levoleucovorin calcium
levoleucovorin calcium
(lee-vo-loo-koe-vor-in kal-see-um ) levoleucovorincalcium,Fusilev
(trade name)Classification
Therapeutic: antidotesPharmacologic: folic acid analogues
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
IV | unknown | end of infusion | 3–6 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
(all patients also received methotrexate)Central nervous system
- confusion
Respiratory
- dyspnea
Gastrointestinal
- nausea (most frequent)
- stomatitis (most frequent)
- vomiting (most frequent)
- altered taste
- diarrhea
- dyspepsia
Dermatologic
- dermatitis
Genitourinary
- abnormal renal function
Neurologic
- neuropathy
Miscellaneous
- allergic reactions
Interactions
Drug-Drug interaction
↑ risk of toxicity from fluorouracil.May ↓ effectiveness of phenobarbital , phenytoin, or primidone leading to ↑ risk of seizures.May ↓ effectiveness of trimethoprim-sulfamethoxazole when used to treat Pneumocustis carnii pneumonia in HIV-infected patients.Route/Dosage
Levoleucovorin Rescue Following High-Dose Methotrexate—based on a methotrexate dose of 12 grams/m2 IV over 4 hr and concurrent with hydration and maintenance of urine pH ≥7.0
Levoleucovorin Rescue Following Inadvertent Overdosage of Methotrexate
Palliative Treatment of Advanced Metastatic Colorectal Cancer (in combination with 5–fluorouracil)
Availability
Nursing implications
Nursing assessment
- Assess patient for nausea and vomiting secondary to methotrexate therapy or folic acid antagonists (pyrimethamine and trimethoprim) overdose.
- Monitor for development of allergic reactions (rash, urticaria, wheezing). Notify health care professionalif these occur.
- Lab Test Considerations: Monitor serum methotrexate and creatinine at least once daily levels to determine dosage and effectiveness of therapy. Leucovorin calcium levels should be equal to or greater than methotrexate level. Rescue continues until serum methotrexate level is <5 × 10−8 M.
- Monitor electrolytes and hydration status, and urine pH every 6 hr during therapy; pH should be maintained >7 to decrease nephrotoxic effects of high-dose methotrexate.
Potential Nursing Diagnoses
Risk for injury (Indications)Imbalanced nutrition: less than body requirements (Indications)
Implementation
- Levoleucovorin is dosed at one-half the usual dose of the racemic form.
Intravenous Administration
- Intermittent Infusion: Reconstitute 50 mg vial with 5.3 mL of 0.9% NaCl without preservatives for a concentration of 10 mg/mL. Diluent: Dilute further immediately with 0.9% NaCl or D5W. Concentration: 0.5 mg/mL–5 mg/mL. Initial reconstitution or dilutions in 0.9% NaCl are stable at room temperature for 12 hr. Dilutions in D5W are stable for 4 hrs at room temperature. Do not administer solutions that are cloudy or contain a precipitate.
- Rate: Administer at no more than 16 mL of reconstituted solution (160 mg levoleucovorin) per min; due to calcium content of solution.
- Additive Incompatibility: Do not admix with other solutions.
Patient/Family Teaching
- Explain purpose of medication to patient.
Evaluation/Desired Outcomes
- Reversal of toxic effects of methotrexate or in overdose of folic acid antagonists.