Cytoprotective and supportive care agents:
Indications for VORAXAZE:
Treatment of toxic plasma methotrexate (MTX) concentrations (>1 micromole per liter) in patients with delayed MTX clearance due to impaired renal function.
Limitations of Use:
Not recommended in those who exhibit the expected clearance and expected plasma methotrexate concentration; may result in subtherapeutic exposure.
Adults and Children:
<1 month: not established. ≥1 month: Give as bolus IV inj over 5mins. 50Units/kg as a single injection. First 48hrs after glucarpidase: administer same leucovorin dose as given prior to glucarpidase. Beyond 48hrs after glucarpidase: determine leucovorin dose based on the measured MTX concentration. Continue leucovorin until the MTX concentration has been maintained below the leucovorin rescue threshold for a minimum of 3 days.
Monitor MTX concentrations only by chromatographic methods within 48hrs following administration. Continue hydration and alkalinization of urine as indicated. Pregnancy. Nursing mothers.
May reduce concentrations of leucovorin, other folate analogs or folate analog metabolic inhibitors. When concomitant leucovorin, give at least 2hrs before or 2hrs after glucarpidase administration.
Paresthesia, flushing, nausea, vomiting, hypotension, headache; rare: hypersensitivity reactions, antibody formation.