Folinic acid

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Contents

[edit] BRAND NAMES

  • International: Leucovorin
  • Italy: Prefolic, Levofolene, Lederfolin, Citofolin

[edit] STRUCTURE

Folinic acid.jpg

[edit] MECHANISM OF ACTION

Folinic acid is an active metabolite of folic acid and an essential coenzyme for nucleic acid synthesis.

Administration of Folinic acid can counteract the therapeutic and toxic effects of folic acid antagonists such as methotrexate, which act by inhibiting dihydrofolate reductase. In contrast, Folinic acid can enhance the therapeutic and toxic effects of fluoropyrimidines used in cancer therapy, such as 5-fluorouracil.

[edit] INDICATIONS

  • Antidote for folic acid antagonists overdosage
  • Folinic acid "rescue" after high-dose methotrexate therapy
  • To potentiate cytotoxic effects of fluorouracil in advanced colorectal cancer.
  • Treatment of folate-deficient megaloblastic anemia.

[edit] DOSAGE

  • Adjunct to fluorouracil in colorectal cancer, Adults: 200 mg/m2 body surface area by slow w intravenous injection over a minimum of 3 minutes, followed by 5-fluorouracil at 370 mg/m2 by intravenous injection. Treatment is repeated daily for five days. This five-day treatment course may be repeated at 4 week (28-day) intervals, for 2 courses and then repeated at 4-5 week (28-35 day) intervals provided that the patient has completely recovered from the toxic effects of the prior treatment course.
  • Folinic acid rescue after high-dose methotrexate therapy: ADULT and CHILD up to 120 mg in divided doses over 12–24 hours by intramuscular or intravenous injection or by intravenous infusion (usually started 24 hours after methotrexate), then 12–15 mg by intramuscular injection or 15 mg by mouth every 6 hours for 48–72 hours.
  • Methotrexate overdosage (started as soon as possible, preferably within 1 hour of methotrexate), by intravenous injection or infusion, ADULT and CHILD, dose equal to or higher than that of methotrexate, at rate not exceeding 160 mg/minute.
  • Treatment of folate-deficient megaloblastic anemia: 15 mg by mouth daily.

[edit] CONTRAINDICATIONS

  • Untreated vitamin B12 deficiency.
  • Folinic acid is improper therapy for pernicious anemia and other megaloblastic anemias secondary to the lack of vitamin B12.

[edit] PRECAUTIONS

[edit] INTERACTIONS

[edit] PREGNANCY AND LACTATION

[edit] SIDE EFFECTS

  • Occasional hypersensitivity reactions
  • Rarely pyrexia after parenteral administration.

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

[edit] REFERENCES