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Leucovorin is indicated to diminish the toxicity and counteract the effect of inadvertently administered overdosages of Methotrexate. Leucovorin administration should begin as promptly as possible. As the time interval between Methotrexate administration and leucovorin initiation increases, the effectiveness of Leucovorin in counteracting toxicity decreases. Monitoring of the serum Methotrexate concentration is essential in determining the optimal dose and duration of treatment with Leucovorin.
In cases of massive overdosage, hydration and urinary alkalinisation may be necessary to prevent the precipitation of Methotrexate and/or its metabolites in the renal tubules. Neither hemodialysis nor peritoneal dialysis has been shown to improve Methotrexate elimination.
