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Folinic acid (calcium leucovorin / calcium folinate)

Presentation

  • 15mg tablets
  • 50mg vials

Note: Folinic acid is not interchangeable with folic acid

*VIALS ONLY – KEEP REFRIGERATED*

Role

  • To decrease absorption and bypass inhibition of dihydrofolate reductase following high-risk acute methotrexate overdose involving staggered ingestions over 36h, massive ingestions > 1000mg (>5mg/kg in children) or any acute ingestion in patients with renal impairment.
  • To bypass methotrexate’s inhibition of dihydrofolate reductase and restore reduced folate stores in established methotrexate toxicity.
  • Co-factor in the treatment of methanol toxicity.
folinic acid tablets and vials

Dose

Management of high-risk acute methotrexate overdose

  • 15mg PO followed by 15mg IV q6h for 3 days (initial dose is given orally to reduce ongoing methotrexate absorption from GI tract)

Management of established methotrexate toxicity

  • 15mg IV/PO q6h until bone marrow recovers and mucosal ulceration resolves

Management of methanol toxicity

  • 50mg IV q6h

Stocking recommendations

Tertiary centre Regional centre Rural centre Remote centre

10 x 50mg vials

and

10 x 15mg tablets

10 x 50mg vials

and

0 – 10 x 15mg tablets

0 – 10 x 50mg vials 0 vials

Rationale

Patients with established methotrexate toxicity have bone marrow suppression which would warrant management in at least a regional centre. The IV preparation can be given orally if the tablet formulation is unavailable.

Disclaimer

Fact sheet developed by Queensland Poisons Information Centre, Updated: July 2020.

This fact sheet is about the use of these antidotes in Australia, and may not apply to other countries. Children’s Health Queensland Hospital and Health Service cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this fact sheet.

CHQ