Order KHAPZORY Today

Inconsistent supply of generic leucovorin continues

  • Generic leucovorin supply issues have not been fully resolved since December 20081
  • Some generic leucovorin manufacturers continue to report delays and inability to produce to demand
  • Full details of supply shortages can be read at the FDA web site here.1,2

KHAPZORY is available with consistent supply

Order KHAPZORY today for Hospitals Order KHAPZORY today for Practices

Drug shortages can have negative impacts3

The impact of oncology drug shortages was explored in a 2013 article that examined results from a 2011 survey of 1,672 members of the Hematology/Oncology Pharmacy Association and other organizations.

Generic racemic leucovorin was rated among the top four drugs most difficult to obtain.

KHAPZORY is available with consistent supply

  • Available in single-dose vials containing 175 mg (NDC 68152-112-01) or 300 mg (NDC 68152-114-01) of levoleucovorin formulated as a lyophilized powder.

Indications and Usage

KHAPZORYTM is a folate analog indicated for:

  • Rescue after high-dose methotrexate therapy in patients with osteosarcoma.
  • Diminishing the toxicity associated with overdosage of folic acid antagonists or impaired methotrexate elimination.
  • Treatment of patients with metastatic colorectal cancer in combination with fluorouracil.

Limitations of Use

KHAPZORY is not indicated for the treatment of pernicious anemia and megaloblastic anemia secondary to lack of vitamin B12 because of the risk of progression of neurologic manifestations despite hematologic remission.

Important Safety Information


  • KHAPZORY is contraindicated in patients who have had severe hypersensitivity to leucovorin products, folic acid, or folinic acid.

Warnings and Precautions

  • Increased gastrointestinal toxicities with fluorouracil: Gastrointestinal toxicities, including stomatitis and diarrhea, occur more commonly and may be of greater severity and of prolonged duration. Deaths from severe enterocolitis, diarrhea, and dehydration have occurred in elderly patients receiving weekly d,l-leucovorin and fluorouracil. Do not initiate or continue therapy with KHAPZORY and fluorouracil in patients with symptoms of gastrointestinal toxicity until those symptoms have resolved. Monitor patients with diarrhea until it has resolved as rapid deterioration leading to death can occur.
  • Drug interaction with trimethoprim-sulfamethoxazole: Concomitant use of d,l-leucovorin with trimethoprim-sulfamethoxazole for the acute treatment of Pneumocystis jiroveci pneumonia in patients with HIV infection increased treatment failure and morbidity.

Adverse Reactions

  • The most common adverse reactions (≥20%) in patients receiving high-dose methotrexate therapy with levoleucovorin rescue were stomatitis (38%) and vomiting (38%).
  • The most common adverse reactions (>50%) in patients receiving levoleucovorin in combination with fluorouracil for metastatic colorectal cancer were stomatitis (72%), diarrhea (70%), and nausea (62%).

Drug Interactions

Leucovorin products increase the toxicity of fluorouracil.

Use in Specific Populations

Levoleucovorin is administered in combination with methotrexate or fluorouracil, which can cause embryo-fetal harm. Refer to methotrexate and fluorouracil prescribing information for additional information.

Please click here to see full Prescribing Information for KHAPZORY.


Reporting of Suspected Adverse Reactions

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.


  1. U.S. Food and Drug Administration (FDA). FDA current drug shortages. Accessed December 21, 2017
  2. American Society of Health-System Pharmacists (ASHP). Current drug shortage bulletin: Leucovorin calcium injection. Updated April 24, 2014. Accessed April 29, 2014.
  3. McBride A, Holle LM, Westendorf C, et al. National survey on the effect of oncology drug shortages on cancer care. Am J Health Syst Pharm. 2013;70:609-617.

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