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Calcium Folinate is metabolized into 5-methyltetrahydrofolate, which:
- Neutralizes Methotrexate Effects: Supplies the cofactor blocked by methotrexate.
- Enhances Fluorouracil Activity: Stabilizes the binding of 5-dUMP with thymidylate synthetase.
- Counteracts Folic Acid Antagonists: Neutralizes toxic effects of methotrexate while enhancing 5-fluorouracil efficacy.
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✅ Description:
Foly 15mg contains Calcium Folinate, which is essential for the synthesis of purine and pyrimidine, aiding in the production of blood and its components. It serves as a coenzyme in numerous metabolic systems and is especially effective in countering the toxicity of methotrexate and in treating folate deficiency-related conditions.
- Colorectal Cancer: As an adjunct to enhance the efficacy of fluorouracil.
- Methotrexate Toxicity: Antidote to prevent or reverse toxicity caused by methotrexate.
- Megaloblastic Anemia: Particularly anemia caused by folate deficiency.
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✔️ Methotrexate Toxicity:
- Adults: 15 mg every 6 hours for 10 doses. Start 24 hours after initiating methotrexate infusion. Continue until methotrexate serum levels drop below 0.05 micromolar.
Megaloblastic Anemia (Folate Deficiency):
- Adults: 15 mg daily.
✔️ Side Effects
- Common: Rash, pruritus, erythema, urticaria, nausea, vomiting, fever (pyrexia).
- Allergic Sensitization: Possible with rash and skin irritation.
✔️ Drug Interactions
Fluorouracil:
- Calcium Folinate increases fluorouracil's efficacy but may also enhance its toxicity.
- Severe Adverse Effects: Enterocolitis, diarrhea, dehydration (especially in elderly patients).
Sulfamethoxazole-Trimethoprim:
- Calcium Folinate can reduce its efficacy in treating Pneumocystis carinii pneumonia in AIDS patients.
✔️ Contraindications
- Hypersensitivity: To Calcium Folinate or its components.
- Vitamin B12 Deficiency-Related Anemias: Such as pernicious anemia or megaloblastic anemia caused by Vitamin B12 deficiency.
- Intrathecal/Intraventricular Administration: Strictly contraindicated.
✔️ Notes:
- Avoid excessive use of folate supplements or folinic acid without a doctor’s recommendation, as it may interfere with necessary therapies (e.g., methotrexate).
- Patients with AIDS or compromised immune systems must be monitored closely for potential drug interactions.
✔️
- Undiagnosed Megaloblastic Anemia: May obscure diagnosis and delay appropriate treatment.
- Folate-Dependent Tumors: Caution in such patients.
- Pregnancy: Use only when the benefits outweigh the risks.
- Gastrointestinal Toxicity: Administer parenterally if the patient experiences severe nausea, vomiting, or GI toxicity.
- Monitoring:
- Calcium Levels: For patients receiving combined 5-Fluorouracil and Folinic Acid treatment.
- Methotrexate Serum Levels: Determine the optimal dose and duration of Folinic Acid therapy.
- CBC, Electrolytes, and Liver Function Tests: Before and during treatment.
✔️ Storage
- Store below 30°C.
- Keep away from direct light and out of reach of children.
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