calcium folinate: clinical use

Prescribing considerations

• Use with methotrexate or fluorouracil should be supervised by clinicians experienced in cancer chemotherapy.
• Confirm the cause of megaloblastic anaemia before treatment.
• The tablets described here contain lactose.

Contraindications and cautions

• Hypersensitivity to calcium folinate or an excipient.
• Pernicious anaemia or another megaloblastic anaemia caused by vitamin B12 deficiency.
• Calcium folinate must not be administered intrathecally.

Monitoring

• During combination treatment with fluorouracil, monitor full blood count, renal function, serum electrolytes, and gastrointestinal and oral toxicity.
• During methotrexate rescue, assess for delayed clearance or toxicity.

Clinical pharmacology

Calcium folinate provides 5-formyltetrahydrofolate, a reduced folate that bypasses dihydrofolate-reductase blockade. It replenishes intracellular tetrahydrofolate and may competitively displace methotrexate from dihydrofolate reductase.

Formulation and product differences

• The product described here is an oral, scored, uncoated tablet containing lactose.
• Parenteral formulations exist but must never be administered intrathecally.
• Oral administration reaches peak serum folate later than intramuscular administration.