Select therapeutic use:

Colorectal and other GI cancers:

Indications for FUSILEV:

Treatment of metastatic colorectal cancer in combination with 5-fluorouracil (5-FU).

Limitations of Use:

Not for treating pernicious anemia and megaloblastic anemia secondary to the lack of Vit. B12; risk of neurologic manifestations despite hematologic remission.

Adult:

Regimen 1: give levoleucovorin at 100mg/m2 by IV inj over a minimum of 3 minutes, followed by 5-FU at 370mg/m2 by IV inj. Regimen 2: give levoleucovorin at 10mg/m2 by IV inj, followed by 5-FU at 425mg/m2 by IV inj. Both: Treat daily for 5 days. The five-day treatment course may be repeated every 4 weeks for 2 courses, and then every 4–5 weeks provided that patient recovered from the toxicity from prior treatment course. Do not adjust levoleucovorin dosage for toxicity. Refer to 5-FU full labeling for dose modifications.

Children:

Not established.

Warnings/Precautions:

Hypercalcemia. Monitor for GI toxicities. Do not initiate or continue therapy if GI toxicities (eg, stomatitis, diarrhea) occur until symptoms resolved. Pregnancy. Nursing mothers.

Pharmacologic Class:

Folate analogue.

Interactions:

Potentiates 5-FU toxicity. Antagonizes TMP/SMZ. May antagonize anticonvulsants (eg, phenobarbital, primidone, phenytoin); monitor. May be affected by drugs that affect MTX elimination.

Adverse Reactions:

Stomatitis, nausea, diarrhea.

Elimination:

Half-life: 5.1 hours.

Generic Availability:

NO

How Supplied:

Single-dose vial—1

Pricing for FUSILEV

5ml of 50mg vial (Qty: 1)
Appx. price $250
GoodRx

Cytoprotective and supportive care agents:

Indications for FUSILEV:

In osteosarcoma, for rescue after high-dose methotrexate (MTX) therapy. To diminish the toxicity associated with overdosage of folic acid antagonists or impaired MTX elimination.

Limitations of Use:

Not for treating pernicious anemia and megaloblastic anemia secondary to the lack of Vit. B12; risk of neurologic manifestations despite hematologic remission.

Adults and Children:

<6yrs: see full labeling. ≥6yrs: Give by IV inj; max rate 160mg/min. High-dose MTX rescue: Start 24hrs after the beginning of MTX infusion (based on MTX dose of 12g/m2 over 4hrs). Normal MTX elimination: give levoleucovorin 7.5mg (approximately 5mg/m2) every 6hrs for 10 doses. Delayed late MTX elimination: continue levoleucovorin 7.5mg every 6hrs until MTX <0.05micromolar. Delayed early MTX elimination and/or evidence of acute renal injury: levoleucovorin 75mg every 3hrs until MTX <1micromolar, then 7.5mg every 3hrs until MTX <0.05micromolar. May continue another 24hrs for subsequent courses in cases of significant clinical toxicity. MTX overdose or impaired elimination: Start as soon as possible or within 24hrs if impaired MTX excretion; give levoleucovorin 7.5mg every 6hrs until MTX <0.05micromolar. See full labeling.

Warnings/Precautions:

Hypercalcemia. Monitor for GI toxicities. Do not initiate or continue therapy if GI toxicities (eg, stomatitis, diarrhea) occur until symptoms resolved. Monitor serum creatinine and MTX levels every 24hrs. Delayed early MTX elimination may cause reversible renal failure; provide hydration, alkalinize urine with sodium bicarbonate, closely monitor fluid and electrolytes until serum MTX <0.05 micromolar and renal failure resolves. Pregnancy. Nursing mothers.

Pharmacologic Class:

Folate analogue.

Interactions:

Potentiates 5-FU toxicity. Antagonizes TMP/SMZ. May antagonize anticonvulsants (eg, phenobarbital, primidone, phenytoin); monitor. May be affected by drugs that affect MTX elimination.

Adverse Reactions:

Stomatitis, vomiting, nausea.

Elimination:

Half-life: 5.1 hours.

Generic Availability:

NO

How Supplied:

Single-dose vial—1

Pricing for FUSILEV

5ml of 50mg vial (Qty: 1)
Appx. price $250
GoodRx