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Calcium Folinate [Folinic Acid]: Brands, Price & Uses in Bangladesh
Calcium Folinate [Folinic Acid] (leucovorin, a reduced folate) is indicated for the following uses, classified by strength of evidence: Established / Approved Uses Leucovorin rescue after high-dose…
About Calcium Folinate [Folinic Acid]
Indications of Calcium Folinate [Folinic Acid]
Calcium Folinate [Folinic Acid] (leucovorin, a reduced folate) is indicated for the following uses, classified by strength of evidence:
Established / Approved Uses
- Leucovorin rescue after high-dose methotrexate therapy — used in osteosarcoma and other regimens employing high-dose methotrexate to reduce the toxicity of methotrexate to normal cells without compromising its antitumor effect. This is always used as part of a planned, physician-supervised protocol together with methotrexate, never as a standalone treatment for cancer.
- Treatment of accidental overdosage of folic acid antagonists, such as methotrexate, trimethoprim, or pyrimethamine, to counteract their toxic effects.
- Treatment of megaloblastic anemia due to folic acid deficiency, when oral folic acid therapy is considered inappropriate or impractical (for example, in patients unable to absorb or tolerate oral folic acid).
Guideline-Supported Combination / Adjunct Use
- Adjunct to 5-fluorouracil (5-FU) chemotherapy in the palliative treatment of advanced colorectal cancer — Calcium Folinate [Folinic Acid] is combined with 5-FU (never used alone for this purpose) to biochemically enhance the anticancer activity of 5-FU. This combination is a well-established, guideline-supported chemotherapy regimen.
Calcium Folinate [Folinic Acid] is not effective, and must not be used, as a treatment for pernicious anemia or other vitamin B12-deficiency anemias (see Contraindications).
Dosage & Administration of Calcium Folinate [Folinic Acid]
Dosing of Calcium Folinate [Folinic Acid] is highly indication-specific and must always follow the treating physician's protocol; the following is general reference information, not a substitute for individualized medical guidance.
| Indication | Typical Adult Dosing |
|---|---|
| Methotrexate rescue after high-dose methotrexate | Usually 15 mg (approx. 10 mg/m²) by mouth, intramuscularly, or intravenously every 6 hours, beginning approximately 24 hours after the start of the methotrexate infusion, and continued (with dose/frequency adjusted per serum methotrexate level) until the methotrexate level falls below the threshold specified in the treatment protocol (commonly less than 0.05–0.1 micromol/L). Exact timing is protocol- and hospital-specific. |
| Folic acid antagonist overdosage (e.g., methotrexate, trimethoprim, pyrimethamine) | As soon as possible, generally starting at approximately 10 mg/m² by mouth, intramuscularly, or intravenously, then every 6 hours until the serum methotrexate (or antifolate) level falls to a safe threshold; dose is adjusted upward if methotrexate elimination is delayed. |
| Megaloblastic anemia due to folate deficiency (when oral folic acid is not appropriate) | Up to 1 mg per day, intramuscularly, until the clinical situation permits switching to oral folic acid. |
| Adjunct to 5-fluorouracil in advanced colorectal cancer | Given as part of established combination regimens, for example 200 mg/m² or 20 mg/m² by slow intravenous injection, followed by 5-fluorouracil, on a schedule (commonly daily for 5 days, repeated in cycles) determined by the treating oncologist. Regimen and dose vary by protocol. |
Calcium Folinate [Folinic Acid] is administered by the intravenous, intramuscular, or oral route depending on the formulation and clinical situation. Calcium Folinate [Folinic Acid] must never be administered intrathecally — intrathecal administration has caused fatalities. When given intravenously, the rate of administration should not exceed the maximum recommended rate (due to the calcium content of the injection) as specified in the product label. See Reconstitution for preparation of the injectable powder form.
Side Effects of Calcium Folinate [Folinic Acid]
When used alone, Calcium Folinate [Folinic Acid] is generally well tolerated. Reported side effects include:
- Rare allergic/hypersensitivity reactions, including urticaria (hives), fever, and rare cases of anaphylaxis.
