Folicare

• Neutralising the immediate toxic effects of folic acid antagonists - e.g., methotrexate
• Calcium folinate rescue - using calcium folinate in conjunction with folic acid antagonists to minimise systemic toxicity
• Treatment of megaloblastic anaemias due to sprue, nutritional deficiency, pregnancy, infancy, liver disease and malabsorption syndrome

Folinic acid (5-formyl derivative of tetrahydrofolic acid) is a metabolite and active form of folic acid that is involved as a cofactor for 1-carbon transfer reactions in the biosynthesis of purine and pyrimidines of nucleic acids. Impairment of thymidylate synthesis in patients with folic acid deficiency leads to defective DNA synthesis that results in megaloblast formation and megaloblastic anemias. Folinate is a potent antidote for hematopoietic and reticuloendothelial toxic effects of folic acid antagonists (e.g., methotrexate, pyrimethamine, trimethoprim).

Folinic Acid Rescue:

• Required when methotrexate is given at doses exceeding 500 mg/m2.
• Start approximately 24 hours after the beginning of methotrexate infusion.
• Generally 15 mg (approximately 10 mg/m2) every 6 hours for 10 doses.

Neutralising Methotrexate Toxicity:

• Dose of Folinic Acid should be equal to or greater than the dose of methotrexate.
• Administer within one hour of methotrexate administration.

Megaloblastic anaemia (folate deficiency):

• 5 mg to 15 mg per day.

Children and adolescents: Safety and efficacy have not been established.

* Use as directed by the registered physician

Common Side Effects:

• Mucositis
• Stomatitis
• Leukopenia
• Diarrhea
• Allergic sensitisation
• Rash
• Pruritus
• Nausea
• Vomiting
• Pyrexia

Use in Pregnancy: No adequate and well-controlled studies in pregnant women. Use only if potential benefit justifies potential risk to the fetus.

Precautions:

• Use under the direct supervision of a clinician experienced in cancer chemotherapeutic agents.
• Caution in undiagnosed megaloblastic anaemia and folate dependent tumors.
• Ensure prompt excretion of methotrexate by alkalinising urine (pH >7.0) and increasing fluid intake.

Overdose: Excessive amounts may nullify the chemotherapeutic effect of folic acid antagonists. No specific antidote. Give appropriate supportive care.

Storage: Do not store above 30°C. Keep away from light and out of reach of children.