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Expert Guidelines

Consensus Guidelines Recommend Early Use of Voraxaze1

Consensus guidelines for use recommend administration of Voraxaze® (glucarpidase) at 48 hours following initiation of high-dose methotrexate (HDMTX) therapy when MTX concentrations are above 5 μM (2.27 μg/mL) and the serum creatinine is elevated relative to the baseline measurement.1

Beyond 48 to 60 hours, life-threatening toxicities and even death may not be preventable. Early and rapid reduction of methotrexate (MTX) concentrations can lower the risk of irreversible damage.1

Download the Algorithm Review Guideline Highlights

High-Dose Methotrexate (HDMTX) Monitoring Guideline and Voraxaze Treatment Algorithm1


High-Dose Methotrexate (HDMTX) Monitoring Guideline and Voraxaze Treatment Algorithm


*For MTX doses of 1-8 g/m2 over 24 hours, if MTX concentration is >120 μM or CrCl is greater than 1.5x baseline, continue supportive care and check MTX concentration at 36 hours1. CrCl, creatinine clearance.

Expert Consensus Guidelines Recommend Having 5 Vials of Voraxaze Readily Available2

  • Expert Consensus Guidelines published in 2018 recommend that all hospitals that provide emergency care should stock 5 vials of Voraxaze.2
  • The Institute for Safe Medication Practices (ISMP) recommends that all appropriate antidotes should be readily available.3
  • Standardized protocols and/or a coupled order should be set in place that permit the emergency administration of all appropriate antidotes used in the facility.3

Stock Voraxaze According to Guidelines

Not every patient requires Voraxaze, but having it on hand can help you be prepared in an emergency.

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View a Roadmap to Management of Patients With Delayed MTX Clearance

Download PDF: HDMTX Roadmap for Success