LEUCOVORIN CALCIUM
Background and Date of Approval
Leucovorin calcium is a folic acid analog that received approval for medical use from the US Food and Drug Administration on 2 December 2002.
Uses
Leucovorin calcium is used to prevent the harmful effects of methotrexate medicine when treating certain types of cancer. It is also used to treat people who have accidentally overdosed on methotrexate medicine or medications that belong to a similar class. It is also used with other anticancer medications to treat colorectal cancer (cancer that begins in the colon or rectum). Other uses include treating anemia caused by low levels of folic acid in the body.
How is it administered?
Leucovorin calcium is available as injection and tablet. The drug should be administered only by healthcare professionals experienced with cancer chemotherapy. Your physician will determine the dose and frequency of administration based on the type of cancer and severity of the disease. The medicine is administered either intravenously (into your vein) or intramuscularly (into your muscle) based on your disease condition. If you are prescribed tablets, then take the tablets as prescribed by your doctor. Do not break, crush, or chew the tablets. Swallow the tablet whole with a glass of water. It is important to take your medicine at the same time every day.
Side Effects
The common side effects include diarrhea, nausea, vomiting, inflamed and sore mouth, and tiredness. Serious side effects include allergic reactions like rash, low blood pressure, wheezing, shortness of breath, and swelling of the face or throat.
Warnings
This drug may cause hypercalcemia (high calcium levels in your blood). Notify your healthcare professional if you face any symptoms during or after the administration of the drug. Inform your physician immediately if you have diarrhea symptoms after administering leucovorin calcium.
Precautions
Inform your physician if you have or ever had liver disease, kidney problems, heart problems, before starting the treatment with this medicine. Consult your doctor if you are pregnant, suspect pregnancy, or planning to become pregnant. Do not take this medicine if you are allergic to leucovorin calcium, calcium folinate, or any of the other ingredients in it. Inform your healthcare provider about all the medicines you take, including prescription medications, over-the-counter medications, nutritional and vitamin supplements, and herbal products. Certain medications may interact with the effects of Leucovorin calcium and reduce its effectiveness by causing undesirable side effects. Especially inform your physician if you are taking medications for seizures.
Word of Advice
Store leucovorin calcium in a refrigerator at 2° to 8°C. Keep the injection away from the reach of children and pets. If you miss a scheduled dose, inform your healthcare professional immediately and arrange for rescheduling. Inform your doctor if vomiting occurs immediately after receiving the injection. In case of accidental overdose of leucovorin calcium, contact your doctor and seek medical advice immediately. Do not discontinue this medicine without your doctor's instruction. Your doctor may recommend regular blood tests to monitor your disease condition and assess treatment effectiveness.
References
Calcium Folinate 10 mg/ml Injection - Summary of Product Characteristics (SmPC) - (emc) [Internet]. www.medicines.org.uk. 2020 [cited 2023 Apr 4]. Available from: https://www.medicines.org.uk/emc/product/1572/smpc HIGHLIGHTS OF PRESCRIBING INFORMATION [Internet]. [cited 2023 Apr 4]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020140s024lbl.pdf Goodman & Gilmanâs, The Pharmacological Basis of Therapeutics, Drug toxicity and poisoning, 12th edition, 2011, 86. KD Tripathi, Essentials of Medical Pharmacology, Haematinics and erythropoietin, 7th edition, 2013, 611.
Frequently Asked Questions
What should I do if missed taking leucovorin calcium?
It is important to get leucovorin calcium at the right time. If you missed your appointment, contact your healthcare provider and schedule your dosing immediately. Keep follow-ups on your next schedule.
Why is leucovorin calcium given 24 hours after methotrexate?
Leucovorin calcium is usually administered 24 hours after methotrexate so that it does not interfere with the therapeutic effect of methotrexate. It can also be used in methotrexate overdose; it should be administered as soon as possible.
Can leucovorin calcium cause swelling?
Leucovorin calcium may cause allergic reactions like rash, low blood pressure, wheezing, shortness of breath, and swelling of the face or throat.
Can leucovorin calcium cause seizures?
There is no evidence that leucovorin calcium cause seizures. But the medicine can affect the effect of seizure medication when administered concurrently. Inform your physician about all your medicines, including over-the-counter medications.
How long does it take for leucovorin calcium to work?
Leucovorin calcium starts acting on the body within 5 minutes of administration. However, this might vary with respect to dosage, the patient receiving the drug, and response to treatment.
What measures should be taken to ensure the prompt excretion of methotrexate during treatment with leucovorin calcium?
A healthcare professional will monitor you during the treatment with this medicine. Maintenance of urine output above 2,500 mL/24hr in adults by increasing oral or intravenous fluids 12 hours before and for 36 hours after the end of methotrexate infusion. To monitor the alkalinization of urine (this enhances drug excretion) so that the urinary pH is greater than 7.0 before methotrexate infusion. Foods, drinks, and drugs that may increase urinary acidity should be avoided during the therapy. Finally, blood methotrexate concentration should be measured at least 24, 48, and 72 hours after the initiation of the methotrexate infusion.