Kalciumfolinat Stada (Calcium Folinate)

Calcium folinate is used in clinical situations that involve folate pathway disruption or increased folate demand.

• Methotrexate toxicity: provides rescue therapy that rapidly restores folate pools and reduces toxic effects.
• Folate deficiency: prevents or treats low folate levels in patients at risk.
• Cancer chemotherapy protocols: serves as an adjunct to lessen folate‑antagonist toxicity during treatment.

• Calcium folinate is a reduced form of folic acid that bypasses the dihydrofolate reductase step. By directly supplying 5‑methyltetrahydrofolate, it restores intracellular folate‑dependent one‑carbon transfer reactions, DNA synthesis, and methylation processes that are inhibited by antifolate drugs such as methotrexate. This biochemical bypass re‑establishes normal cellular function without requiring enzymatic reduction.

Calcium folinate may be associated with several adverse reactions, ranging from mild to severe.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Vomiting: occasional emesis following injection.
• Injection site pain: local discomfort or erythema.
• Headache: transient cranial discomfort.
• Fatigue: generalized tiredness.
• Mild fever: low‑grade temperature elevation.

Serious or Rare Side Effects

• Anaphylaxis: severe allergic reaction requiring immediate medical attention.
• Severe hypotension: marked drop in blood pressure post‑administration.
• Renal toxicity: impaired kidney function, especially with high doses.
• Hepatic dysfunction: elevated liver enzymes or hepatitis.
• Severe neutropenia: marked reduction in neutrophil count.
• Thrombocytopenia: significant drop in platelet levels.

When using calcium folinate, several precautionary measures should be observed to ensure safe administration.

• Renal impairment: adjust dose and monitor renal function closely.
• Hepatic dysfunction: evaluate liver enzymes before and during therapy.
• Pregnancy: potential risk to the fetus; use only if benefits outweigh risks.
• Concomitant methotrexate: monitor folate levels and clinical response.
• Pediatric use: exercise caution and adjust dosing based on weight and age.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Calcium folinate can interact with several medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Methotrexate: may reduce antidotal effect if not timed correctly.
• Antifolate agents (e.g., pemetrexed): antagonize therapeutic action.
• Trimethoprim: potentiates folate deficiency.
• Phenytoin: may decrease folate levels.
• Carbamazepine: induces folate metabolism, reducing effectiveness.

Moderate Interactions (Monitor Closely)

• NSAIDs: may increase risk of renal toxicity.
• Oral contraceptives: folate supplementation can affect hormone metabolism.
• Warfarin: folate may alter anticoagulant response.
• Sulfonamides: combined effect on folate pathways.
• Allopurinol: potential for enhanced toxicity in renal patients.