Parenteral Manual


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Alternate Name(s): 
CPDG2, VORAXAZE, NSC 732443, Carboxypeptidase-G2 (Investigational)
Rescue agent, Recombinant enzyme
Original Date: 
August 2005
Revised Date: 
November 2008
  • 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.

- Solutions Compatible: NS


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct

Usual dilution: undiluted (1000 units/mL)
Infusion time: 5 minutes

IV Intermittent Infusion NO
IV Continuous Infusion NO

Usual dilution: dilute in age appropriate volume of NS
Infusion time: 5 minutes


QS to volume with NS

1 year

6 mL

>1 year

8 mL

>2 years

10 mL

>3 years

12 mL


(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


>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
  • 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

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