Calcium folinate: Indication, Dosage, Side Effect, Precaution

Generic Medicine Info Patient Medicine Information

This information is not country-specific. Please refer to the Indonesia prescribing information.

Generic Medicine Info

Indications and Dosage

Intramuscular
Folate-deficient megaloblastic anaemia

Adult: Up to 1 mg/day.

Intravenous
Adjunct to fluorouracil in colorectal cancer

Adult: 200 mg/m² BSA by slow IV inj over at least 3 min followed by 370 mg/m² fluorouracil by IV inj. Treatment is given for 5 consecutive days and repeated at intervals of 28 days for 2 courses. Subsequently, may repeat at 4-5 wkly intervals if the patient has recovered completely from the toxic effects of the prior treatment course.

Oral
Antidote for methotrexate toxicity

Adult: 15 mg every 6 hr for 10 doses starting 24 hr after the start of methotrexate infusion. Continue admin until serum levels of methotrexate is <0.05 micromolar. May also be given via IM/IV inj.

Oral
Folate-deficient megaloblastic anaemia

Adult: 15 mg daily.

Incompatibility

Incompatible with fluorouracil when mixed in various ratios and stored in PVC containers at various temperatures.

Contraindications

Hypersensitivity, pernicious anaemia and other megaloblastic anaemias secondary to vit B₁₂-deficiency, intrathecal and intraventricular admin.

Special Precautions

Undiagnosed megaloblastic anaemia, folate dependent tumors; pregnancy. Monitor calcium levels in patients receiving combined 5-Fluorouracil/Folinic acid treatment. To be given parenterally in the presence of GI toxicity, nausea or vomiting. Monitor serum levels of methotrexate to determine the optimal dose and duration of folinic acid admin. Monitor CBC, electrolytes and liver function tests before and regularly during treatment.

Adverse Reactions

Allergic sensitisation, rash, pruritus, eythema, urticaria, nausea, vomiting, pyrexia.

Pregnancy Category (US FDA)

IM/IV/Parenteral/PO: C

Drug Interactions

Reduces methotrexate toxicity. Enhances cytotoxic and anti-neoplastic effects of fluorouracil. Increases risk of seizures in epileptic patients treated with primidone, phenytoin, phenobarbital and succinimides.

Action

Description:
Mechanism of Action: Calcium folinate enters the cells as 5-methyl tetrahydrofolate and supplies the cofactor blocked by methotrexate. It stabilises the binding of 5-dUMP and thymidylate synthetase, enhances fluorouracil activity and neutralises the effects of folic acid antagonists such as methotrexate but increases those of 5-fluorouracil.
Pharmacokinetics:
Absorption: Well absorbed (oral, IM).
Distribution: Widely distributed; concentrated in the liver and CSF.
Metabolism: Hepatic, intestinal; converted to biologically active 5-methyltetrahydrofolate.
Excretion: Urine, faeces (small amounts).

Storage

Store at 15-30°C.

MIMS Class

Antidotes & Detoxifying Agents / Haematopoietic Agents / Supportive Care Therapy / Vitamins & Minerals (Pre & Post Natal) / Antianemics

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