Calcium folinate


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Antidote for methotrexate toxicity 15 mg 6 hrly for 10 doses starting 24 hr after the start of methotrexate infusion. Continue until serum levels of methotrexate is <0.05 micromolar. Folate-deficient megaloblastic anaemia 15 mg/day. IV Adjunct to fluorouracil in colorectal cancer 200 mg/m2 over at least 3 mins followed by fluorouracil. Continue for 5 days and repeat at intervals of 28 days for 2 courses. IM Folate-deficient megaloblastic anaemia Up to 1 mg/day.
Dosage Details
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.
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: 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.
Disclaimer: This information is independently developed by MIMS based on Calcium folinate from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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