The solution is administered intramuscularly or intravenously.
When administered intravenously in one minute, no more than 160 mg of calcium folinate should be administered because of the calcium present in the solution.
Before use with the intravenous route of administration calcium folinate can be diluted with 0.9% solution of sodium chloride or 5% solution of dextrose.
When preparing the injection solution calcium folinate can be diluted with Ringer's solution, Ringer's solution with lactate, 10% dextrose solution, 5% dextrose solution, 0.9% sodium chloride solution to a concentration of 0.06 mg / ml to 1 mg / ml. The resulting solution remains stable for 24 hours. Do not use the remaining solution.
Prevention of toxic effects of methotrexate, used in high doses
The regimens of calcium folinate treatment depend on the regimens of therapy with medium and high doses of methotrexate, so it is advisable to consult the appropriate protocol for the treatment of methotrexate for the necessary information.
The following recommendations can serve as a guide for the determination of doses and the scheme for the protective use of calcium folinate in adults, the elderly and children.
Prevention of toxic effects of methotrexate used in high doses is carried out by parenteral administration in patients with malabsorption syndrome or other pathology of the digestive tract, when intestinal absorption may be difficult. Doses of 25 to 50 mg should be administered parenterally due to saturable absorption of calcium folinate in the intestine.
The dose and duration of calcium folinate, first of all, depend on the type and doses of methotrexate therapy, the appearance of signs of toxicity and the specific features of methotrexate excretion. Typically, the first dose of calcium folinate is 15 mg (6 - 12 mg / m2), administered after 12-24 hours (no later than 24 hours) after the start of infusion of methotrexate. The same dose is prescribed every 6 hours for 72 hours. After parenteral administration, several doses of the drug can be replaced by the use of oral forms.
Also an essential addition to the introduction of calcium folinate in the prevention of toxic effects of methotrexate, used in high doses are measures that accelerate the excretion of methotrexate (ensuring the adequacy of the urinary function andalkalinization of urine). The kidney function should be monitored daily by measuring the concentration of serum creatinine.
It is recommended to measure the concentration of methotrexate in the blood serum 48 hours after the start of the infusion. If the residual concentration of methotrexate is more than 0.5 μmol / l, then the dosing regimen of calcium folinate should be adapted according to the following table:
The recommended correction of calcium folinate therapy in the prevention of toxic effects of methotrexate, used in high doses depending on its residual concentration
| The residual level of methotrexate in the blood after 48 hours after the onset of methotrexate: | Additional doses of calcium folinate, administered every 6 hours for 48 hours or until the levels of methotrexate fall below 0.05 μmol / l: |
| > 0.5 μmol / l | 15 mg / m2 |
| > 1.0 μmol / l | 100 mg / m2 |
| > 2.0 μmol / l | 200 mg / m2 |
Cytotoxic therapy in combination with fluorouracil
Apply different doses and regimens of the drug.
Doses above 50 mg should be given parenterally. The use of higher doses does not lead to higher concentrations in the blood due to saturable absorption of calcium folinate.
Two-month mode: Intravenous infusion of calcium folinata in a dose of 200 mg / m for two hours, followed by a bolus injection of 400 mg / m2 fluorouracil and a 22-hour infusion of fluorouracil (600 mg / m2) for 2 consecutive days every 2 weeks.
Monthly mode: calcium folinate in a dose of 20 mg / m injected intravenously bolus or 200 - 500 mg / m2 infuzionno within 2 hours immediately after intravenous bolus 425 mg / m2 or 370 mg / m2 fluorouracil, for 5 consecutive days.
Weekly mode: calcium folinate in a dose of 20 mg / m injected intravenously bolus or from 200 to 500 mg / m2 infuzionno within 2 hours and bolus introduction in the middle or the end infusion of calcium folinata 500 mg / m2 fluorouracil.
When a combination with fluorouracil is used, it may be necessary to modify the treatment regimen by alternating periods of therapy at intervals without treatment. This depends on the patient's condition, clinical response and dose limiting toxicity, as stated in the drug information fluorouracil. A decrease in the dose of calcium folinate is not required.
The number of repeated cycles is at the discretion of the attending physician.Data on the use of these combinations in children is not available:
Intoxication with folic acid antagonists (methotrexate, trimethoprim, pyrimethamine)
Methotrexate overdose
Calcium folinate is administered at a dose equal to or greater than the dose of methotrexate administered no later than 1 hour after the dose of methotrexate administered, then the drug is administered at 10 mg / m2 every 3 hours until the signs of toxicity disappear.
Toxicity of trimethoprim
After stopping the administration of trimethoprim, calcium folinate in a dose 3-10 mg / day until the recovery of the clinical blood count.
The toxicity of pyrimethamine
In the case of high doses of pyrimethamine or a prolonged period of treatment with low doses, calcium folinate in a dose 5-50 mg / day, depending on the parameters of the clinical blood test.
Therapy should be discontinued with the number of leukocytes and blood platelets of less than 3.5 thousand and 100.0 thousand, respectively. Also, therapy should be discontinued if bleeding occurs from the gastrointestinal tract, severe diarrhea (> 7 times a day), exfoliative dermatitis.
With megaloblastic anemia, caused by a deficiency of folic acid, calcium folinate prescribe a dose of up to 5 mg (maximum to 15 mg) per day.