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Generic name: glucarpidase
Drug class: Antidotes

Medically reviewed by  A Ras MD.

What is Voraxaze used for?

Voraxaze is a prescription medicine that is used to treat high methotrexate levels.


Glucarpidase is a carboxypeptidase produced by recombinant DNA technology in genetically modified Escherichia coli. Glucarpidase is a 390-amino acid homodimer protein with a molecular weight of 83 kDa. Each potency Unit corresponds to the enzymatic cleavage of 1 µmol/L of methotrexate per minute at 37°C.

VORAXAZE (glucarpidase) for injection, for intravenous use is supplied as a sterile, preservative-free, white lyophilized powder in single-dose vials. Each vial contains 1,000 Units of glucarpidase, lactose monohydrate (10 mg), Tris-HCl (0.6 mg) and zinc acetate dihydrate (0.002 mg).

  Mechanism of Action

Glucarpidase is a recombinant bacterial enzyme that hydrolyzes the carboxyl- terminal glutamate residue from folic acid and classical antifolates such as methotrexate.

Glucarpidase converts methotrexate to its inactive metabolites 4-deoxy-4-amino-N10– methylpteroic acid (DAMPA) and glutamate. VORAXAZE provides an alternate non-renal pathway for methotrexate elimination in patients with renal dysfunction during high-dose methotrexate treatment.

Before taking Voraxaze, tell your doctor:

  • If you are allergic to Voraxaze; any part of this medicine; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.

This medicine may interact with other drugs or health problems.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take Voraxaze with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take Voraxaze?

  • Tell all of your health care providers that you take Voraxaze. This includes your doctors, nurses, pharmacists, and dentists.
  • Have blood work checked as you have been told by the doctor. Talk with the doctor.
  • This medicine may affect certain lab tests. Be sure your doctor and lab workers know you use Voraxaze.
  • If you are also taking another drug called leucovorin, keep taking it as you were told by your doctor. Do not take leucovorin within 2 hours before or after a dose of Voraxaze. Talk with your doctor.
  • You may need to do other things to help treat high methotrexate levels. Talk with your doctor.
  • Tell your doctor if you are pregnant, plan on getting pregnant, or are breast-feeding. You will need to talk about the benefits and risks to you and the baby.

How is Voraxaze best taken?

Use Voraxaze as ordered by your doctor. Read all information given to you. Follow all instructions closely.

  • It is given as a shot into a vein.

What do I do if I miss a dose?

  • Call your doctor to find out what to do.

What are the side effects of Voraxaze that I need to call my doctor about immediately?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Very bad dizziness or passing out.
  • Flushing.
  • A burning, numbness, or tingling feeling that is not normal.
  • Feeling hot.
  • Headache.

What are some other side effects of Voraxaze?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch.

If overdose is suspected:

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

How do I store and/or throw out Voraxaze?

  • If you need to store Voraxaze at home, talk with your doctor, nurse, or pharmacist about how to store it.



Package Label – Principal Display Panel – VORAXAZE Vial


Package Label - Principal Display Panel - VORAXAZE Vial



Package Label – Principal Display Panel – VORAXAZE Carton


Package Label - Principal Display Panel - VORAXAZE Carton




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