Leucovorin Dosage

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Colorectal Cancer

200 mg/m2 (rounded to the nearest 5 mg) IV diluted to 10 mg/100 mL with sterile water for injection, over at least 3 minutes. Follow with 5-FU 370 mg/m2 IV. An alternative regimen is leucovorin 20 mg/m2 (rounded to the nearest 5 mg) IV diluted to 10 mg/mL with sterile water for injection. Follow with 5-FU 425 mg/m2 IV. Either regimen may be continued daily for 5 days, then repeated on a 28-day cycle for 2 cycles, then repeated at 28 to 35 day cycle intervals as long as the patient has recovered from toxicity.

Usual Adult Dose for Methotrexate Rescue

10 mg/m2 diluted to 10 mg/mL with bacteriostatic water for injection IV, IM, or orally every 6 hours for 60 hours (10 doses starting 24 hours after the beginning of the methotrexate (MTX) 12 to 15 g/m2 infusion. The dosage of leucovorin may then be adjusted according to the following guidelines: If the serum MTX levels are approximately 10,1, and < 0.2 micromolar at 24, 48, and 72 hours, the above regimen may suffice. Delayed elimination of MTX: If the serum MTX levels are > 0.2 and > 0.05 micromolar at 72 and 96 hours, the above regimen may be continued every 6 hours until the MTX level is < 0.05 micromolar.
Delayed early elimination of MTX and/or acute renal failure: If the serum MTX levels are > 50 or 5 micromolar at 24 and 48 hours, or if there is a 50% or more increase in serum creatinine within the first 24 hours after the beginning of the MTX infusion, the dosage of leucovorin should be increased 20-fold (twice the dose and frequency) to 100 mg/m2 IV every 3 hours until the MTX level is < 0.05 micromolar.

Usual Adult Dose for Megaloblastic Anemia

1 mg IV or IM once a day. Vitamin B12 should be replenished prior to or during folate replacement lest neurologic symptoms persist or worsen during hematologic remission. Leucovorin is not proper therapy for pernicious anemia and other megaloblastic anemias secondary to the lack of vitamin B12.

Usual Adult Dose for Folic Acid Antagonist Overdose

2 to 15 mg/day orally for 3 days or until blood counts are normal or 5 mg orally every 3 days. 6 mg/day orally is recommended for use in patients with platelet counts <100,000/mm3.

Usual Adult Dose for Pneumocystis Pneumonia

20 mg/m2 body surface area intravenously every six hours or 20 mg/m2 body surface area orally every six hours. Since oral absorption becomes saturated, individual oral doses greater than 25 mg are not recommended and should be given parenterally instead.

Treatment should start with the first dose of trimetrexate and continued for 72 hours after the last dose. Intravenous leucovorin may be administered immediately before or after the dosage of trimetrexate. The line should be flushed thoroughly to avoid precipitation.

The dosage of leucovorin should be adjusted for patients with trimetrexate-induced hematologic toxicity. In patients with a neutrophil count of less than 1000 per mm3 or a platelet count of less than 75,000 per mm3, the dosage of leucovorin should be increased to 40 mg/m2.

Usual Adult Dose for Pneumocystis Pneumonia Prophylaxis

25 mg orally once a week

Usual Adult Dose for Toxoplasmosis

10 to 25 mg/day orally

Usual Adult Dose for Toxoplasmosis - Prophylaxis

25 mg orally once a week or requiring secondary prophylaxis with pyrimethamine is 10 to 25 mg orally once a day

Usual Pediatric Dose for Colorectal Cancer

200 mg/m2 (rounded to the nearest 5 mg) IV diluted to 10 mg/100 mL with sterile water for injection, over at least 3 minutes. Follow with 5-FU 370 mg/m2 IV. An alternative regimen is leucovorin 20 mg/m2 (rounded to the nearest 5 mg) IV diluted to 10 mg/mL with sterile water for injection. Follow with 5-FU 425 mg/m2 IV. Either regimen may be continued daily for 5 days, then repeated on a 28-day cycle for 2 cycles, then repeated at 28 to 35 day cycle intervals as long as the patient has recovered from toxicity.

Usual Pediatric Dose for Methotrexate Rescue

10 mg/m2 diluted to 10 mg/mL with bacteriostatic water for injection IV, IM, or orally every 6 hours for 60 hours (10 doses starting 24 hours after the beginning of the methotrexate (MTX) 12 to 15 g/m2 infusion. The dosage of leucovorin may then be adjusted according to the following guidelines: If the serum MTX levels are approximately 10,1, and < 0.2 micromolar at 24, 48, and 72 hours, the above regimen may suffice. Delayed elimination of MTX: If the serum MTX levels are > 0.2 and > 0.05 micromolar at 72 and 96 hours, the above regimen may be continued every 6 hours until the MTX level is < 0.05 micromolar.
Delayed early elimination of MTX and/or acute renal failure: If the serum MTX levels are > 50 or 5 micromolar at 24 and 48 hours, or if there is a 50% or more increase in serum creatinine within the first 24 hours after the beginning of the MTX infusion, the dosage of leucovorin should be increased 20-fold (twice the dose and frequency) to 100 mg/m2 IV every 3 hours until the MTX level is < 0.05 micromolar.

Usual Pediatric Dose for Megaloblastic Anemia

1 mg IV or IM once a day. Vitamin B12 should be replenished prior to or during folate replacement lest neurologic symptoms persist or worsen during hematologic remission. Leucovorin is not proper therapy for pernicious anemia and other megaloblastic anemias secondary to the lack of vitamin B12.

Usual Pediatric Dose for Folic Acid Antagonist Overdose

2 to 15 mg/day orally for 3 days or until blood counts are normal or 5 mg orally every 3 days. 6 mg/day orally is recommended for use in patients with platelet counts <100,000/mm3.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Leucovorin should never be given intrathecally.

Dialysis

Data not available

Other Comments

IV administration is generally recommended for MTX rescue, especially in cases of renal insufficiency, inadequate hydration, significant gastrointestinal toxicity, if doses > 25 mg are needed, or in the presence of third space fluids. Monitoring renal function (BUN, creatinine and urine output) and serum MTX levels at least daily are recommended. Aggressive hydration (3 liters or more/day), and urinary Alkalinization (pH > 7.0) is recommended until the serum MTX level is < 0.05 micromolar.

Hide
(web1)