Folinic Acid (Leucovorin): Uses, Benefits, and Side Effects

Summary of Key Points

Folinic acid, also known as Leucovorin, is a form of folate used to treat or prevent conditions related to folate deficiency and to reduce the side effects of certain medications, such as methotrexate. It is commonly prescribed for patients with cancer, anemia, and other metabolic disorders. Always consult your healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to help manage your treatment plan.

Names of Medication

US Brand Name: Leucovorin

Generic Name: Folinic Acid

The ‘generic name’ refers to the active ingredient, while the brand name is the marketed version. The generic name (Folinic Acid) is listed in parentheses.

Pharmacologic Category

Folate Analog

Antidote (to folic acid antagonists)

Folinic Acid Dosing

Folinic acid is used to treat various conditions, with the dosage depending on the specific condition being treated. Always consult your doctor before making any changes to your dosage. Our telemedicine providers are available to assist with any questions or concerns about your treatment.

Folate Deficiency

Dosage: 5-15 mg orally once daily. The length of treatment depends on the severity of the deficiency and your response to therapy.

Methotrexate Toxicity

Dosage: 10-15 mg/m² every 6 hours, starting 24 hours after methotrexate administration. Treatment continues until methotrexate levels are within a safe range.

Colorectal Cancer

Dosage: 200 mg/m² intravenously (IV) once daily for 5 days, in combination with fluorouracil. This cycle is repeated every 4-5 weeks.

Osteosarcoma

Dosage: 15 mg orally or IV every 6 hours for 72 hours, starting 24 hours after high-dose methotrexate.

Acute Lymphoblastic Leukemia

Dosage: 10 mg/m² IV every 6 hours, starting 24 hours after methotrexate administration. The duration of treatment depends on methotrexate levels and patient response.

Anemia

Dosage: 5-15 mg orally once daily. Treatment duration varies based on the underlying cause of the anemia.

Neural Tube Defects (Prevention)

Dosage: 0.4-5 mg orally once daily, depending on risk factors. Women planning pregnancy or in early pregnancy should consult their doctor for the appropriate dose.

Hyperhomocysteinemia

Dosage: 5-15 mg orally once daily. Treatment duration depends on homocysteine levels and response to therapy.

Malabsorption Syndromes

Dosage: 5-15 mg orally once daily. The length of treatment varies based on the severity of the malabsorption issue.

Methylmalonic Acidemia

Dosage: 5-15 mg orally once daily. Treatment duration depends on the patient’s response to therapy.

Dosage Forms and Strengths

Tablets: 5 mg, 10 mg, 15 mg, 25 mg

Injection: 10 mg/mL, 50 mg/vial, 100 mg/vial

Administration Instructions for Folinic Acid

Folinic acid can be taken orally in tablet form or administered by injection. If taking the tablet, swallow it whole with water, with or without food. For injections, a healthcare provider will administer the dose. Always follow your doctor’s instructions carefully and consult them if you have any questions. If you need help managing your medication, our telemedicine providers are available to assist you.

Folinic Acid Side Effects and Adverse Reactions

Like all medications, folinic acid may cause side effects. Most are mild, but some can be more serious. If you experience any severe reactions, contact your healthcare provider immediately. You can also schedule a telemedicine appointment with one of our providers for further guidance.

Common Side Effects: Nausea, vomiting, diarrhea, and fatigue. These are usually mild and tend to resolve on their own.

Less Common Side Effects: Allergic reactions, including rash, itching, or swelling. Contact your doctor if you experience these symptoms.

Serious Side Effects: Seizures, difficulty breathing, or severe allergic reactions (anaphylaxis). Seek immediate medical attention if you experience any of these symptoms.

Contraindications for Folinic Acid

A contraindication is a specific situation or condition where a medication should not be used because it may cause harm. It’s important to know if any of these apply to you before starting folinic acid therapy. Discuss your full medical history with your healthcare provider, including any other medications or supplements you are taking.

Known hypersensitivity to Folinic Acid: If you are allergic to folinic acid or any of its components, taking this medication can cause serious allergic reactions, such as rash, itching, swelling, or difficulty breathing.

Pernicious anemia or other megaloblastic anemias due to vitamin B12 deficiency: Folinic acid can mask the symptoms of vitamin B12 deficiency, which can lead to worsening neurological damage if not treated properly. It’s important to rule out vitamin B12 deficiency before starting folinic acid.

Severe renal impairment: In patients with severe kidney problems, folinic acid may not be processed effectively, leading to potential complications. Your healthcare provider will assess your kidney function before prescribing this medication.

Drug Interactions with Folinic Acid

Folinic acid can interact with other medications, which may affect how well it works or increase the risk of side effects. Be sure to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below are some common medications that may interact with folinic acid:

5-Fluorouracil (Adrucil): Folinic acid is often used alongside 5-Fluorouracil in cancer treatment, but this combination can increase the risk of severe side effects such as mouth sores, diarrhea, and low blood cell counts.

