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Wellcovorin 350mg Vial
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Indications & Clinical Uses
- No current label under the brand name Wellcovorin was found, so this information comes from generic leucovorin calcium for injection labels (Hikma, Mylan Institutional and Bedford); Wellcovorin should be treated as an unverified brand name.
- Leucovorin calcium is a chemically reduced derivative of folic acid, supplied here as a 350 mg lyophilised vial for intravenous or intramuscular injection by a healthcare professional.
- It is indicated for rescue after high-dose methotrexate therapy in osteosarcoma; to diminish the toxicity and counteract the effects of impaired methotrexate elimination and of overdose of folic acid antagonists; for megaloblastic anaemias due to folic acid deficiency when oral therapy is not feasible; and, with fluorouracil, in the palliative treatment of advanced colorectal cancer.
- A 350 mg vial made up with 17.5 mL of diluent gives 20 mg/mL.
Side Effects
- Allergic reactions, including anaphylactoid reactions, have been reported after leucovorin.
- Seizures and fainting have rarely been reported in cancer patients receiving it.
- When leucovorin is given with fluorouracil, the side effects are mainly those of fluorouracil, made more frequent or severe by leucovorin: in trials of this combination leukopenia, mouth ulceration (stomatitis), nausea and diarrhoea were very common, and gastrointestinal toxicity can be more common and severe.
- The label has no boxed warning.
- Because the injection is given in hospital or clinic, report any rash, swelling, breathing difficulty, severe diarrhoea or mouth sores to your care team straight away.
Precautions & Warnings
- Leucovorin may be harmful or fatal if given intrathecally (into the spinal fluid) and must only be given intravenously or intramuscularly.
- It is improper therapy for pernicious anaemia and other megaloblastic anaemias caused by lack of vitamin B12,.
- Because of the calcium content, no more than 160 mg should be injected intravenously per minute.
- For doses above 10 mg/m2, the vial should be reconstituted with sterile water for injection rather than the benzyl alcohol-containing bacteriostatic water.
- Excessive amounts may nullify the effect of folic acid antagonist chemotherapy.
- Leucovorin should be given to a pregnant woman only if clearly needed.
- Store unopened vials at 20°C to 25°C and protect from light.
Avoid Interactions
- Medicines whose effect or toxicity leucovorin increases: fluorouracil, where leucovorin enhances gastrointestinal and other toxicity, so the fluorouracil dose is adjusted by the oncology team.
- Medicines whose effect leucovorin may reduce: large amounts of folic acid or leucovorin can counteract the antiepileptic action of phenobarbital, phenytoin and primidone and may increase seizure frequency; it may reduce the efficacy of intrathecal methotrexate; and excessive leucovorin may nullify the effect of folic acid antagonists.
- A negative interaction has been reported with trimethoprim-sulfamethoxazole used for Pneumocystis pneumonia in HIV patients.
- Reconstitute only with the diluent the label specifies for the dose, and tell your healthcare provider about all medicines and supplements.
References
Frequently Asked Questions
Leucovorin calcium, listed on this sheet as Wellcovorin, is a folic acid derivative used to rescue normal cells after high-dose methotrexate, to reverse methotrexate overdose, to treat folic acid deficiency anaemia, and with fluorouracil for advanced colorectal cancer. A clinician gives it by injection.
Leucovorin calcium injection is given by a healthcare professional into a vein or muscle, never into the spinal fluid. For methotrexate rescue, one labelled schedule is 15 mg every 6 hours for 10 doses, starting 24 hours after the methotrexate infusion begins. No more than 160 mg is injected into a vein per minute.
Leucovorin calcium can cause allergic reactions, including anaphylactoid reactions, and rarely seizures or fainting. With fluorouracil it can worsen diarrhoea, mouth sores, nausea and low white cell counts. Tell your care team at once about rash, swelling, breathing trouble or severe diarrhoea. There is no boxed warning.
Leucovorin calcium must never be given into the spinal canal, as it may be harmful or fatal. It is not suitable for pernicious anaemia or B12-deficiency anaemia. It can weaken phenobarbital, phenytoin and primidone, and it increases fluorouracil toxicity, so tell your care team about all medicines you take.
Your healthcare team prepares leucovorin calcium from a 350 mg vial (20 mg/mL when mixed with 17.5 mL diluent) and injects it into a vein or muscle at a set schedule. For methotrexate rescue, timing matters, so keep every appointment and report any nausea, vomiting or diarrhoea straight away.
Leucovorin calcium should be given to a pregnant woman only if clearly needed, according to the label. Tell your healthcare provider if you are pregnant or planning pregnancy. Leucovorin is usually given alongside chemotherapy, which carries its own pregnancy risks that your care team will discuss with you.
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