearance due to impaired renal function. Methotrexate is a chemotherapy drug commonly used to treat various types of cancer, including leukemia and lymphoma.

Glucarpidase works by rapidly converting methotrexate into inactive metabolites, thus lowering toxic plasma levels of methotrexate. This can be crucial in cases where high levels of m

Glucarpidase (Voraxaze) is a synthetic enzyme that inactivates methotrexate. It is used in patients with methotrexate overdose or toxicity. Methotrexate administered in high doses as in cancer patients may result in nephrotoxicity that can further impair the excretion of methotrexate. Life-threatening toxicity may occur that can be prevented by the intravenous administration of glucarpidase.

Glucarpidase (Voraxaze) Uses:

• Methotrexate toxicity:
  • In patients with acute or chronic kidney disease where elimination of methotrexate is reduced and plasma concentration greater than 1 umol/L
  • Limitations of use: Not indicated when renal function is normal or mildly deranged when clearance is not impaired
• Off Label Use of Glucarpidase in Adults:
  • Intrathecal methotrexate overdose

Glucarpidase (Voraxaze) Dose in Adults

Note:

• Leucovorin calcium and methotrexate are both drugs used in cancer treatment. Glucarpidase is another drug that helps to reduce the harmful effects of methotrexate in the body.
• However, when you're using glucarpidase, you need to be careful with the timing of leucovorin calcium. Leucovorin calcium can 'compete' with methotrexate for the same places in the body where they work. So, it's important not to give leucovorin calcium too close to when you give glucarpidase.
• To make sure they don't interfere with each other, it's recommended not to give leucovorin calcium within 2 hours before or after giving glucarpidase. This way, each drug can do its job properly without getting in each other's way.

Glucarpidase (Voraxaze) Dose in the treatment of Methotrexate toxicity:

• When treating methotrexate toxicity with glucarpidase, the typical dose given intravenously (IV) is 50 units per kilogram of body weight as a single dose.

Glucarpidase (Voraxaze) Dose in the treatment of Intrathecal methotrexate overdose (off-label route/use):

• In the treatment of intrathecal methotrexate overdose, which is an off-label route or use of glucarpidase, the typical dose is 2,000 units.
• This dose should be administered as soon as possible after the accidental overdose of methotrexate.

Glucarpidase (Voraxaze) Dose in Children

Note: Don't give leucovorin calcium too close to glucarpidase. They both work in similar ways and can compete for the same spots in the body. To avoid them getting in each other's way, wait at least 2 hours between giving leucovorin calcium and glucarpidase.

Glucarpidase (Voraxaze) Dose in the treatment of Methotrexate toxicity:

• For treating methotrexate toxicity in infants, children, and adolescents, the typical dose of glucarpidase given intravenously (IV) is 50 units per kilogram of body weight as a single dose.

Glucarpidase (Voraxaze) Dose in the treatment of Intrathecal methotrexate overdose:

• In treating intrathecal methotrexate overdose, specifically in children aged 5 years and older, as well as adolescents, the recommended dose of glucarpidase is 2,000 units.
• This should be administered as soon as possible after accidental exposure to methotrexate.

Pregnancy Risk Factor C

• The pregnancy risk factor for glucarpidase is classified as Category C.
• This means that animal reproduction studies haven't been conducted, so it's unclear what risk it poses to a developing fetus if administered to a pregnant woman.
• However, if it's necessary for the health and prognosis of the mother, it may be used, but the potential risks to the fetus should be weighed against the benefits to the mother.

Use during breastfeeding:

• It's uncertain whether glucarpidase is present in breast milk.
• Therefore, caution is advised when considering its use in breastfeeding women.
• The potential risks and benefits should be discussed with a healthcare provider before making a decision.

Dose in Kidney disease:

• No dosage adjustment is needed for glucarpidase in individuals with renal impairment.

• This means that the standard dose of glucarpidase can be given to patients with kidney problems without needing to change the amount based on their kidney function.

