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Leucovorin

Oral
Intravenous
Intramuscular
Class
Vitamin B9 vitamers
Subclass
Tetrahydrofolic acid derivatives
Substance name
Leucovorin calcium, folinic acid
Common formulations
Tablet
Indications for use
Off-label indications
Adults
•
Treatment of methotrexate toxicity in patients with rheumatoid arthritis
•
Prevention of neural tube defects in females
Safety risks
Contraindications
A history of folic acid hypersensitivity or folinic acid hypersensitivity
•
Prioritize careful patient screening for any history of anaphylactic or anaphylactoid reactions to medications before prescribing Folinic acid
Pernicious anemia or other malabsorption syndromes
•
Evaluate patients for pernicious anemia or malabsorption syndromes before prescribing Folinic acid, and consider Vitamin B12 supplementation if needed.
Warnings and precautions
Seizures
•
Use caution with a history of seizure disorder. Monitor patients with a history of seizures carefully when using Folinic acid. Discontinue Folinic acid, provide appropriate seizure management, and consult a healthcare provider for guidance on further treatment and management.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: A
•
Use only if benefits outweigh potential risks. Animal studies using doses at least 50 times the human dose did not show fetal harm.
•
Use by a large number of pregnant women has not shown increased malformations or other harmful effects on the fetus; however safety has not been established, so caution is recommended.
•
There are no controlled data in human pregnancy.
Breastfeeding
Little information available on breastfeeding safety.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Unknown frequency
•
Anaphylactoid reactions, urticaria, diarrhea, nausea, vomiting, urticaria, ↑ platelet count, stomatitis, wheezing
Interactions
Drug(s)
Check Interactions
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