Glucarpidase at a glance
Medicine class
Detoxifying enzyme for antineoplastic treatment
Licensed use
Delayed elimination of toxic methotrexate concentrations in adults and children aged 28 days and older
Administration
Prepared and injected into a vein by a healthcare professional
Ongoing care
Folinic acid, hydration, urine alkalinisation and monitoring may still be required
What is Glucarpidase used for?
Glucarpidase is licensed to reduce toxic plasma methotrexate concentrations when methotrexate elimination is delayed.
For adults and children aged 28 days and older.
Used with, not instead of, folinic acid and other supportive measures.
How does Glucarpidase work?
Glucarpidase splits methotrexate into inactive metabolites that are cleared mainly through non-renal pathways. It acts in the bloodstream but does not remove methotrexate already inside tissues or cancer cells.
How to take Glucarpidase
Glucarpidase is supplied as a powder, reconstituted with sterile sodium chloride and given into a vein under medical supervision. It is not taken by mouth, and food does not affect administration.
The intravenous line is flushed before and after administration.
The prepared solution should not be mixed with other medicines because compatibility data are unavailable.
Monitoring and other methotrexate-rescue measures continue afterwards.
Glucarpidase side effects
Common or expected effects
- No adverse reactions are classified as common. Uncommon reactions include tingling or burning sensations, flushing, headache and feeling hot.
Get urgent medical advice
- Severe allergic reaction or anaphylaxis, potentially causing breathing difficulty, throat tightness, low blood pressure or collapse.
- An extensive rash or other significant infusion-related reaction.
Glucarpidase in pregnancy
There are no adequate pregnancy data for glucarpidase. Methotrexate is genotoxic, teratogenic and contraindicated in pregnancy. Glucarpidase should be used during pregnancy only when the specialist team considers it clearly necessary.
Glucarpidase while breastfeeding
It is unknown whether glucarpidase or its metabolites pass into breast milk, and risk to a breastfed infant cannot be excluded. The specialist team must weigh the need for treatment against the benefits of breastfeeding and advise whether breastfeeding should stop.
Glucarpidase interactions
The most clinically important interactions involve folate-related treatments used during methotrexate rescue.
Folinic acid (leucovorin)
Glucarpidase can break down folinic acid and reduce its rescue effect, so administration must be coordinated by the treating team.
Other folate analogues or folate-antagonist medicines
Glucarpidase may reduce their circulating concentrations; the oncology or pharmacy team should assess clinical relevance.
Common questions about Glucarpidase
Answers are fully visible for fast scanning and source review.
Is glucarpidase chemotherapy?
No. It is a detoxifying enzyme used to remove methotrexate from the bloodstream when elimination is delayed.
Does it remove methotrexate from inside cells?
No. It acts mainly in plasma and does not readily cross cell membranes.
Does it replace folinic acid rescue?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.