Trimethoprim-sulfamethoxazole (Bactrim, Septra): This antibiotic can interfere with the effects of folinic acid, potentially reducing its effectiveness in treating folate deficiency.

Phenytoin (Dilantin): Folinic acid may reduce the effectiveness of Phenytoin, an anti-seizure medication, which could lead to an increased risk of seizures.

Phenobarbital (Luminal): Similar to Phenytoin, folinic acid may decrease the effectiveness of Phenobarbital, which is also used to control seizures.

Methotrexate (Trexall, Rheumatrex): Folinic acid is often used to reduce the toxic effects of Methotrexate, but the timing and dosage must be carefully managed by your healthcare provider to avoid complications.

Folinic Acid in Pregnancy

Is it Safe to Take Folinic Acid During Pregnancy?

Folinic acid, also known as Leucovorin, is generally considered safe during pregnancy, particularly when prescribed to address folate deficiency or to counteract the side effects of medications like Methotrexate. However, it is essential to consult your healthcare provider before starting folinic acid while pregnant. Your provider will carefully weigh the potential benefits and risks based on your individual health needs.

Folinic Acid While Breastfeeding

Is it Safe to Take Folinic Acid While Breastfeeding?

Folinic acid is generally regarded as safe during breastfeeding and is not known to pose any risk to the nursing infant when taken at prescribed doses. Nevertheless, it is always advisable to discuss any medications with your healthcare provider to ensure the safety of both you and your baby.

Estimated Cost of Folinic Acid Medication

The cost of a 30-day supply of folinic acid can vary depending on the dosage and the pharmacy. Without insurance, using a GoodRx coupon, the estimated price for a 30-day supply typically ranges from $30 to $60. Prices may fluctuate, so it’s a good idea to check with your pharmacy and explore available discount options.

Possible Alternatives to Folinic Acid

Depending on the condition being treated, alternative therapies or lifestyle changes may be beneficial. Always consult your healthcare provider before making any changes to your treatment plan. If you need further guidance, our telemedicine providers are available to discuss your options.

Folate Deficiency

Alternatives to folinic acid for folate deficiency include increasing your intake of folate-rich foods, such as leafy greens, citrus fruits, and legumes. Folic acid supplements may also be recommended as an alternative to folinic acid.

Methotrexate Toxicity

In cases of Methotrexate toxicity, in addition to folinic acid supplementation, your healthcare provider may consider reducing the Methotrexate dose or switching to a different medication. Your provider will guide you through these options based on your specific situation.

Colorectal Cancer

Treatment options for colorectal cancer include chemotherapy, targeted therapy, radiation, and surgery. Lifestyle changes, such as adopting a healthy diet and engaging in regular physical activity, may also help manage symptoms and improve outcomes. Folinic acid is often used alongside chemotherapy to enhance its effectiveness.

Osteosarcoma

Treatment alternatives for osteosarcoma include surgery, chemotherapy, and radiation. Your oncologist may also discuss clinical trials or emerging therapies, which may include the use of folinic acid in combination with other treatments.

Acute Lymphoblastic Leukemia

For acute lymphoblastic leukemia, treatment options include chemotherapy, targeted therapy, and bone marrow transplants. Your healthcare provider will tailor the treatment plan to your specific case, which may or may not involve folinic acid therapy.

Anemia

Depending on the type of anemia, alternatives may include iron supplements, vitamin B12 injections, or dietary changes to increase iron and vitamin intake. Folinic acid may be used in cases of anemia related to folate deficiency.

Neural Tube Defects

Folic acid supplementation is the primary preventive measure for neural tube defects. Women planning to become pregnant are typically advised to take folic acid supplements as recommended by their healthcare provider. While folinic acid and folic acid are sometimes compared, folic acid is generally recommended for prevention.

Hyperhomocysteinemia

Managing hyperhomocysteinemia may involve supplementing with folic acid, vitamin B6, and vitamin B12, along with dietary changes to lower homocysteine levels. In certain cases, folinic acid may also be considered.

Malabsorption Syndromes

Treatment for malabsorption syndromes may include dietary modifications, enzyme supplements, or other medications to improve nutrient absorption. Folinic acid supplementation may be recommended if folate absorption is impaired.

Methylmalonic Acidemia

Treatment options for methylmalonic acidemia include a low-protein diet, vitamin B12 supplementation, and, in some cases, liver or kidney transplantation. Folinic acid may be used alongside other treatments depending on the patient’s specific needs.

Recent Updates on Folinic Acid Research

Recent research on folinic acid has focused on its role in reducing the side effects of chemotherapy and its potential in treating neurological conditions. A 2022 study explored the use of folinic acid in patients with autism spectrum disorder, showing promising results in improving communication and social skills. Ongoing clinical trials are also investigating folinic acid in combination with other drugs to enhance cancer treatment, particularly in colorectal cancer and osteosarcoma. As research continues to evolve, staying informed about new developments is important. If you have questions about how these updates may affect your treatment, our telemedicine providers are here to assist you.

James Kingsley

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