Glucarpidase is in a class of medications called enzymes. It works by helping to break down and remove methotrexate from the body.

What kind of drug is Glucarpidase?

Glucarpidase is in a class of medications called enzymes. It works by helping to break down and remove methotrexate from the body.

What is IV Glucarpidase?

Glucarpidase (Voraxaze) is an FDA-approved intravenous drug for the treatment of elevated levels of methotrexate (defined as 1 micromol/L) during treatment of cancer patients who have impaired kidney function (and thus cannot reduce the drug to safe levels sufficiently after the drug has been given).

Which drug is the antidote of methotrexate?

Glucarpidase. Glucarpidase is an antidote (remedy) for methotrexate toxicity. It’s usually given in combination with leucovorin to help prevent severe and potentially life-threatening methotrexate toxicity.

When should I take Glucarpidase?

VORAXAZE (glucarpidase) is indicated for the treatment of toxic plasma methotrexate concentrations (>1 micromole per liter) in patients with delayed methotrexate clearance due to impaired renal function.

How much is Glucarpidase?

The current average wholesale price (AWP) of glucarpidase is $27,000 per 1,000 unit vial. Therefore, one dose of glucarpidase in a 70 kg patient (i.e., four vials needed to supply 3,500 units) may cost >$100,000 if dosed per the FDA approved dosage.

Who makes Glucarpidase?

The drug substance glucarpidase is a recombinant protein of 41,400 D produced in E coli. The current manufacturer of the drug substance is Eurogentec, Belgium.

Why is methotrexate so toxic?

It is generally considered to be safe and therefore, it is not unusual to prescribe doses as high as 25 to 30 mg per week in modern rheumatology [6, 7]. Methotrexate toxicity is mainly due to its effects on folate metabolism.

Can methotrexate hurt your kidneys?

Methotrexate can lead to kidney injury at high doses for cancer and is contraindicated in advanced CKD. The effect of low-dose methotrexate (LD-MTX, ≤25 mg weekly) on eGFR and kidney adverse events (AEs) with normal kidney function or mild-to-moderate CKD is unclear.

What is the most common acute toxicity of methotrexate?

A common issue with administration of high-dose methotrexate (MTX) is nephrotoxicity, which may occur through both precipitation in the renal tubules and direct toxicity to the tubules [1].

Can methotrexate be dialyzed?

Methotrexate (MTX) can be toxic to patients suffering from end stage renal disease (ESRD) on hemodialysis even at low doses. This increase in toxicity is more notable in terms of bone marrow suppression in the form of pancytopenia.