Leucovorin Calcium (Citrovorum Factor, Folinic Acid)(loo koe vor’ in)
PREGNANCY CATEGORY C
Drug class
Folic acid derivative
Therapeutic Actions
Active reduced form of folic acid; required for nucleoprotein synthesis and maintenance of normal hematopoiesis.
Indications
“Leucovorin rescue”—after high-dose methotrexate therapy for various cancers
Parenteral form: Treatment of megaloblastic anemias due to sprue, nutritional deficiency, pregnancy, and infancy when oral folic acid therapy is not feasible
IV: With 5-FU for palliative treatment of metastatic colorectal cancer
To decrease toxicity of methotrexate caused by decreased elimination or for inadvertent overdose of folic acid antagonists such as trimethoprim
Contraindications and Cautions
Contraindicated with allergy to leucovorin on previous exposure, pernicious anemia or other megaloblastic anemias in which vitamin B12 is deficient.
Use cautiously with pregnancy, lactation.
Available Forms
Tablets—5, 10, 15, 25 mg; injection—10 mg/mL; powder for injection—50, 100, 200, 350, 500 mg/vial
Dosages
Adults
Rescue after methotrexate therapy: Begin therapy within 24 hr of methotrexate dose. 10 mg/m2 PO every 6 hr for 10 doses or until methotrexate level is less than 0.05 micromolar. If at 24 hr following methotrexate administration, serum creatinine is 100% greater than the pretreatment level, or based on methotrexate levels, increase the leucovorin dose to 150 mg IV every 3 hr until the serum methotrexate level is less than 1.0 micromolar; then 15 mg IV every 3 hr until methotrexate level is less than 0.05 micromolar.
Megaloblastic anemia: Up to 1 mg/day IM may be used. Do not exceed 1 mg/day.
Metastatic colon cancer: Give 200 mg/m2 by slow IV injection over up to 3 min, followed by 5-FU 370 mg/m2 IV or 20 mg/m2 IV, followed by 5-FU 425 mg/m2 IV. Repeat daily for 5 days; may be repeated at 4-wk intervals.
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