Wellcovorin

Leucovorin (loo-koe-VOR-in) is used as an antidote to the harmful effects of methotrexate (a cancer medicine) that is given in high doses. It is used also to prevent or treat certain kinds of anemia. Leucovorin acts the same way in the body as folic acid, which may be low in these patients.

Leucovorin is also used along with fluorouracil (a cancer medicine) to treat cancer of the colon (bowel).

Leucovorin is available only with a prescription and is to be given only by or under the supervision of your doctor. It is available in the following dosage forms:

                      In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For leucovorin, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to leucovorin. Also tell your health care professional if you are allergic to any other substance, such as foods, sulfites or other preservatives, or dyes.

Pregnancy—Studies on effects in pregnancy have not been done in either humans or animals.

Breast-feeding—It is not known whether leucovorin passes into the breast milk. However, it has not been reported to cause problems in nursing babies.

Children—In children with seizures, leucovorin may increase the number of seizures that occur.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of leucovorin in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Other medical problems—The presence of other medical problems may affect the use of leucovorin. If you are taking leucovorin as an antidote to methotrexate, make sure you tell your doctor if you have any other medical problems, especially:

Kidney disease—Levels of methotrexate may be increased because of its slower removal from the body, so the dose of leucovorin may not be enough to block the unwanted effects of methotrexate

Nausea and vomiting—Not enough leucovorin may be absorbed into the body to block the unwanted effects of methotrexate

                                 It is very important that you take leucovorin exactly as directed , especially when it is being taken to counteract the harmful effects of cancer medicine. Do not miss any doses. Also, it is best to take the doses at evenly spaced times day and night . For example, if you are to take 4 doses a day, the doses should be spaced about 6 hours apart. If this interferes with your sleep or other daily activities, or if you need help in planning the best times to take your medicine, check with your health care professional.

Do not stop taking leucovorin without checking with your doctor . It is very important that you get exactly the right amount.

Dosing—The dose of leucovorin will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of leucovorin. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets or doses of injection that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking leucovorin .

For use as an antidote to methotrexate:

For oral (tablets) or injection dosage forms:

Adults, teenagers, and children—Dose is based on body size and must be determined by your doctor.

For use as an antidote to other medicines:

For oral (tablets) or injection dosage forms:

Adults, teenagers, and children—Dose may range from 0.4 milligrams (mg) to 15 mg a day and must be determined by your doctor.

For certain kinds of anemia:

For oral (tablets) or injection dosage forms:

Adults, teenagers, and children—Up to 1 mg a day.

For colon cancer:

For injection dosage forms:

Adults and teenagers—Dose is based on body size and must be determined by your doctor.

Children—Dose must be determined by your doctor.

Missed dose—If you miss a dose of leucovorin or if you vomit shortly after taking a dose, check with your doctor right away . Your doctor may want you to take extra leucovorin to make up for what you missed. Do not take more medicine on your own, however, since it is very important that you receive just the right dose at the right time.

Storage—To store this medicine:

Keep out of the reach of children.

Store away from heat and direct light.

Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.

Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

                           Along with its needed effects, a medicine may cause some unwanted effects. Leucovorin usually does not cause any side effects.

However, check with your doctor immediately if any of the following side effects occur shortly after you receive this medicine:

Rare

Skin rash, hives, or itching; wheezing

Check with your doctor as soon as possible if the following side effect occurs:

Rare—reported with use in treatment of cancer

Convulsions (seizures)

                        

Valcyte

Valcyte is changed into ganciclovir in the body and may cause severe blood side effects (eg, low platelets, low blood cell counts, anemia). Notify your doctor immediately if you develop unusual fatigue, easy bruising or bleeding, or signs of an infection such as persistent fever or sore throat. Valcyte causes cancer, birth defects, and a lack of sperm production in animals.

                       Valcyte is used for:

Treating cytomegalovirus (CMV) infection of the eye in patients with AIDS. It is used to prevent CMV disease in high risk kidney, heart, and kidney-pancreas transplant patients. It may also be used for other conditions as determined by your doctor.

