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 Zambia HIV National Guidelines
 


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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Miscellaneous>
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Leucovorin

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
11-24-2010

Zambia Specific Information

  • Available formulation in Zambia: tablets : 5 mg, 10 mg, 15 mg
  • Prevention of drug induced bone marrow suppression from pyrimethamine + sulfadiazine: leucovorin (folinic acid) 15 mg/d
Zambia Information Author: Paul A. Pham Pharm.D.

INDICATIONS

FDA

  • Prophylaxis for drug induced bone marrow toxicity (e.g methotrexate, pyrimethamine, or trimethoprim)
  • Antidote to the toxic effects of folic acid antagonists such as methotrexate, pyrimethamine, and trimethoprim.
  • Megaloblastic anemias associated with sprue, nutritional deficiency, pregnancy, and infancy when oral folic acid therapy can not be given.

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
Leucovorin Folinic acid Several generic manufacturers (Quad Pharmaceutical, Abbott, American Pharmaceutical and others) Oral
tab
5 mg, 10 mg, 15 mg, 25 mg.
$2.36 per 5mg tab
      IV
IV vial
50mg, 100mg, 350mg vial
$4.80 per 100mg vial

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose

DOSING FOR GLOMERULAR FILTRATION OF 10-50

No data. Usual dose likely, but may need to be increased if coadministered folate antagonist antimicrobial T1/2 is increased.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

No data. Usual dose likely, but may need to be increased if coadministered folate antagonist antimicrobial T1/2 is increased.

DOSING IN HEMODIALYSIS

No data. Usual dose likely, but may need to be increased if coadministered folate antagonist antimicrobial T1/2 is increased.

DOSING IN PERITONEAL DIALYSIS

No data

DOSING IN HEMOFILTRATION

No data

ADVERSE DRUG REACTIONS

Well tolerated

RARE

  • Frequency not defined: anaphylactoid reactions, rash, erythema, pruritus, and thrombocytosis

DRUG INTERACTIONS

Does not antagonize activity of anti-folate antimicrobials (i.e trimethoprim or pyrimethamine)

PHARMACOLOGY

Pharmacology

COMMENTS

Used to prevent pyrimethamine-induced hematologic toxicity in HIV+ pts. Must be administered when using pyrimethamine (plus either sulfadiazine or clindamycin) to prevent severe bone marrow suppression. Does not interfere with antimicrobial activity of trimethoprim or pyrimethamine (protozoa unable to utilize leucovorin). Normal folate levels are 0.005-0.015 mcg/mL (but fluctuates rapidly); consider checking RBC folate levels (if < 0.1 mcg/mL, supplement ).

REFERENCES

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