Calcium folinate

Dosing regimen of calcium folinate after intravenous infusion of methotrexate in high doses (12-15 g / m² after 4 h) set individually, taking into account the state of renal excretory function, subject to the systematic (at least 1 time / day) control of plasma creatinine and methotrexate concentrations.

With normal removal of methotrexate (the level of methotrexate in plasma is approximately 10 μM after 24 hours after administration, 1 μM after 48 hours and less than 0.2 μM after 72 hours) calcium folinate is used at a dose of 15 mg (approximately 10 mg / m²) orally, intravenously or intramuscularly every 6 hours for 60 hours (10 doses, starting 24 hours after the start of methotrexate administration).

With delayed removal of methotrexate (the level of methotrexate is higher than 0.2 μM after 72 hours and higher than 0.05 μM after 96 hours after administration) calcium folinate is continued to be administered at a dose of 15 mg orally, IV or intramuscularly every 6 hours until the level plasma methotrexate will not fall below 0.05 μM.

With slow early clearance of methotrexate from the body (the level of methotrexate 50 μM and above after 24 hours, 5 μM and above after 48 hours or an increase in plasma creatinine level by 100% or more within 24 hours after administration of methotrexate) calcium folinate is administered at a dose of 150 mg IV every 3 h until plasma methotrexate level drops below 1 μM, then at a dose of 15 mg IV every 3 h until plasma methotrexate level drops below 0.05 μM. It is necessary to simultaneously conduct hydration and the introduction of sodium bicarbonate (for the prevention of the development of renal failure).

In cases where severe toxic reactions are observed, treatment with calcium folinate should be continued additionally, for another 24 hours (a total of 14 consecutive doses in 84 hours).

With megaloblastic anemia caused by folic acid deficiency, Calcium folinate is prescribed at a dose of up to 1 mg / day.

If necessary, the use of calcium folinata during pregnancy should carefully assess the intended benefit of therapy for the mother and the potential risk to the fetus.

If necessary, use during lactation should stop breastfeeding.

When treating with methotrexate in cases where clinical signs of toxicity or any deviations in laboratory parameters are noted, the possibility of increasing the concentration of methotrexate in plasma due to interaction with other drugs that violate the removal of methotrexate or displacing it from plasma albumin should be excluded.

Calcium folinate is used with caution in acidic urine reactions, ascites, dehydration, exudative pleurisy, and impaired renal function. It should be borne in mind that with nausea and vomiting, absorption of calcium folinate may deteriorate (it is preferable to use parenteral administration).

Before and during the therapy, the kidney function, urine pH should be monitored.

In case of an accidental overdose of methotrexate, calcium folinate intake should be started as soon as possible.

When used in children It should be borne in mind that calcium folinate may increase the frequency of seizures in susceptible patients, by reducing the effectiveness of anticonvulsants.