Levofolic (Levoleucovorin Disodium)

Levofolic provides reduced folate to support patients receiving antifolate chemotherapy or with folate deficiency.

• Methotrexate toxicity: restores folate metabolism to reduce mucosal and hematologic toxicity.
• Pemetrexed therapy: mitigates folate‑related side effects during treatment.
• Folate deficiency: supplies active folate to correct deficiency in patients unable to absorb folic acid.
• High‑dose chemotherapy support: enhances folate‑dependent DNA synthesis in normal cells during intensive regimens.

• Levoleucovorin disodium is a reduced form of folate that bypasses the dihydrofolate reductase step, directly entering the folate cycle. By supplying 5‑methyltetrahydrofolate equivalents, it restores one‑carbon transfer reactions essential for nucleotide synthesis and methylation, thereby supporting DNA replication and repair in normal cells while counteracting the effects of antifolate agents.

Levofolic is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Nausea: mild to moderate upset stomach.
• Vomiting: occasional emesis following infusion.
• Fever or chills: transient temperature rise.
• Headache: mild discomfort during or after administration.
• Injection site reactions: erythema, pain, or swelling at the IV site.
• Elevated liver enzymes: mild, transient increase.

Serious or Rare Side Effects

• Anaphylactic reaction: sudden severe allergy requiring emergency care.
• Acute renal failure: rapid decline in kidney function.
• Severe hypotension: marked drop in blood pressure during infusion.
• Pulmonary edema: fluid accumulation in lungs.
• Cardiac arrhythmias: irregular heart rhythms.
• Severe electrolyte disturbances: dangerous shifts in potassium, calcium, or magnesium.

Levofolic should be used with careful clinical monitoring.

• Renal function assessment: evaluate creatinine clearance before and during therapy.
• Hematologic monitoring: check complete blood counts regularly.
• Hypersensitivity screening: avoid use in patients with known allergy to folate derivatives.
• Concomitant nephrotoxic drugs: use caution when combined with agents such as aminoglycosides.
• Hepatic impairment: adjust dosing or monitor liver enzymes closely.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Levofolic may interact with several drug classes; awareness of interaction severity guides management.

Major Interactions (Avoid)

• Methotrexate: timing must be coordinated to prevent excessive toxicity.
• Pemetrexed: concurrent use requires precise scheduling to avoid reduced efficacy.
• High‑dose cytarabine: may increase risk of myelosuppression.

Moderate Interactions (Monitor Closely)

• Non‑steroidal anti‑inflammatory drugs (NSAIDs): can affect renal clearance of folate.
• Aminoglycoside antibiotics: combined nephrotoxic potential.
• Loop diuretics: may exacerbate electrolyte imbalances when used together.