Version June 2024
| Clinical situation | Laboratory findings | Recommendations for leucovorin dosage and duration and use of glucarpidase |
| Normal methotrexate elimination | Serum methotrexate level approximately 10 micromolar at 24 hours after administration, 1 micromolar at 48 hours, and less than 0.2 micromolar at 72 hours. | Leucovorin 15 mg orally, IM, or IV every 6 hours for 60 hours (10 doses starting at 24 hours after start of methotrexate infusion). |
| Delayed late methotrexate elimination | Serum methotrexate level remaining above 0.2 micromolar at 72 hours, and more than 0.05 micromolar at 96 hours after administration. | Continue leucovorin 15 mg orally, IM, or IV every 6 hours, until methotrexate level is less than 0.05 micromolar. |
| Delayed early methotrexate elimination and/or evidence of acute renal injury | Serum methotrexate level of ≥50 micromolar at 24 hours, ≥30 micromolar at 36 hours, or ≥5 micromolar at 48 hours after administration, OR; a 100% or greater increase in serum creatinine level at 24 hours after methotrexate administration (eg, an increase from 0.5 mg/dL to a level of 1 mg/dL or more). | Increase leucovorin dose to 150 mg IV every 3 hours, until methotrexate level is less than 1 micromolar; then 15 mg IV every 3 hours until methotrexate level is less than 0.05 micromolar. If evidence of acute kidney injury with delayed methotrexate elimination, consider use of glucarpidase. Refer to UpToDate topics on use of methotrexate. |
IM: intramuscular; IV: intravenous.
* This table is for general use only, local hospital practice and specific protocol predefined leucovorin dose adjustments should supercede use of this table for clinical practice.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
