Levofolinate De Calcium Zentiva (Levoleucovorin)

Levoleucovorin is used in oncology and metabolic support to counteract antifolate chemotherapy and address folate deficiency.

• Rescue therapy after high‑dose methotrexate: provides rapid folate replenishment to protect normal tissues.
• Reduction of methotrexate toxicity: diminishes adverse effects such as mucositis and bone‑marrow suppression.
• Adjunct in folate deficiency when oral supplementation is not feasible: supplies reduced folate intravenously for patients unable to take oral tablets.

• Levoleucovorin is a reduced form of folic acid that bypasses the dihydrofolate reductase (DHFR) step inhibited by antifolate agents such as methotrexate. By directly supplying the 5‑methyltetrahydrofolate cofactor needed for thymidylate and purine synthesis, it restores DNA replication in healthy cells while allowing the antineoplastic drug to continue acting on malignant cells.

Levofolinate De Calcium Zentiva may be associated with a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Nausea: mild to moderate feeling of sickness.
• Headache: transient mild headache.
• Rash: localized skin erythema or itching.
• Elevated liver enzymes: mild, reversible increase in transaminases.

Serious or Rare Side Effects

• Anaphylactic reaction: severe allergic response with airway compromise.
• Hypotension: sudden drop in blood pressure requiring intervention.
• Stevens‑Johnson syndrome: severe skin detachment and mucosal involvement.

Before initiating Levofolinate De Calcium Zentiva, several precautionary measures should be considered to ensure safe use.

• Assess renal function: evaluate creatinine clearance to adjust dosing if needed.
• Monitor hepatic enzymes: check liver function tests prior to and during therapy.
• Observe blood counts: watch for cytopenias that may indicate marrow toxicity.
• Adjust dose in renal impairment: reduce or extend interval in patients with reduced clearance.
• Use with caution in pregnancy: safety data are limited; weigh potential benefits against unknown risks.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Levofolinate De Calcium Zentiva can interact with other medicines, influencing efficacy or safety.

Major Interactions (Avoid)

• Concurrent high‑dose antifolate agents (e.g., pemetrexed) without proper timing: may blunt therapeutic effect of the anticancer drug.
• Sulfonamide antibiotics: may compete for folate pathways and reduce rescue efficiency.

Moderate Interactions (Monitor Closely)

• Nephrotoxic drugs (e.g., aminoglycosides, NSAIDs): increase risk of renal impairment when combined.
• Hepatotoxic agents (e.g., isoniazid, valproate): may exacerbate liver enzyme elevations.
• Warfarin: folate supplementation can alter INR, requiring closer coagulation monitoring.
• Vitamin B12 deficiency: may limit folate utilization, necessitating assessment.