Folifol 5

Indications

Folinic Acid (also called calcium folinate or leucovorin) is a form of folate used mainly in hospital and specialist care:

• As a "rescue" after high-dose Methotrexate, to protect healthy cells from damage.
• Together with Fluorouracil in the treatment of bowel (colorectal) cancer, to make that treatment work better.
• To treat megaloblastic anaemia (large, immature red blood cells) caused by folate deficiency when Folic Acid by mouth cannot be used.
• To lower side effects of medicines that block folate, such as Pyrimethamine.

How It Works

Folinic Acid is an active form of folate that the body can use straight away, even when medicines such as Methotrexate block the normal folate pathway. Cells need it to make DNA and divide. With Fluorouracil, it helps that medicine bind more strongly to its target in cancer cells.

Dosage and Administration

Available as tablets and as injections. The dose, timing and length of treatment depend on the condition and the other medicines used, and must be exactly as prescribed by the specialist. Timing after Methotrexate is very important; do not miss or delay a dose. Injections are given by a doctor or nurse into a vein or muscle. It must never be injected into the spine.

Interactions

• Increases both the effect and the side effects of Fluorouracil; the doctor adjusts doses.
• Can reduce the effect of the epilepsy medicines Phenobarbital, Phenytoin and Primidone, which may increase seizures.
• Given at the wrong time or dose it can weaken the effect of Methotrexate.
• May reduce the effect of Trimethoprim with Sulfamethoxazole in some infections.

Contraindications

• Allergy to Folinic Acid or any ingredient of the product.
• Pernicious anaemia or other anaemia caused by vitamin B12 deficiency, because it can hide the anaemia while nerve damage continues.

Side Effects

On its own it is usually well tolerated. Allergic reactions and fever are rare. When used with Fluorouracil, side effects of that treatment such as diarrhoea, mouth sores, nausea and low blood counts can be stronger.

Get urgent medical help for severe or ongoing diarrhoea, fever or signs of infection, painful mouth ulcers that stop you eating or drinking, or swelling of the face, rash or trouble breathing.

Pregnancy and Lactation

Folinic Acid itself is not known to harm the baby, but it is often used with medicines that are harmful in pregnancy. Use in pregnancy and breastfeeding only as advised by your specialist.

Precautions and Warnings

• Older people and those with poor kidney function or dehydration may have more side effects with Fluorouracil.
• Tell your doctor if you have epilepsy or vitamin B12 deficiency.
• Regular blood tests are needed during treatment.

Overdose

Too much may reduce the effect of Methotrexate or other cancer treatment and may increase seizures in people with epilepsy. Contact the treating doctor straight away.

Therapeutic Class

Folic acid derivative; antidote (detoxifying agent) used with cancer treatment.

Storage

Tablets: store below 30°C in a dry place, away from light. Injections: store as stated on the label (many need 2 to 8°C in a fridge and protection from light); usually kept by the hospital. Keep out of the reach of children.