Leucovorin rescue scheduling based on MTX levels and time post-infusion
| 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 |
