Glucarpidase (Voraxaze)

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General information

Class/mechanism: Recombinant bacterial enzyme that degrades folic acid and antifolates such as methotrexate by hydrolyzing their carboxyl-terminal glutamate residues. Glucarpidase catalyzes the degradation of methotrexate to the inactive metabolites 4-deoxy-4-amino-N10-methylpteroic acid (DAMPA) and glutamate.[1][2][3]
Route: IV
Extravasation: no information

For conciseness and simplicity, currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias or the prescribing information.[1]

Patient drug information

History of changes in FDA indication

  • 2012-01-17: Initial FDA approval for the treatment of toxic plasma methotrexate concentrations (greater than 1 micromole per liter) in patients with delayed methotrexate clearance due to impaired renal function.

History of changes in PMDA indication

  • 2021-09-27: Newly indicated to reduce toxic plasma methotrexate concentration in patients with delayed clearance of methotrexate due to methotrexate/leucovorin salvage therapy.

Also known as

  • Generic name: carboxypeptidase G2
  • Brand names: Megludase, Voraxaze


  1. Buchen S, Ngampolo D, Melton RG, Hasan C, Zoubek A, Henze G, Bode U, Fleischhack G. Carboxypeptidase G2 rescue in patients with methotrexate intoxication and renal failure. Br J Cancer. 2005 Feb 14;92(3):480-7. link to original article link to PMC article PubMed