disodium levofolinate at a glance
Medicine class
Reduced folate and detoxifying agent used in cancer treatment.
Main roles
Folate-antagonist rescue and enhancement of fluorouracil treatment.
Administration
Given into a vein by injection or infusion under specialist supervision; it must never be given intrathecally.
What is disodium levofolinate used for?
Licensed uses include:
Reducing toxicity and counteracting folate antagonists such as methotrexate during cytotoxic treatment or after overdose, in adults and children.
Enhancing fluorouracil's anticancer activity during cytotoxic treatment.
How does disodium levofolinate work?
Levofolinic acid is an already reduced, biologically active folate. It bypasses the enzyme blocked by methotrexate and replenishes folate compounds needed by healthy cells. With fluorouracil, it prolongs inhibition of an enzyme needed for DNA production.
disodium levofolinate preparations and strengths
Injection
Route: Parenteral
Strengths: 50 mg/mL
How to take disodium levofolinate
This formulation is administered intravenously by trained healthcare professionals, either undiluted as an injection or diluted for infusion. It must not be injected into the spine.
Treatment with methotrexate or fluorouracil requires direct supervision by a clinician experienced in cancer chemotherapy.
The solution should be clear and free from visible particles before use.
Do not use folic-acid or folate supplements as substitutes unless instructed by the specialist team.
disodium levofolinate side effects
Common or expected effects
- With fluorouracil: inflamed or ulcerated mouth, diarrhoea, nausea, vomiting and reduced blood-cell production.
- Hand-foot skin reaction during fluorouracil combination treatment.
- Fever after injection.
Get urgent medical advice
- Severe allergic reaction, including swelling, breathing difficulty or collapse.
- Severe diarrhoea, dehydration or extensive mouth inflammation, particularly with fluorouracil.
- Serious infection, fever or unusual bleeding associated with bone-marrow suppression.
- Increased seizure frequency in people with epilepsy.
disodium levofolinate in pregnancy
Evidence specifically for disodium levofolinate is limited, although folinic acid itself is not known to cause harm. Use depends on the accompanying treatment: methotrexate requires strict specialist assessment, while fluorouracil combination treatment is generally contraindicated during pregnancy. Discuss pregnancy or pregnancy plans with the specialist team.
disodium levofolinate while breastfeeding
It is unknown whether disodium levofolinate enters breast milk, but it may be used alone when clinically necessary. Breastfeeding must stop before treatment involving methotrexate or fluorouracil.
disodium levofolinate interactions
Important interactions depend on the treatment context:
Methotrexate and other anticancer folate antagonists
Incorrectly timed or excessive rescue can reduce the intended anticancer effect; delayed rescue may be less effective against toxicity.
Cotrimoxazole or pyrimethamine
Their folate-antagonist effect may be reduced or completely neutralised.
Fluorouracil
Both its activity and toxicity are enhanced, particularly gastrointestinal and bone-marrow toxicity.
Common questions about disodium levofolinate
Answers are fully visible for fast scanning and source review.
Is disodium levofolinate the same as folic acid?
No. Levofolinic acid is an already reduced, biologically active folate that bypasses the metabolic step blocked by methotrexate.
Does it reverse every effect of methotrexate?
No. It does not reverse kidney injury caused by methotrexate precipitation, so supportive measures and monitoring remain essential.
Can it worsen fluorouracil side effects?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.