Levoleucovorin

Administration

• Type: Folinic Acid
• Dosage Forms: IV
• Routes of Administration: Intravenous
• Common Trade Names: Fusilev

Adult Dosing

• Methotrexate toxicity, levoleucovorin rescue
  • 7.5 mg IV q6h
    • Start: ASAP after overdose and w/in 24 hr if delayed methotrexate elimination
    • Continue until methotrexate level <0.01 micromolar
    • Adjust dose/freqency based on elimination and renal function
• Levoleucovorin rescue, high dose methotrexate
  • 7.5 mg IV q6h x10 doses
    • Start: 24 hr after methotrexate start
    • Adjust dose/frequency based on elimination and renal function

Pediatric Dosing

• 6+ yo, Methotrexate toxicity, levoleucovorin rescue
  • 5 mg/m^2 IV q6h
    • Start: ASAP after overdose and w/in 24 hr if delayed methotrexate elimination
    • Continue until methotrexate level <0.01 micromolar
    • Adjust dose/freqency based on elimination and renal function
• 6+ yo, high-dose methotrexate, levoleucovorin rescue
  • 5 mg/m^2 IV q6h x10 doses
    • Start: 24 hr after methotrexate start
    • Adjust dose/frequency based on elimination and renal function

Special Populations

• Pregnancy Rating: C; No human data available
• Lactation risk: L3; Safety unknown

Renal Dosing

• Adult: Not defined
• Pediatric: Not defined

Hepatic Dosing

• Adult: Not defined
• Pediatric: Not defined

Contraindications

• Allergy to class/drug/component
• Hypersensitivity to folic acid
• Hypersensitivity to folinic acid
• Intrathecal administration

Adverse Reactions

Serious

• May occur, but none reported

Common

• Stomatitis
• Vomiting
• Nausea
• Diarrhea
• Dyspepsia
• Typhlitis
• Dyspnea
• Confusion
• Neuropathy
• Renal impairment
• Taste changes
• Dermatitis
• Pruritus
• Rash
• Fever
• Rigor

Pharmacology

• Half-life: 6.8 hr
• Metabolism: Liver, GI tract; CYP450: Unknown
• Excretion: Urine

Mechanism of Action

• Participates in reactions utilizing folates
• Counteracting folate antagonists
• Enhances the effects of fluoropyrimidines

See Also

• Methotrexate toxicity