Leucovorin: Difference between revisions

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==Adult Dosing==
==Adult Dosing==
*Fluorouracil adjuvant tx, adv. colorectal CA
*Fluorouracil adjuvant treatment, adv. colorectal CA
**high dose: 200 mg/m^2 IV qd x5 days
**high dose: 200mg/m^2 IV QD x5 days
**low dose: 20 mg/m^2 IV qd x5 days
**low dose: 20mg/m^2 IV QD x5 days


*Leucovorin rescue, high-dose methotrexate
*Leucovorin rescue, high-dose [[methotrexate]]
**normal methotrexate elimination: 15 mg PO/IM/IV q6h x10 doses
**normal methotrexate elimination: 15mg PO/IM/IV q6h x10 doses
**delayed late methotrexate elimination: 15 mg PO/IM/IV q6h; Max: 25 mg/dose PO, May give higher doses IM/IV
**delayed late methotrexate elimination: 15mg PO/IM/IV q6h; Max: 25mg/dose PO, May give higher doses IM/IV


*Delayed early methotrexate elimination and/or acute renal injury: 150 mg IV q3h until methotrexate level <1 micromolar, then 15 mg IV q3h
*Delayed early methotrexate elimination and/or acute renal injury: 150mg IV q3h until methotrexate level <1 micromolar, then 15mg IV q3h


*Leucovorin rescue, methotrexate overdose: 10 mg/m^2 PO/IM/IV q6h
*Leucovorin rescue, methotrexate overdose: 10mg/m^2 PO/IM/IV q6h


*Folate antagonist overdose
*Folate antagonist overdose
**pemetrexed: 50 mg/m^2 IV q6h x8 days; Start: 100 mg/m^2 IV x1
**pemetrexed: 50mg/m^2 IV q6h x8 days; Start: 100mg/m^2 IV x1
**pyrimethamine, trimethoprim: 5-15 mg PO/IM/IV qd until hematopoiesis restored
**pyrimethamine, trimethoprim: 5-15mg PO/IM/IV QD until hematopoiesis restored


*Megaloblastic anemia, folate-deficient: <1 mg IM/IV qd
*Megaloblastic anemia, folate-deficient: <1mg IM/IV QD
**Max: 1 mg/day
**Max: 1mg/day


==Pediatric Dosing==
==Pediatric Dosing==
*Leucovorin rescue, high-dose methotrexate
*Leucovorin rescue, high-dose methotrexate
**normal methotrexate elimination: 10 mg/m^2 PO/IM/IV q6h x10 doses; Start: 24h after methotrexate start; Max: 25 mg/dose PO
**normal methotrexate elimination: 10mg/m^2 PO/IM/IV q6h x10 doses; Start: 24h after methotrexate start; Max: 25mg/dose PO
**delayed late methotrexate elimination: 10 mg/m^2 PO/IM/IV q6h; Max: 25 mg/dose PO
**delayed late methotrexate elimination: 10mg/m^2 PO/IM/IV q6h; Max: 25mg/dose PO
**delayed early methotrexate elimination and/or acute renal injury: 100 mg/m^2 IV q3h until methotrexate level <1 micromolar, then 10 mg/m^2 IV q3
**delayed early methotrexate elimination and/or acute renal injury: 100mg/m^2 IV q3h until methotrexate level <1 micromolar, then 10mg/m^2 IV q3


*Leucovorin rescue, methotrexate overdose: 10 mg/m^2 PO/IM/IV q6h
*Leucovorin rescue, methotrexate overdose: 10mg/m^2 PO/IM/IV q6h


*Folate antagonist overdose: 5-15 mg PO/IM/IV qd until hematopoiesis restored
*Folate antagonist overdose: 5-15mg PO/IM/IV QD until hematopoiesis restored


*Megaloblastic anemia, folate-deficient: <1 mg IM/IV qd
*Megaloblastic anemia, folate-deficient: <1mg IM/IV QD
**Max: 1 mg/day
**Max: 1mg/day


==Special Populations==
==Special Populations==
*Pregnancy Risk Factor: C
*Pregnancy Risk Factor: C
*Breast Feeding: Leucovorin is a form of folic acid and is present in breast milk which may be beneficial to the newborn.


===Renal Dosing===
===Renal Dosing===
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*anaphylactoid rxn
*anaphylactoid reaction
*seizures
*seizures
*syncope
*syncope
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==References==
==References==
<Epocrates, UpToDate>
<Epocrates, UpToDate>
[[Category:Drugs]]
[[Category:Pharmacology]] [[Category:Heme/Onc]]

Latest revision as of 22:52, 22 September 2019

Administration

  • Type: Antidote; Chemotherapy Modulating Agent; Rescue Agent (Chemotherapy)
  • Dosage Forms: 5,10,15,25
  • Routes of Administration: IV, IM
  • Common Trade Names: Lederle Leucovorin

Adult Dosing

  • Fluorouracil adjuvant treatment, adv. colorectal CA
    • high dose: 200mg/m^2 IV QD x5 days
    • low dose: 20mg/m^2 IV QD x5 days
  • Leucovorin rescue, high-dose methotrexate
    • normal methotrexate elimination: 15mg PO/IM/IV q6h x10 doses
    • delayed late methotrexate elimination: 15mg PO/IM/IV q6h; Max: 25mg/dose PO, May give higher doses IM/IV
  • Delayed early methotrexate elimination and/or acute renal injury: 150mg IV q3h until methotrexate level <1 micromolar, then 15mg IV q3h
  • Leucovorin rescue, methotrexate overdose: 10mg/m^2 PO/IM/IV q6h
  • Folate antagonist overdose
    • pemetrexed: 50mg/m^2 IV q6h x8 days; Start: 100mg/m^2 IV x1
    • pyrimethamine, trimethoprim: 5-15mg PO/IM/IV QD until hematopoiesis restored
  • Megaloblastic anemia, folate-deficient: <1mg IM/IV QD
    • Max: 1mg/day

Pediatric Dosing

  • Leucovorin rescue, high-dose methotrexate
    • normal methotrexate elimination: 10mg/m^2 PO/IM/IV q6h x10 doses; Start: 24h after methotrexate start; Max: 25mg/dose PO
    • delayed late methotrexate elimination: 10mg/m^2 PO/IM/IV q6h; Max: 25mg/dose PO
    • delayed early methotrexate elimination and/or acute renal injury: 100mg/m^2 IV q3h until methotrexate level <1 micromolar, then 10mg/m^2 IV q3
  • Leucovorin rescue, methotrexate overdose: 10mg/m^2 PO/IM/IV q6h
  • Folate antagonist overdose: 5-15mg PO/IM/IV QD until hematopoiesis restored
  • Megaloblastic anemia, folate-deficient: <1mg IM/IV QD
    • Max: 1mg/day

Special Populations

  • Pregnancy Risk Factor: C
  • Breast Feeding: Leucovorin is a form of folic acid and is present in breast milk which may be beneficial to the newborn.

Renal Dosing

  • Not defined

Hepatic Dosing

  • Not defined

Contraindications

  • Allergy to class/drug
  • intrathecal administration
  • caution if pernicious anemia
  • caution if megaloblastic anemia, vitamin B12 deficient
  • caution if vitamin B-12 deficiency

Adverse Reactions

Serious

  • anaphylactoid reaction
  • seizures
  • syncope

Common

  • urticaria
  • nausea/vomiting (IV use)

Pharmacology

  • Half-life: 6hr
  • Metabolism: liver, GI, CYP450
  • Excretion: Urine

Mechanism of Action

Comments

See Also

References

<Epocrates, UpToDate>

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