- Injection-site reactions (with parenteral use).
When Calcium Folinate [Folinic Acid] is combined with 5-fluorouracil chemotherapy, the following adverse effects are more frequent and can be more severe (these are largely attributable to enhanced 5-FU toxicity, not to Calcium Folinate [Folinic Acid] alone):
- Gastrointestinal effects: nausea, vomiting, diarrhea, stomatitis/mucositis (mouth sores).
- Bone marrow suppression: leukopenia, and less commonly thrombocytopenia or anemia.
Patients should seek prompt medical attention for signs of a severe allergic reaction, severe diarrhea, mouth sores, unusual bleeding/bruising, fever, or signs of infection during combination chemotherapy.
Contraindications of Calcium Folinate [Folinic Acid]
Calcium Folinate [Folinic Acid] is contraindicated in:
- Known hypersensitivity to folinic acid, calcium folinate, folic acid, or any component of the formulation.
- Pernicious anemia and other megaloblastic anemias caused by vitamin B12 deficiency. Calcium Folinate [Folinic Acid] can produce a hematologic response in B12-deficiency anemia while allowing progressive, irreversible neurological damage to continue undetected and untreated. Calcium Folinate [Folinic Acid] must not be used to treat any megaloblastic anemia unless vitamin B12 deficiency has first been excluded.
Frequently Asked Questions about Calcium Folinate [Folinic Acid]
What is Calcium Folinate [Folinic Acid] used for?
Calcium Folinate [Folinic Acid] is mainly used to protect the body's normal cells during high-dose methotrexate cancer treatment ('rescue' therapy), to treat accidental overdose of folic acid antagonist drugs, to enhance the effect of 5-fluorouracil chemotherapy in colorectal cancer, and to treat megaloblastic anemia due to folate deficiency when oral folic acid cannot be used.
Is Calcium Folinate [Folinic Acid] the same as folic acid?
No. Calcium Folinate [Folinic Acid] (folinic acid) is a reduced, already-active form of folate, whereas folic acid must be converted in the body through several steps, including a step blocked by methotrexate, before it becomes active. This is why Calcium Folinate [Folinic Acid], not ordinary folic acid, is used to rescue cells from methotrexate toxicity.
Can Calcium Folinate [Folinic Acid] be used to treat pernicious anemia or vitamin B12 deficiency?
No. Calcium Folinate [Folinic Acid] is contraindicated in pernicious anemia and other vitamin B12-deficiency anemias. It can improve the blood picture while allowing the neurological damage caused by B12 deficiency to progress unnoticed. A physician must rule out vitamin B12 deficiency before treating any megaloblastic anemia with Calcium Folinate [Folinic Acid].
Is it safe to use Calcium Folinate [Folinic Acid] during pregnancy or breastfeeding?
Calcium Folinate [Folinic Acid] should be used during pregnancy only if clearly needed and if the potential benefit outweighs the potential risk to the fetus, as judged by a physician. It is not established whether Calcium Folinate [Folinic Acid] passes into breast milk, so a doctor should be consulted before use while breastfeeding. Do not start or stop Calcium Folinate [Folinic Acid] in pregnancy or while breastfeeding without medical advice.
What are the common side effects of Calcium Folinate [Folinic Acid]?
Used alone, Calcium Folinate [Folinic Acid] is generally well tolerated, with rare allergic reactions such as hives or, rarely, anaphylaxis. When combined with 5-fluorouracil chemotherapy, side effects such as nausea, diarrhea, mouth sores (stomatitis), and low white blood cell counts are more common because Calcium Folinate [Folinic Acid] intensifies the effects of 5-fluorouracil.
Can Calcium Folinate [Folinic Acid] be given by any injection route?
No. Calcium Folinate [Folinic Acid] can be given by mouth, by intramuscular injection, or by intravenous injection/infusion as directed by a physician, but it must never be given by the intrathecal (spinal) route, as this has caused fatal reactions. Intravenous doses must also not be injected faster than the recommended rate.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.