Class: Supportive Care
Generic Name: leucovorin (loo-koh-VOR-in), folinic acid, citrovorum factor
Trade Name: Calcium Leucovorin
How is Calcium Leucovorin used? Leucovorin is FDA approved to prevent or reduce side effects caused by the chemotherapy agent methotrexate, and is commonly used to enhance the effectiveness of the chemotherapy agent fluorouracil (5-FU) for patients with advanced colorectal cancer. It can also treat anemia that is caused by a lack of folic acid.
What is the mechanism of action? Leucovorin is an agent that is similar in structure and function to folic acid, which is a vitamin that is necessary for cellular life. Leucovorin enhances anti-cancer effects of fluorouracil by providing greater binding properties of fluorouracil within a cell. This allows fluorouracil to stay inside a cell for a greater period of time, producing longer lasting anti-cancer effects within the cell. Leucovorin helps to protect healthy cells against the side effects of methotrexate by providing a source of folic acid to cells. Since methotrexate counteracts or competes with folic acid in cells, severe side effects may be caused. However, leucovorin provides the source of folic acid, and helps to alleviate the side effects.
How is Calcium Leucovorin given (administered)? Leucovorin may be given into a vein (intravenously), into a muscle (intramuscular), or as a tablet by mouth. The dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient.
How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with leucovorin. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Patients will be monitored by allergic-type reactions, including wheezing, difficulty breathing, hives, closing of the throat and/or dizziness. If patients experience any of these symptoms, they should contact their healthcare provider immediately.
What are the side effects associated with treatment with Calcium Leucovorin? Side effects directly attributable to leucovorin are not common. However, patients may experience an allergic-type reaction to leucovorin that may be characterized by difficulty breathing, wheezing, rash, itching, hives, closing of the throat and/or dizziness.
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?
- Pay careful attention to the physician’s instructions and inform the physician of any side effects.
- Maintain adequate rest and nutrition.
- Wear sunscreen and protective clothing and try to minimize sun exposure.
- Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
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Are there any special precautions patients should be aware of before starting treatment?
- Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
- It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
- Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
- Patients should check with their physician before starting any new drug or nutritional supplement.
- Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
- If an oral dose is missed, do not double up on doses. Patients should contact their physician in this event.
- Keep tablets out of reach of children and return to the pharmacy for safe disposal if treatment is terminated.
When should patients notify their physician?
- Signs of an allergic-type reaction – wheezing, difficulty breathing, closing of the throat, rash, itching, hives and/or dizziness.
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
Important Limitations of Use
The information provided above on the drug you have selected is provided for your information only and is not a substitute for consultation with an appropriate medical doctor. We are providing this information solely as a courtesy and, as such, it is in no way a recommendation as to the safety, efficacy or appropriateness of any particular drug, regimen, dosing schedule for any particular cancer, condition or patient nor is it in any way to be considered medical advice. Patients should discuss the appropriateness of a particular drug or chemotherapy regimen with their physician.
As with any printed reference, the use of particular drugs, regimens and drug dosages may become out-of-date over time, since new information may have been published and become generally accepted after the latest update to this printed information. Please keep in mind that health care professionals are fully responsible for practicing within current standards, avoiding use of outdated regimens, employing good clinical judgment kin selecting drugs and/or regimens, in calculating doses for individual patients, and verifying all dosage calculations.
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The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.