Leucovorin and Voraxaze

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Glucarpidase and leucovorin should not be given together at the same time. Doing so may reduce the effectiveness of both medications in the treatment of excessive blood levels of methotrexate and its related side effects. The doses of glucarpidase and leucovorin should be separated by at least two hours. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

ADJUST DOSING INTERVAL: Concomitant administration of glucarpidase may decrease the plasma concentrations of leucovorin, which is a substrate for glucarpidase. Conversely, leucovorin may interfere with the action of glucarpidase in the treatment of toxic plasma methotrexate concentrations in patients with impaired renal function by reducing the availability of glucarpidase, a recombinant bacterial enzyme that provides an alternate nonrenal pathway for methotrexate elimination by converting methotrexate to an inactive metabolite and glutamate. In a study of cancer patients receiving a high-dose methotrexate (>=1 g/m2) and leucovorin rescue regimen, intravenous administration of glucarpidase 50 units/kg two hours before leucovorin decreased the peak plasma concentration (Cmax) of the active 6S(-) enantiomer of leucovorin by 52% and its systemic exposure (AUC) by 33%. In addition, the Cmax and AUC of the active metabolite, 6S(-)5-methyltetrahydrofolate, decreased by more than 90% each. In another study performed in the absence of methotrexate, healthy adult subjects who were given glucarpidase 50 units/kg followed by 5 doses of leucovorin (150 mg/m2) at 2, 8, 14, 20 and 26 hours post-glucarpidase had a 47% reduction in the AUC of 6S(-)leucovorin after the 2-hour dose and a 22% reduction in the AUC after the 26-hour dose.

MANAGEMENT: Leucovorin should be continued following treatment with glucarpidase; however, it should not be administered within two hours before or two hours after a dose of glucarpidase. For the first 48 hours after glucarpidase administration, the same leucovorin dose as given prior to glucarpidase treatment is appropriate. Beyond 48 hours, the leucovorin dose should be based on the measured methotrexate concentration. Do not discontinue leucovorin based on the determination of a single methotrexate concentration below the leucovorin treatment threshold. Therapy with leucovorin should be continued until the methotrexate concentration has been maintained below the leucovorin treatment threshold for a minimum of 3 days. Hydration and alkalinization of the urine should be continued as indicated.

Leucovorin

Generic Name: leucovorin

Brand name: Wellcovorin

Synonyms: Leucovorin Calcium

What is Leucovorin?

Voraxaze

Generic Name: glucarpidase

Brand name: Voraxaze

Synonyms: n.a.

What is Voraxaze?