Dose in Liver disease:

• No dosage adjustments for glucarpidase are provided in the manufacturer's labeling for individuals with hepatic impairment.
• This means that the appropriate dose remains the same regardless of any liver-related issues.
• However, it's important to note that this lack of adjustment is because the effects of hepatic impairment on glucarpidase haven't been specifically studied.

Side Effects of Glucarpidase (Voraxaze):

• Immunologic:
  • Antibody development

• Cardiovascular:
  • Flushing
  • Hypotension
• Central nervous system:
  • Headache
• Gastrointestinal:
  • Nausea/vomiting
• Neuromuscular & skeletal:
  • Paresthesia

Contraindications to Glucarpidase (Voraxaze):

• According to the manufacturer's labeling, there are no contraindications listed for glucarpidase.
• This means that there are no specific situations or conditions where the use of glucarpidase is absolutely prohibited.

Warnings and precautions

Hypersensitivity

• Hypersensitivity reactions, including serious allergic reactions, have been reported with the use of glucarpidase.
• This means that some individuals may experience severe allergic responses when receiving glucarpidase treatment.

Glucarpidase (Voraxaze): Drug Interaction

Monitoring parameters:

Serum Methotrexate Levels:

• Timing: If less than 48 hours have passed since glucarpidase administration:
  • Use a chromatographic method for measuring serum methotrexate levels.
• Reasoning: DAMPA can interfere with immunoassay results until more than 48 hours after glucarpidase administration.

Monitoring Parameters:

• Complete Blood Count (CBC) with Differential
• Bilirubin Levels
• Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) Levels
• Serum Creatinine Levels
• Signs/Symptoms Evaluation:
  • Look for any signs or symptoms of methotrexate toxicity.

How to administer Glucarpidase (Voraxaze)?

Intravenous Administration:

• Infusion Duration: Administer over 5 minutes.
• IV Line Flushing: Flush the IV line before and after glucarpidase administration.
• Caution with Leucovorin Calcium:
  • Do not give leucovorin calcium within 2 hours before or after glucarpidase to avoid competition for binding sites.

Intrathecal Administration (Off-label for Intrathecal Methotrexate Overdose):

• Timing: Glucarpidase should be given within 3 to 9 hours of accidental intrathecal methotrexate overdose.
• Administration Routes:
  • Administered over 5 minutes via lumbar route, ventriculostomy, Ommaya reservoir, or both lumbar and ventriculostomy.
• Dosage in Case Report:
  • In one case, 1,000 units were administered through the ventricular catheter over 5 minutes, followed by another 1,000 units through the lumbar catheter.

Mechanism of action of Glucarpidase (Voraxaze):

• Glucarpidase is a type of recombinant enzyme.
• Its main job is to quickly break down a specific part of methotrexate, a drug used in cancer treatment.
• By doing this, it turns methotrexate into inactive substances called DAMPA and glutamate.
• This process happens outside of the cells in the body, and it happens fast.
• One important thing to note is that this breakdown of methotrexate by glucarpidase doesn't depend on how well the kidneys are working.

Onset of Action:

• Methotrexate Toxicity:
  • Reduces methotrexate concentrations by at least 97% within 15 minutes of IV administration.

Duration:

• Methotrexate Toxicity:
  • Maintains a greater than 95% reduction of methotrexate concentrations for up to 8 days.

Distribution:

• Volume of Distribution (V):
  • IV Administration: 3.6 liters.
  • Distribution is restricted to plasma volume.

Half-life Elimination:

• IV Administration:
  • Normal Renal Function:
    • Serum glucarpidase activity levels: 5.6 hours.
    • Serum total glucarpidase: approximately 9 hours.
  • Impaired Renal Function (Creatinine Clearance <30 mL/minute):
    • Half-life: 8 to 10 hours.

International Brand Names of Glucarpidase:

• Voraxaze

Glucarpidase Brand Names in Pakistan:

Not available.