Kalcijev Folinat Pliva (Calcium Folinate)

Kalcijev Folinat Pliva is a folate analog used in clinical situations where rescue from antifolate toxicity is required.

• Methotrexate toxicity: restores nucleotide synthesis and reduces organ damage.
• Folate deficiency: provides reduced folate for patients unable to convert folic acid.
• 5‑Fluorouracil toxicity: mitigates myelosuppression and mucosal injury.
• Cancer chemotherapy protocols: used as an adjunct to protect healthy tissue during high‑dose regimens.

• Calcium folinate supplies a reduced form of folic acid that bypasses dihydrofolate reductase inhibition. By entering cells directly, it restores the tetrahydrofolate pool, enabling normal synthesis of purines and thymidylate, which protects non‑cancerous tissues from the cytotoxic effects of antifolate agents such as methotrexate and pemetrexed.

Adverse reactions may occur with any injectable folate analog.

Common Side Effects

• Nausea
• Vomiting
• Mild rash or erythema at the injection site
• Transient fever
• Headache
• Elevated liver enzymes (ALT/AST)

Serious or Rare Side Effects

• Anaphylactic or severe allergic reaction
• Severe hypotension or shock
• Acute renal failure
• Severe hepatic dysfunction
• Neutropenia or agranulocytosis
• Seizures or neurologic disturbances

Careful monitoring and patient assessment are essential when using Kalcijev Folinat Pliva.

• Renal function monitoring: assess creatinine clearance before and during therapy.
• Hepatic function monitoring: check liver enzymes regularly.
• Use in known folate deficiency: ensure appropriate supplementation.
• Hypersensitivity: discontinue if signs of severe allergic reaction appear.
• Pregnancy considerations: weigh potential benefits against unknown fetal risk.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Calcium folinate can modify the activity of several drugs, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• High‑dose methotrexate: may diminish rescue effect if timing is inappropriate.
• 5‑Fluorouracil: concurrent use without proper scheduling can reduce chemotherapy efficacy.
• Pemetrexed: may counteract intended cytotoxic action.

Moderate Interactions (Monitor Closely)

• NSAIDs: can increase renal toxicity when combined with methotrexate rescue.
• Proton‑pump inhibitors: may alter folate metabolism.
• Anticonvulsants (e.g., phenytoin): potential for reduced folate levels, requiring dose adjustment.