NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

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Which agent is used as a rescue therapy for high-dose methotrexate to rapidly lower its levels?

  1. Leucovorin

  2. Folic acid

  3. Glucarpidase

  4. Vitamin B12

The correct answer is: Glucarpidase

When high-dose methotrexate is administered, there can be concerns about toxicity due to its prolonged half-life. Glucarpidase is used as a rescue therapy in such cases because it rapidly lowers methotrexate levels by converting it into inactive metabolites. This helps prevent or manage methotrexate toxicity, especially in cases where renal function is compromised. Leucovorin (Choice A) and folic acid (Choice B) are commonly used to reduce the toxicity of methotrexate, but they are not as rapidly effective as glucarpidase in lowering methotrexate levels. Vitamin B12 (Choice D) is not used as a rescue therapy for high-dose methotrexate toxicity.

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