Levoleucovorin Dosage
Medically reviewed by Drugs.com. Last updated on Jul 3, 2024.
Applies to the following strengths: 50 mg; 175 mg; 10 mg/mL; 300 mg
Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Methotrexate Rescue
Rescue after high dose methotrexate therapy, based on a methotrexate (MTX) dose of 12 grams/m2 IV over 4 hours, depending on methotrexate clearance:
7.5 mg (approximately 5 mg/m2) IV every 6 hours for 10 doses
- Start 24 hours after beginning of methotrexate infusion.
Normal Methotrexate Clearance (serum MTX approximately 10 micromolar 24 hour after administration, 1 micromolar at 48 hours, less than 0.2 micromolar at 72 hours): Follow above dosing
Delayed Methotrexate Clearance (serum MTX above 0.2 micromolar at 72 hours, and more than 0.05 micromolar at 96 hours):
Continue 7.5 mg IV every 6 hours until MTX level is less than 0.05 micromolar
Delayed Early Methotrexate Elimination (serum MTX 50 micromolar or higher at 24 hours, or 5 micromolar or higher at 48 hours)
and/or
Evidence of Acute Renal Injury (100% or greater increase in serum creatinine at 24 hours after MTX administration; e.g. increase from 0.5 mg/dL to 1 mg/dL or above):
75 mg IV every 3 hours until MTX level is less than 1 micromolar; then 7.5 mg IV every 3 hours until MTX level is less than 0.05 micromolar
Comments:
- Measure serum creatinine and methotrexate levels at least once daily.
- Continue levoleucovorin, hydration, and urinary alkalinization (pH of 7.0 or higher) until methotrexate level is below 0.05 micromolar.
- Patients with delayed early methotrexate elimination are likely to develop reversible renal failure; continue hydration and urinary alkalinization, and closely monitor fluid and electrolyte status until MTX is under 0.05 micromolar and renal failure has resolved.
- If significant clinical toxicity is observed, continue levoleucovorin for an additional 24 hours (total of 14 doses over 84 hours) in subsequent courses of therapy.
- Consider that other medications that interact with methotrexate may be being used when laboratory abnormalities or clinical toxicities are seen.
- Delayed methotrexate excretion may be from accumulation in a third space fluid collection (i.e. ascites, pleural effusion), renal insufficiency, or inadequate hydration; higher levoleucovorin doses or prolonged administration may be indicated.
- Although this drug may ameliorate methotrexate's hematologic toxicity, it has no effect on other toxicities such as nephrotoxicity.
Use(s): As a rescue after high dose methotrexate therapy in osteosarcoma
Usual Adult Dose for Methotrexate Overdosage
7.5 mg IV every 6 hours until serum methotrexate is less than 0.01 micromolar
- If serum creatinine increased 50% over baseline, or methotrexate is over 5 micromolar at 24 hours or 0.9 micromolar at 48 hours, increase levoleucovorin dose to 50 mg/m2 IV every 3 hours until methotrexate level is less than 0.01 micromolar
Comments:
- Begin as soon as possible after the overdosage and within 24 hours of methotrexate when there is delayed excretion.
- As the time interval between methotrexate and levoleucovorin administration increases, the effectiveness of levoleucovorin decreases.
- Determine serum creatinine and methotrexate levels at 24 hour intervals.
- Use concomitant hydration (3 L/day) and urinary alkalinization to maintain a pH of 7.0 or greater.
Use(s): Inadvertent methotrexate overdosage
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Data not available
Precautions
CONTRAINDICATIONS:
- Allergic reactions to folic acid or folinic acid
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- For intravenous administration only.
- Do not give intrathecally.
- Maximum infusion rate is 16 mL per minute.
IV compatibility:
- Do not mix with other agents in the same admixture.
More about levoleucovorin
- Check interactions
- Compare alternatives
- Pricing & coupons
- Side effects
- During pregnancy
- Drug class: antidotes
- En español
Patient resources
Other brands
Professional resources
Other brands
Related treatment guides
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.