Folinic acid
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Hypersensitivity: case report A 53-year-old man developed hypersensitivity during treatment with IV folinic acid [leucovorin; initial dosage not stated]. The man, who had stage IV colon cancer, started treatment with folinic acid, fluorouracil, oxaliplatin (FOLFOX 6 regimen) and bevacizumab in May 2008. He completed 12 cycles of FOLFOX 6 and went into remission. He relapsed after several months and started treatment with folinic acid, fluorouracil, irinotecan (FOLFIRI regimen) and bevacizumab in July 2009. He completed 12 cycles of FOLFIRI. New lesions were found, and he was reinitiated on his 13th cycle of FOLFOX 6 and bevacizumab in March 2010. His dose of IV folinic acid was 900mg [frequency not clearly stated], and his premedications were palonosetron and dexamethasone. He developed scalp pruritus, flushing and scattered wheals on his chest and neck. The onset of his reaction was 10 minutes [time to reaction onset not clearly stated], and the reaction lasted 30 minutes. The patient’s infusion was stopped, but he was rechallenged on the same day. His rechallenge was completed with ranitidine and diphenhydramine, without further complications. The patient continued to receive additional cycles of FOLFOX 6 and bevacizumab with varying doses and reactions. Oxaliplatin hypersensitivity was initially suspected. Oxaliplatin was discontinued for his 20th cycle, but headache, facial flushing, generalised pain, diaphoresis and severe back spasms developed 15 minutes after the start of his IV folinic acid 500mg infusion. The infusion was stopped. Sensitisation to folinic acid was deduced. At last follow-up, the patient had received four cycles of oxaliplatin and bevacizumab without complications. Author comment: "Based on the adverse events that the patient experienced from the last five cycles of therapy which included [folinic acid], and on the minimal complications when oxaliplatin was administered as monotherapy, it can be deduced that the patient had developed a sensitization to leucovorin. . . Based on the Naranjo’s Adverse Drug Reaction Probability Scale, the score totaled 6 out of 10, categorizing this as a ’probable’ adverse reaction." Damaske A, et al. Leucovorin-induced hypersensitivity reaction. Journal of Oncology Pharmacy Practice 18: 136-139, No. 1, Mar 2012. Available from: URL: 803070352 http://dx.doi.org/10.1177/1078155210396577 - USA
0114-9954/10/1402-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 19 May 2012 No. 1402
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