What is the appropriate dosing of folinic acid (leucovorin) for a patient weighing 91 pounds?

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Folinic Acid (Leucovorin) Dosing for a 91-Pound Patient

For a patient weighing 91 pounds (41.3 kg), the appropriate dose of folinic acid (leucovorin) is 10-20 mg three times weekly when used as a supplement with methotrexate therapy.

Dosing Guidelines Based on Clinical Context

Methotrexate Therapy

  • For patients receiving methotrexate as part of chemotherapy regimens (such as FOLFOX or FOLFIRI), leucovorin is dosed at 400 mg/m² IV over 2 hours on day 1 1
  • For prevention of methotrexate toxicity, folinic acid supplementation at 10-20 mg three times weekly is recommended 1, 2
  • For patients with significant methotrexate toxicity, higher rescue doses may be required based on methotrexate levels 2, 3

Dietary Deficiency or Chronic Conditions

  • For treatment of folate deficiency, 1-5 mg of folinic acid daily is recommended 1
  • For patients on chronic hemodialysis, 1-5 mg daily or 1 mg after each dialysis session is sufficient to maintain therapeutic folate levels 1, 4

Toxoplasmosis Treatment

  • For children with toxoplasmosis, 10-20 mg three times weekly is recommended when used alongside pyrimethamine 1

Weight-Based Considerations

  • For a 91-pound (41.3 kg) patient:
    • If calculating based on body surface area (BSA), first convert to BSA using standard formulas (approximately 1.3 m² for this weight)
    • For chemotherapy protocols, the dose would be approximately 520 mg (400 mg/m² × 1.3 m²) 1
    • For supplementation with methotrexate therapy, the standard 10-20 mg three times weekly is appropriate regardless of weight 1, 2

Administration Routes

  • Oral administration is preferred for long-term supplementation 1
  • Intravenous administration is used in chemotherapy protocols 1
  • In cases where oral treatment is ineffective or not tolerated, subcutaneous, IV, or IM administration at 0.1 mg/day can be considered 1

Monitoring and Adjustments

  • Monitor complete blood count, liver function, and renal function regularly during therapy 2
  • For patients with renal insufficiency, dose adjustments may be necessary as both methotrexate and folinic acid are primarily excreted by the kidneys 2, 3
  • Measure folate status in plasma or serum (for short-term status) or RBC (for long-term status) using validated methods 1

Common Pitfalls to Avoid

  • Do not confuse folinic acid (leucovorin) with folic acid, as they have different metabolic pathways and clinical applications 1, 5
  • Leucovorin does not require the same metabolic conversion as folic acid and may be more bioavailable 5
  • When using l-leucovorin instead of d,l-leucovorin, the dose should be reduced by half as only the l-isomer is pharmacologically active 6
  • Excessive folic acid supplementation (>5 mg/day) may mask vitamin B12 deficiency 1

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Management of Methotrexate-Induced Leucopenia

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Research

Folic acid dosage for chronic hemodialysis patients.

Clinical pharmacology and therapeutics, 1975

Guideline

Leucovorin Therapy in Children with Autism and Elevated B12 Levels

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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