Calcium Folinate is a Calcium salt of Folinic acid (citrovorum factor), is a mixture of the diastereoisomers of the 5-formyl derivative of Tetrahydrofolic acid. It is a metabolite of Folic acid and an essential co-enzyme for nucleic acid synthesis used in cytotoxic therapy.

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.

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.

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.

• 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.

Overdose Effects

There have been no reported sequelae in patients who have received significantly more Calcium Folinate than the recommended dosage. However, excessive amounts of Calcium Folinate may nullify the chemotherapeutic effect of folic acid antagonists.

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.

Pregnancy & Lactation

There are no adequate and well-controlled clinical studies conducted in pregnant or breastfeeding women. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Calcium Folinate is administered to a nursing mother.