Folinex 50

5 ml

• Generic name: Calcium folinate (folinic acid), a reduced form of folic acid

• Strength: 50 mg per 5 ml vial (10 mg/mL) 

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✅ Indications

Used as:

1. Rescue therapy after high-dose methotrexate to reduce toxicity

2. Adjunctive therapy with 5‑fluorouracil in colorectal cancer

3. Treatment of megaloblastic anemia when oral folate isn’t suitable 

Also indicated for folinic acid deficiency in various conditions:
colorectal cancer, methotrexate toxicity, and megaloblastic anemia 

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📦 Form & Packaging

• Clear, pale yellow solution for IM or IV injection/infusion

• Supplied in 5 ml glass vials

• Contains approximately 16.74 mg sodium per 5 ml, worth noting for sensitive patients 

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💉 How It Works

• Folinic acid bypasses the metabolic block caused by methotrexate, replenishing folate for DNA synthesis

• Enhances fluorouracil’s efficacy by stabilizing thymidylate synthase–5‑dUMP complex

• Offsets the effect of folic acid antagonists like methotrexate 

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🧾 Dosage Guidelines

• Methotrexate rescue: Begin 12–24 hr post-infusion; up to 120 mg over 1st day by IM/IV, then 15 mg every 6 hr for 48 hr, or until methotrexate <0.05 µM 

• Fluorouracil adjunct (colorectal cancer): 200 mg/m² slow IV over ≥3 min, followed by 5‑FU infusion, repeated for 5 days in 28‑day cycles 

• Megaloblastic anemia: 1 mg IM daily or 15 mg orally daily 

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⚠️ Contraindications & Precautions

• Contraindicated in: Vitamin B12 deficiency (can mask neurological progression), hypersensitivity reactions

• Not for: Intrathecal/intraventricular use — potentially fatal 

• Monitor: Renal function, CBC, electrolytes, liver enzymes, serum methotrexate levels, and calcium (when used with fluorouracil) 

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🚨 Side Effects & Interactions

Common side effects: mild GI upset, rash, pruritus, fever, urticaria
Serious/risk factors:

• Allergic reactions (bronchospasm, anaphylaxis)

• Seizure risk in epileptics

• Enhanced fluorouracil toxicity (severe diarrhea, mucositis, myelosuppression) 

Drug interactions:

• May reduce effectiveness of methotrexate and folate antagonist antibiotics

• May decrease levels of anticonvulsants like phenytoin 

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🧊 Storage & Handling

• Store at 2–8 °C, protected from light

• Use immediately after vial is opened; discard if not used within 24 hrs

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🧾 Summary Table