Leucovorin Dosing Guidelines

Colorectal Cancer Chemotherapy Regimens

• The National Comprehensive Cancer Network recommends leucovorin 400 mg/m² IV infused over 2 hours on day 1, repeated every 2 weeks, for standard FOLFOX and FOLFIRI protocols 1, 2
• Levoleucovorin 200 mg/m² is equivalent to standard leucovorin 400 mg/m² because levoleucovorin contains only the active L-isomer 1, 4
• For the Roswell-Park regimen, leucovorin 500 mg/m² IV over 2 hours is given on days 1, 8, 15, 22, 29, and 36, repeated every 8 weeks 4
• The simplified biweekly regimen (sLV5FU2) uses the same 400 mg/m² dose as FOLFOX/FOLFIRI 4

Congenital Toxoplasmosis and Trimetrexate Rescue

• For treatment of congenital toxoplasmosis in infants, leucovorin 10 mg PO three times weekly prevents hematologic toxicity, according to the American Academy of Pediatrics 5
• When trimetrexate glucuronate is used for Pneumocystis pneumonia, leucovorin 20 mg/m² every 6 hours for 24 days is required, as recommended by the Centers for Disease Control and Prevention 6

Critical Safety Considerations

• The National Comprehensive Cancer Network advises limiting chemotherapy orders to 24-hour units to minimize medication errors 1, 4