Alternate Name(s):
CPDG2, VORAXAZE, NSC 732443, Carboxypeptidase-G2 (Investigational)
Classification:
Rescue agent, Recombinant enzyme
Original Date:
August 2005
Revised Date:
November 2008
Indications:
- Rescue agent for intrathecal methotrexate overdose >100 mg (cleaves the methotrexate molecule into inactive metabolites)
- Rescue agent for patients with markedly delayed methotrexate clearance secondary to renal dysfunction
Reconstitution and Stability:
- Available as a vial containing 1000 units of glucarpidase
- Store vials in fridge (2-8°C) in original package
- Stable at room temperature for 24 hours
- Vials are stoppered with rubber closures
- Reconstitute with 1 mL of NS immediately prior to use. Final concentration 1000 units/mL.
Compatibility:
- Solutions Compatible: NS
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO | ||||||||||
| IM | NO | ||||||||||
| IV Direct |
YES |
||||||||||
| IV Intermittent Infusion | NO | ||||||||||
| IV Continuous Infusion | NO | ||||||||||
| Intrathecal |
YES
|
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
- IT Methotrexate Overdose:
- 2,000 units (2 vials) intrathecally (via lumbar puncture or Omaya reservoir) - Delayed Methotrexate Clearance:
- 50 units/kg (no maximum dose)
|
MTX level prior to Glucarpidase dose |
# Doses |
|
<100 µM |
1 |
|
>100 µM |
2 (48 hours apart) |
- Dosing in severely obese patients should be based on lean body weight
Potential hazards of parenteral administration:
- Reversible side effects: feeling of warmth, tingling fingers, flushing, shaking, minimal burning of face and extremities, itchiness of face and legs
- Potential for severe hypersensitivity reactions (glucarpidase is a bacterial protein)- discontinue glucarpidase if there is an allergic reaction
Notes:
- 1 unit corresponds to the enzyme activity that cleaves 1 micromole methotrexate per minute at 37°C
- Administration of glucarpidase may result in antibody formation which could lead to immunologic reactions and diminished activity in patients receiving more than 1 dose
- Continue leucovorin therapy
- Leucovorin should not be administered 2 hours prior to and for 2 hours following glucarpidase dose
- Increase hydration (with sodium bicarbonate) to maintain urine pH >7
Anaphylaxis Precautions:
- RN must remain with patient for first 15 minutes of first dose. Have anaphylaxis kit available at bedside. Continue vital signs monitoring every 15 minutes x 4 after glucarpidase injection
To obtain the SAP glucarpidase supply:
* Pharmacist, refer to tips for pharmacists binder or the 'R drive' under the oncology folder