Calcium folinate
When ATH:
V03AF03
Characteristic.
Yellowish-white crystalline powder. Easily soluble in water, unsustainable k svetu.
Pharmacological action.
Reduce the toxicity of methotrexate, making up for folic acid deficiency, antianemic.
Application.
Intoxication folic acid antagonists (methotrexate, trimethoprim, pirimetamin); megaloblastic anemia of folate deficiency when oral therapy ineffective folic acid (incl. the syndrome of malabsorption, malnutrition, congenital deficiency dihydrofolate reductase); colon cancer, including the rectum (as adjuvant therapy).
Contraindications.
Hypersensitivity, and other pernicious megaloblastic anemia against deficiency of vitamin B12 (tk. during treatment may improve hematological parameters, while neurologic manifestations continue to progress).
Restrictions apply.
Predisposition to develop seizures in children, impairment of renal function.
Pregnancy and breast-feeding.
Studies in animals and in humans during pregnancy was carried out. Unknown, whether calcium folinate enters the breast milk, however, complications in humans has not been registered.
Side effects.
Allergic reactions (skin rash, hives, or itching, wheezing).
Cooperation.
It reduces the effect of folic acid antagonists. It reduces the anticonvulsant activity of phenobarbital, hydantoin derivatives, and primidone (can increase the frequency of seizures in susceptible children to them). Calcium folinate while the use of fluorouracil can enhance the therapeutic and toxic effects of fluorouracil - caution, although treatment can improve the efficiency of use of these two drugs together.
Dosing and Administration.
/ M, I /, inside. The mode set individually, depending on the evidence. After the on / in infusion of high doses of methotrexate (12-15 g/m2) the dose and frequency of administration of calcium folinate determined by the state of renal excretory function in a systematic (minimum 1 once a day) monitoring of serum creatinine and methotrexate in the blood. The duration of calcium folinate dosage depends on methotrexate and its concentration in the blood. Usually, when the concentration of methotrexate in the blood is below 5 10-8 M use of calcium folinate can be stopped.
In case of accidental overdose of methotrexate treatment for the relief of calcium folinate toxic reactions should start as soon as possible.
When megaloblastic anemia, caused by folic acid deficiency is to 1 mg / day.
Precautions.
Before and during therapy need to monitor renal function, urine pH.
In patients with acidic urine (pH of less than 7), ascites, dehydration, obstruction of the digestive tract, impaired renal function, exudative pleurisy, peritonitis may require higher doses of calcium folinate, and / or increasing the duration of its use (tk. elimination of methotrexate in these cases delayed).
Elderly patients are more likely to age renal dysfunction, and therefore may require adjustment of doses of calcium folinate in patients, receiving it as a means of eliminating the toxic effect of high-dose methotrexate.
If there is a violation of the absorption of the drug as a result of nausea and vomiting is recommended to use parenteral.
Cautions.
Calcium folinate solution for infusion should be prepared time; You can only use it for 12 no.
