Expert Guidelines

National Comprehensive Cancer Network® (NCCN®) recommendations for glucarpidase (Voraxaze)

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) strongly recommend using glucarpidase (VORAXAZE) in adult and pediatric patients receiving high-dose methotrexate who experience delayed elimination due to renal impairment whenV-VIII:

  • Plasma MTX concentrations are 2 standard deviations above the mean expected plasma concentration as determined by MTXPK.org, OR
  • Plasma methotrexate level is >30 µM at 36 hours, >10 µM at 42 hours, or >5 µM at 48 hours

I. Referenced with permission from the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for B-Cell Lymphomas V.4.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed June 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. II. Referenced with permission from the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Pediatric Aggressive Mature B-Cell Lymphomas V.2.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed June 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. III. Referenced with permission from the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Bone Cancer V.2.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed June 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. IV. Referenced with permission from the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Central Nervous System Cancers V.2.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed June 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. V. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Lymphoblastic Leukemia V.2.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed June 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. VI. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for B-Cell Lymphomas V.4.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed June 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. VII. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Pediatric Acute Lymphoblastic Leukemia V.2.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed June 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. VIII. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Pediatric Aggressive Mature B-Cell Lymphomas V.2.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed June 9, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org.
 
NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

MTXPK.ORG TOOL

A free, open-access online tool designed to help clinicians understand the pharmacokinetics of HDMTX, 
especially regarding delayed clearance.*

Get started 
*

This tool is a reference aid and the information contained is not intended to be a substitute for the exercise of professional judgment.

 

HDMTX, high-dose methotrexate; MTX, methotrexate.

Expert Consensus Stocking Guidelines Recommend Having 5 Vials of Voraxaze Readily Available1

  • Expert consensus guidelines published in 2018 recommend that all hospitals that provide emergency care should stock 5 vials of VORAXAZE1
  • The Institute for Safe Medication Practices (ISMP) recommends that all appropriate antidotes should be readily available2
  • Standardized protocols and/or coupled order sets should be in place to permit the emergency administration of all appropriate antidotes used in the facility2
  • †

    Expired, unused product purchased through an authorized distributor of record may be eligible for replacement between 2 months before expiration and the end of the month after the product expires. Additional terms and conditions apply.