Zambian HIV Guidelines:: leucovorin

	Zambia HIV National Guidelines
	Adverse Effects and Toxicity Antiretroviral Therapy Adherence ARV Therapy for Individuals with Tuberculosis Co-Infection Monitoring ARV Therapy Changing or Stopping ART Cotrimoxazole Prophylaxis General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents HIV Counseling and Testing Immune Reconstitution Inflammatory Syndrome (IRIS) Initial Regimen for ARV Therapy Introduction Management of Sexually Transmitted Infections (STIs) in HIV Nutrition Care and Support Palliative Care in HIV and AIDS Post Exposure Prophylaxis Stopping ARV Therapy Treatment Failure When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents WHO Staging in Adults and Adolescents
	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 and Jabbin Mulwanda MMed FCS

Drugs>Miscellaneous>

Leucovorin

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
04-04-2008

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.	$2.35 per 5mg tab
			IV IV vial 50mg, 100mg, 350mg vial	$50.00 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

Toxoplasmosis induction therapy: 20 mg/d x 6 wks (in combination with pyrimethamine and either sulfadiazine or clindamycin)
Toxoplasmosis maintenance therapy: 15mg/d (in combination with pyrimethamine and either sulfadiazine or clindamycin)
Therapy usually oral, but administer IV if vomiting or NPO status.

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-infected pts. Leucovorin must be administered with pyrimethamine and sulfadiazine 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

REFERENCED WITHIN THIS GUIDE

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