Kalcijev Folinat Pliva (Calcium Folinate)

Calcium folinate is used in clinical settings to counteract the effects of antifolate chemotherapy and to support folate metabolism.

• Methotrexate toxicity: reduces hematologic and mucosal damage after high‑dose methotrexate therapy.
• 5‑Fluorouracil chemotherapy: mitigates mucositis and myelosuppression associated with 5‑FU treatment.
• Pemetrexed therapy: decreases hematologic toxicity when given with pemetrexed.
• Folate deficiency: restores normal folate levels in patients with inadequate folate status.

• Calcium folinate provides a reduced folate cofactor that bypasses dihydrofolate reductase inhibition, allowing the regeneration of tetrahydrofolate pools required for purine and pyrimidine synthesis. By supplying this active folate form, it restores normal DNA synthesis and cell division in healthy tissues, thereby protecting them from the cytotoxic effects of antifolate agents.

Calcium folinate is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Vomiting: occasional emesis after administration.
• Rash: transient skin erythema or pruritus.
• Flushing: brief warmth or redness of the face.
• Headache: mild to moderate headache episodes.
• Transient hypotension: temporary drop in blood pressure.

Serious or Rare Side Effects

• Anaphylaxis: severe allergic reaction requiring immediate medical attention.
• Severe hypersensitivity: including angioedema or bronchospasm.
• Renal failure: acute kidney injury in susceptible patients.
• Electrolyte disturbances: significant shifts in potassium or magnesium.
• Cardiac arrhythmia: irregular heart rhythms in high‑risk individuals.
• Hepatic dysfunction: marked elevation of liver enzymes or jaundice.

When using calcium folinate, clinicians should consider several safety measures.

• Renal impairment: monitor renal function and adjust therapy as needed.
• Hepatic dysfunction: assess liver enzymes before and during treatment.
• Pregnancy: use only if the potential benefit justifies the potential risk to the fetus.
• Concurrent chemotherapy: closely monitor blood counts and organ function.
• Allergy: discontinue immediately if signs of hypersensitivity appear.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Calcium folinate can interact with other agents that affect folate pathways or organ function.

Major Interactions (Avoid)

• Methotrexate: concurrent high‑dose methotrexate without rescue can increase toxicity.
• 5‑Fluorouracil: simultaneous high doses may reduce therapeutic efficacy.
• Pemetrexed: lack of rescue may exacerbate hematologic toxicity.

Moderate Interactions (Monitor Closely)

• Anticonvulsants (e.g., phenytoin, carbamazepine): may lower folate levels, requiring dose adjustment.
• NSAIDs: can affect renal clearance of calcium folinate.
• Oral contraceptives: potential alteration of folate metabolism, monitor for efficacy.