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 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).

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.

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.

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.