glucarpidase

REMS

Lowering of toxic methotrexate levels (>1 micromole/L) associated with renal failure.

Contraindicated in:

Patients with expected clearance of methotrexate (methotrexate levels within 2 standard deviations of the mean methotrexate excretion curve specific for the dose given) or those with normal or mildly impaired renal function.

Use Cautiously in:

CV: hypotension

Derm: flushing

GI: nausea, vomiting

Neuro: headache, paresthesia

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Drug-drug:

↓effectiveness of leucovorin(should not be given within 2 hr before or after), similar effects may occur with other substrates of the enzyme including reduced folatesand folate antimetabolites.

Voraxaze

A carboxypeptidase enzyme that breaks methotrexate down into inactive metabolites that can be readily eliminated by non-renal pathways.

Therapeutic effects:

Prevention of damage associated with high levels of methotrexate including kidney and liver damage, mucositis and bone marrow depression.

Therapeutic Classification: orphan drugs, antidotes

Pharmacologic Classification: enzymes

Absorption: IV administration results in complete bioavailability.

Distribution: Restricted to plasma volume.

Metabolism/Excretion: Unknown.

Half-Life: 5.6 hr.

(reduction of methotrexate levels)

ROUTE	ONSET	PEAK	DURATION
IV	within 15 min	unknown	up to 8 days

Advise patient to notify health care professional if signs and symptoms of allergic reactions occur.
Emphasize the importance of continued monitoring of methotrexate blood levels and renal status following hospital discharge.
Advise female patient to notify health care professional if pregnancy is known or suspected or if breastfeeding.

gloo-KAR-pi-dase