Valcyte is an antiviral agent. It works by stopping the growth and reproduction of the virus.

                         Some medical conditions may interact with Valcyte . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding

if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

if you have allergies to medicines, foods, or other substances

if you have kidney problems, blood cell or platelet problems, or a history of bone marrow problems

if you have a history of chemotherapy or radiation treatment, or you have taken other medicines that may cause bone marrow problems. Ask your doctor if you are unsure if any of your medicines may cause bone marrow problems.

Some MEDICINES MAY INTERACT with Valcyte . Tell your health care provider if you are taking any other medicines, especially any of the following:

Didanosine because risk of severe side effects, such as toxicity, may be increased by Valcyte

Probenecid because the risk of toxic effects of Valcyte may be increased

Zidovudine because the risk of toxic effects, such as severe or life-threatening blood problems, may be increased

Mycophenolate mofetil because it may increase Valcyte 's risk of side effects in patients with kidney problems

                           Use Valcyte as directed by your doctor. Check the label on the medicine for exact dosing instructions.

An additional patient leaflet is available with Valcyte . Talk to your pharmacist if you have questions about this information.

Take Valcyte with food.

Swallow Valcyte whole. Do not break, crush, or chew before swallowing.

Do not get broken or crushed tablets on your skin or in your eyes, nose, or mouth. If contact occurs, wash the skin thoroughly with soap and water and rinse eyes with plenty of clear water.

Any broken or leftover medicine should be placed in a plastic bag and disposed of as instructed by your doctor or pharmacist.

Continue to take Valcyte even if you feel well. Do not miss any doses.

If you miss a dose of Valcyte , take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Valcyte .

                            Valcyte may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Valcyte . Using Valcyte alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.

Valcyte is not a cure for CMV infection. Remain under the care of your doctor.

Valcyte may lower your body's ability to fight infection. Prevent infection by avoiding contact with people with colds or other infections. Notify your doctor of any signs of infection, including fever, sore throat, rash, or chills.

Do not substitute Valcyte for ganciclovir because an overdose may occur. Check with your doctor or pharmacist if you have any questions about the brand or dose of your medicine.

Valcyte may reduce the number of clot-forming cells (platelets) in your blood. To prevent bleeding, avoid situations in which bruising or injury may occur. Report any unusual bleeding, bruising, blood in stools, or dark, tarry stools to your doctor.

Use of Valcyte may increase your risk of developing cancer. Discuss any questions or concerns with your doctor.

When your medicine supply begins to run low, get more from your doctor or pharmacist as soon as possible. The virus may develop resistance to Valcyte and become more difficult to treat if you stop taking it, even for a short period of time.

Valcyte may cause decreased sperm production and decreased fertility.

During sexual intercourse with a woman who may become pregnant, men taking Valcyte should use a condom during treatment with Valcyte and for 90 days after it is stopped.

Lab tests, including eye exams, complete blood cell and platelet counts, and kidney function tests, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.

Use Valcyte with caution in the ELDERLY because they may be more sensitive to its effects.

Use Valcyte with extreme caution in CHILDREN. Safety and effectiveness have not been confirmed.

PREGNANCY and BREAST-FEEDING: Valcyte may cause harm to the fetus. Avoid becoming pregnant while taking Valcyte . Use effective contraception to prevent pregnancy while you are taking Valcyte . If you think you may be pregnant, discuss with your doctor the benefits and risks of using Valcyte during pregnancy. It is unknown if Valcyte is excreted in breast milk. Do not breast-feed while taking Valcyte .

                         All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Back pain; constipation; diarrhea; dizziness; drowsiness; headache; nausea; stomach pain; trouble sleeping; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chills; confusion; cough; decreased urination; depression; fever; hallucinations; loss of coordination; numbness or tingling of the skin, hands, or feet; seizures; sore throat; swelling of the legs; tremors; unsteady movements; unusual bruising or bleeding; unusual tiredness or weakness; vision changes.

                    Store Valcyte at 77 degrees F (25 degrees C). Store away from heat, moisture, and light. Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Do not store in the bathroom. Keep Valcyte out of the reach of children and away from pets.