CALCIUM FOLINATE (FOLINIC ACID)

Antidote to methotrexate. Counteracts folate antagonism and speeds up recovery from methotrexate induced mucositis or myelosuppression (‘folinic acid rescue’)

Dosage Forms

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Injection

3 mg/ml

Uses

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  • Methotrexate induced mucositis and myelosuppression
  • Methotrexate overdose
  • Palliative treatment of advanced metastatic colorectal cancer

Dose and Duration

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Prevention of methotrexate-induced adverse effects, usually started 12‒24 hours after start of methotrexate infusion.
Adult and child:By IM or IV injection or by IV infusion, up to 120 mg in divided doses over 12–24 hours, then 12–15 mg by IM injection, or 15 mg by mouth every 6 hours for 48–72 hours
Methotrexate over dosage

Started as soon as possible, preferably within 1 hour of administration of methotrexate

Adult and child: by IV injection or infusion, dose equal to or higher than that of methotrexate, at rate not exceed ing 160 mg/minute
Colorectal cancer (in combination with fluorouracil)
Consult specialist literature

Preparation

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  • Solutions for intravenous infusion may be diluted with 0.9% sodium chloride or 5% glucose

Contraindications

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  • Intrathecal injection of calcium folinate
  • Pernicious anaemia or other anaemias due to Vitamin B1 deficiency (see caution)
  • Known hypersensitivity to calcium folinate

Side Effects

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  • Allergic reactions
  • Pyrexia after parenteral administration

Pregnancy

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  • Can be used

Breastfeeding

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  • Can be used

Storage

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  • Store at 2–8oC in a refrigerator in the original container

⚠️ Caution

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  • Do not administer simultaneously with methotrexate
  • Treatment may mask pernicious anaemia and other anaemias resulting from vitamin B12 deficiency
  • Do not inject more than 160 mg of calcium folinate per minute