Folate repletion
Reduced folate repletion
- Restores thymidylate and purine synthesis
- Rescues marrow from antifolates
- Used after high-dose methotrexate
- “Rescue” bypasses the block rather than reversing the drug
- Supplies reduced folate directly, bypassing dihydrofolate reductase
Drugs with this mechanism (1)
- Leucovorin — Reduced folate that rescues methotrexate toxicity but potentiates fluorouracil.
Self-check
- Which enzyme does reduced folate repletion bypass?
Dihydrofolate reductase. - After which high-dose antimetabolite is folate rescue used?
Methotrexate.
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