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Methotrexate (High-Dose) Clearance
Leucovorin rescue scheduling based on MTX levels and time post-infusion
Patient & Dose Information
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MTX Levels (optional — for rescue guidance)
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BSA (m²)
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Total MTX Dose (mg)
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Clearance Risk
Leucovorin Rescue Schedule
| Time Post-Infusion | Level (µmol/L) | Risk | Leucovorin Action |
|---|---|---|---|
| 24h | ≥ 10 | High Risk | Escalate LCV to 100–150 mg Q3–6h IV |
| 24h | 1–10 | Intermediate | Continue standard LCV 15 mg Q6h; monitor closely |
| 48h | ≥ 1 | High Risk | Increase LCV dose; consider glucarpidase consult |
| 72h | ≥ 0.1 | Delayed Clearance | Continue LCV rescue; urgent glucarpidase consideration |
| 72h | < 0.1 | Cleared | Leucovorin can be discontinued |
Supportive Care: IV hydration to achieve urine output ≥100 mL/hr. Urinary alkalinization with sodium bicarbonate to pH ≥7.0 (MTX more soluble at alkaline pH). Monitor renal function, electrolytes, CBC daily. Glucarpidase (Voraxaze) for delayed clearance — consult oncology/pharmacy.
