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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, by slow IV injection (minimum 3 minutes), followed by 5-fluorouracil (the manufacturer product information should be consulted), once a day for 5 days
OR
20 mg/m2, IV, followed by 5-fluorouracil (the manufacturer product information should be consulted), once a day for 5 days

Comments:
-Do not be mix in the same infusion as 5-fluorouracil; a precipitate may form.
-May repeat 5 day treatment course at 4 week (28 day) intervals for 2 courses, then repeat at 4 to 5 week (28 to 35 day) intervals provided the patient is completely recovered from toxicities of the prior course.

Use: For use in combination with 5-fluorouracil to prolong survival in the palliative treatment of patients with advanced colorectal cancer.

Usual Adult Dose for Methotrexate Rescue:

Leucovorin Rescue:
15 mg (approximately 10 mg/m2), orally, IV, or IM, every 6 hours for 10 doses; start 24 hours after beginning of methotrexate infusion (based on a methotrexate dose of 12 to 15 g/m2 IV over 4 hours)

Impaired Methotrexate Elimination or Inadvertent Overdosage:
10 mg/m2 orally, IV, or IM, every 6 hours until methotrexate level is less than 10(-8) mol

Comments:
-Determine serum creatinine and methotrexate levels at least once a day.
-Continue leucovorin, hydration, and urinary alkalization until methotrexate levels are below 5 x 10(-8) mol.
-Give parenterally if gastrointestinal toxicity, nausea, or vomiting are present.

Uses: Leucovorin rescue after high dose methotrexate therapy; diminish the toxicity and counteract the effects of impaired methotrexate elimination and of inadvertent overdosages.

Usual Adult Dose for Methotrexate Overdosage:

Leucovorin Rescue:
15 mg (approximately 10 mg/m2), orally, IV, or IM, every 6 hours for 10 doses; start 24 hours after beginning of methotrexate infusion (based on a methotrexate dose of 12 to 15 g/m2 IV over 4 hours)

Impaired Methotrexate Elimination or Inadvertent Overdosage:
10 mg/m2 orally, IV, or IM, every 6 hours until methotrexate level is less than 10(-8) mol

Comments:
-Determine serum creatinine and methotrexate levels at least once a day.
-Continue leucovorin, hydration, and urinary alkalization until methotrexate levels are below 5 x 10(-8) mol.
-Give parenterally if gastrointestinal toxicity, nausea, or vomiting are present.

Uses: Leucovorin rescue after high dose methotrexate therapy; diminish the toxicity and counteract the effects of impaired methotrexate elimination and of inadvertent overdosages.

Usual Adult Dose for Megaloblastic Anemia:

Up to 1 mg, IV or IM, once a day

Comments:
-There is no evidence that doses above 1 mg daily have greater efficacy; additionally, urinary folate loss becomes roughly logarithmic as the amount administered exceeds 1 mg.

Use: Treatment of megaloblastic anemias due to folic acid deficiency when oral therapy is not feasible

Usual Adult Dose for Folic Acid Antagonist Overdose:

5 to 15 mg orally once a day

Use: Diminish the toxicity and counteract the effects of inadvertent overdosages of folic acid antagonists.

Usual Adult Dose for Pneumocystis Pneumonia:

Treatment of pneumocystis pneumonia is not is not a labeled indication.

20 mg/m2 or 0.5 mg/kg, IV or orally, every 6 hours, continued for 3 days after last trimetrexate dose

Comments:
-Use in combination with trimetrexate.

Use: Treatment of pneumocystis pneumonia in HIV infected patients

Usual Adult Dose for Pneumocystis Pneumonia Prophylaxis:

Prophylaxis of pneumocystis pneumonia is not a labeled indication.

25 mg, orally, once a week, in combination with dapsone and pyrimethamine

Comments:
-Prophylaxis in HIV infected patients usually begins when the CD4+ count is less than 200 cells/mm or for a history of oropharyngeal candidiasis.
-Prophylaxis is usually discontinued when CD4+ count is 200 cells/mm or higher for 3 months.

Use: Pneumocystis pneumonia prophylaxis in immunocompromised patients

Usual Adult Dose for Toxoplasmosis:

Use in the treatment of toxoplasmosis is not a labeled indication.

Ocular toxoplasmosis:
5 to 25 mg orally, IV, or IM, with each dose of pyrimethamine

Acute/primary treatment of toxoplasma encephalitis in AIDS patients:
Standard dose: 10 to 20 mg, orally, IM, or IV, once a day, during and for 1 week after pyrimethamine treatment
Maximum dose: 50 mg once a day

Use: Toxoplasmosis treatment

Usual Pediatric Dose for Colorectal Cancer:

200 mg/m2, by slow IV injection (minimum 3 minutes), followed by 5-fluorouracil (the manufacturer product information should be consulted), once a day for 5 days
OR
20 mg/m2, IV, followed by 5-fluorouracil (the manufacturer product information should be consulted), once a day for 5 days

Comments:
-Do not be mix in the same infusion as 5-fluorouracil; a precipitate may form.
-May repeat 5 day treatment course at 4 week (28 day) intervals for 2 courses, then repeat at 4 to 5 week (28 to 35 day) intervals provided the patient is completely recovered from toxicities of the prior course.

Use: For use in combination with 5-fluorouracil to prolong survival in the palliative treatment of patients with advanced colorectal cancer.

Usual Pediatric Dose for Methotrexate Rescue:

Leucovorin Rescue:
15 mg (approximately 10 mg/m2), orally, IV, or IM, every 6 hours for 10 doses; start 24 hours after beginning of methotrexate infusion (based on a methotrexate dose of 12 to 15 g/m2 IV over 4 hours)

Impaired Methotrexate Elimination or Inadvertent Overdosage:
10 mg/m2 orally, IV, or IM, every 6 hours until methotrexate level is less than 10(-8) mol


Comments:
-Determine serum creatinine and methotrexate levels at least once a day.
-Continue leucovorin, hydration, and urinary alkalization until methotrexate levels are below 0.05 micromol.
-Give parenterally if gastrointestinal toxicity, nausea, or vomiting are present.

Uses: Leucovorin rescue after high dose methotrexate therapy; diminish the toxicity and counteract the effects of impaired methotrexate elimination and of inadvertent overdosages.

Usual Pediatric Dose for Megaloblastic Anemia:

Up to 1 mg, IV or IM, once a day

Comments:
-There is no evidence that doses above 1 mg daily have greater efficacy; additionally, urinary folate loss becomes roughly logarithmic as the amount administered exceeds 1 mg.

Use: Treatment of megaloblastic anemias due to folic acid deficiency when oral therapy is not feasible

Usual Pediatric Dose for Folic Acid Antagonist Overdose:

5 to 15 mg orally once a day

Use: Diminish the toxicity and counteract the effects of inadvertent overdosages of folic acid antagonists.

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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