Indications
Calcium Folinate is indicated in:
- To diminish the toxicity and counteract the effect of impaired Methotrexate elimination.
- To treat the Megaloblastic anemia due to folate deficiency, as in sprue, nutritional deficiency.
- To treat the Megaloblastic anemia of pregnancy and infancy.
Therapeutic Class
Pharmacology
Dosage & Administration
Oral-
- Reduction of harmful effects of folic acid antagonists: The dose is usually one 5-15 mg tablet every 6 hours for 2 to 3 days.
- Megaloblastic anemia: In the treatment of Megaloblastic anemia, the dose is one 5-15 mg tablet daily.
Intravenous-
- Advanced Colorectal Cancer: Folinic Acid is administered at 200 mg/m2 by slow intravenous injection followed by 5-fluorouracil at 370 mg/m2 by intravenous injection. Or 20 mg/m 2 by slow intravenous injection followed by 5-fluorouracil at 425 mg/m2 by intravenous injection. Treatment is repeated daily for 5 days. This 5 day treatment course may be repeated at 4 weeks interval, for 2 courses and then may repeated at 4-5 weekly intervals if the patient has recovered completely from the toxic effects of the prior treatment course.
- Folinic acid rescue after high dose Methotrexate Therapy: Calcium Folinate starts 24 hours after the beginning of the methotrexate infusion at dose of 15mg (10 mg/m2 ) every 6 hours for 10 doses.
Intramuscular-
- Folate deficient megaloboastic anaemia: Up to 1 mg/day. Or, as directed by the registered physician.
Contraindications
Calcium Folinate therapy is contraindicated for the following:
- Known hypersensitivity to Calcium Folinate, or to any components of the product formulation.
- Pernicious anemia or other Megaloblastic anemia where Vitamin B12 is deficient.
Side Effects
- Allergic reaction: one may experience a sudden itchy rash (hives), swelling of the hands, feet, ankles, face, lips, mouth or throat (which may cause difficulty in swallowing or breathing).
- Fits and fainting.
Pregnancy & Lactation
Precautions & Warnings
Calcium Folinate treatment may mask pernicious anemia and other Megaloblastic anemia resulting from Vitamin B12 deficiency.
Calcium Folinate should only be used with 5-fluorouracil or Methotrexate under the direct supervision of a clinician experienced in the use of cancer chemotherapeutic agents.
Many cytotoxic medicinal products- direct or indirect DNA synthesis inhibitors- lead to macrocytosis (hydroxycarbamide, cytarabine, mercaptopurine, thioguanine). Such macrocytosis should not be treated with Folinic acid.
In epileptic patients treated with Phenobarbital, Phenytoin, Primidone, and Succinimides, there is a risk to increase the frequency of seizures due to a decrease of plasma concentrations of anti-epileptic drug.
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