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leucovorin

Pronunciation

Generic Name: leucovorin (oral) (loo koe VOR in)
Brand Name:

What is leucovorin?

Leucovorin is a form of folic acid. Folic acid helps your body produce and maintain new cells, and also helps prevent changes to DNA that may lead to cancer. Folic acid is present in many foods such as dried beans, peas, oranges, spinach, and others.

Leucovorin is used to reduce the side effects of large doses or accidental overdose of medications that can reduce the effects of folic acid in the body. This includes methotrexate (Rheumatrex), pyrimethamine (Daraprim), trimethoprim (Trimpex, Proloprim), and others.

Leucovorin may also be used to treat anemia (lack of red blood cells) caused by chemotherapy.

Leucovorin may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about leucovorin?

Do not take leucovorin if you have anemia that is caused by a lack of vitamin B12.

Before taking leucovorin, tell your doctor if you are allergic to any drugs, or if you have kidney, liver, or lung disease.

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Before taking leucovorin, tell your doctor if you are using fluorouracil (Adrucil), phenytoin (Dilantin), fosphenytoin (Cerebyx), ethotoin (Peganone), phenobarbital (Luminal, Solfoton), or primidone (Mysoline).

When treating an accidental overdose, leucovorin should be started as soon as possible for best effect.

To be sure this medication is helping your condition, your blood will need to be tested often. This will help your doctor determine how long to treat you with leucovorin.

What should I discuss with my healthcare provider before taking leucovorin?

Do not take leucovorin if you have anemia that is caused by a lack of vitamin B12.

Before taking leucovorin, tell your doctor if you are allergic to any drugs, or if you have:

  • kidney disease;

  • liver disease; or

  • lung disease.

If you have any of these conditions, you may not be able to take leucovorin, or you may need to use an injection form of leucovorin (given through a needle placed into a vein).

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether leucovorin passes into breast milk or if it could harm a nursing baby. Do not take this medication without telling your doctor if you are breast-feeding a baby.

How should I take leucovorin?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take leucovorin with a full glass of water.

When treating an accidental overdose, leucovorin should be started as soon as possible for best effect.

You may also be treated with IV fluids to keep you from getting dehydrated during your treatment with leucovorin.

To be sure this medication is helping your condition, your blood will need to be tested often. This will help your doctor determine how long to treat you with leucovorin.

Store this medication at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

If you receive this medication in a hospital, it is not likely that you will miss a dose. If you are taking the medication at home and you miss a dose, call your doctor for instructions.

What happens if I overdose?

An overdose of leucovorin is not likely to cause life-threatening symptoms. However, an overdose can make other medications less effective.

Seek emergency medical attention if you think you have used too much of this medicine.

What should I avoid while taking leucovorin?

There are no restrictions on food, beverages, or activities unless otherwise directed by your doctor.

Leucovorin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Leucovorin dosing information

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.

What other drugs will affect leucovorin?

Before taking leucovorin, tell your doctor if you are using any of the following drugs:

  • fluorouracil (Adrucil);

  • phenytoin (Dilantin), fosphenytoin (Cerebyx), or ethotoin (Peganone);

  • phenobarbital (Luminal); or

  • primidone (Mysoline).

If you are using any of these drugs, you may not be able to take leucovorin, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect leucovorin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist has information about leucovorin written for health professionals that you may read.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 3.03. Revision Date: 2010-12-15, 5:01:39 PM.

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