Calcium Folinate 7.5 mg/ml Injection – patient leaflet, side effects, dosage

1. What Calcium Folinate Injection is and what it is used for

Calcium folinate is one of the B group of vitamins.

Calcium Folinate Injection is used to reduce the side effects of other medicines (a group of medicines called folic acid antagonists). Examples of folic acid antagonists are:

• methotrexate (a medicine often used to treat cancer)
• trimetrexate (an antibiotic and anti-cancer medicine)
• trimethoprim (an antibiotic)
• pyrimethamine (a medicine often used to treat malaria)

It may also be used to treat an overdose of these medicines.

Calcium Folinate Injection may also be used to increase the effectiveness of the anti-cancer medicine fluorouracil.

2. What you need to know before you use Calcium Folinate Injection

Calcium Folinate Injection must not be injected intrathecally (into the spine).

Do not use Calcium Folinate Injection

• if you have shown signs of hypersensitivity (severe allergy) to calcium folinate in the past
• if you have a type of anaemia caused by too little vitamin B₁₂

Tell your doctor if either of the above applies to you before this medicine is used.

Take special care with Calcium Folinate Injection

If you are to receive calcium folinate and fluorouracil treatment at the same time take special care if:

• you have had radiotherapy
• you have stomach or bowel trouble

Tell your doctor if the above applies to you before this medicine is used.

Special care is also needed if you are elderly and you are to receive calcium folinate and fluorouracil treatment at the same time.

Taking/using other medicines

Special care is needed if you are taking/using other medicines as some could interact with Calcium Folinate Injection, for example:

• folic acid antagonists (see section 1 ‘What Calcium Folinate Injection is and what it is used for’ for examples of these medicines) - the effectiveness of these medicines will be reduced by calcium folinate
• fluorouracil (anti-cancer medicine) – the effectiveness and side effects of this medicine will be increased by calcium folinate
• medicines used to treat epilepsy (phenobarbitone, phenytoin, primidone or succinimides) – the effectiveness of these medicines may be reduced by calcium folinate. Your doctor may check blood levels of these medicines and change your dose to prevent increased convulsions (fits)

Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Pregnancy and breast-feeding

Tell your doctor if you are pregnant, trying to become pregnant or breast-feeding.

It is unlikely that your doctor will ask you to take/use a folic acid antagonist or fluorouracil whilst you are pregnant or breast-feeding. However, if you have taken/used a folic acid antagonist whilst pregnant or breast-feeding, this medicine (calcium folinate) may be used to reduce its side effects.

Ask your doctor or pharmacist for advice before taking any medicine.

Calcium Folinate Injection contains sodium

Calcium Folinate 7.5 mg/ml injection solution contains 6.8 mg sodium (main component of cooking/table salt) in each 2 ml ampoule. This is equivalent to 0.3% of the recommended maximum daily dietary intake of sodium for an adult.

3. How to use Calcium Folinate Injection

This medicine may be given by injection (using a syringe) into muscle. Alternatively it may be given by injection or infusion (drip) into a vein. If it is given by infusion Calcium Folinate Injection will be diluted first.

Calcium Folinate 7.5 mg/ml Injection

The following information is intended for medical or healthcare professionals only

Further to the information included in section 3, practical information on the preparation/handling of the medicinal product is provided here.

Incompatibilities

Incompatibilities have been reported between injectable forms of calcium folinate and injectable forms of droperidol, fluorouracil, foscarnet and methotrexate.

Droperidol

1. 1. Droperidol 1.25 mg/0.5 ml with calcium folinate 5 mg/0.5 ml, immediate precipitation in direct admixture in syringe for 5 minutes at 25°C followed by 8 minutes of centrifugation.
2. 2. Droperidol 2.5 mg/0.5 ml with calcium folinate 10 mg/0.5 ml, immediate precipitation when the drugs were injected sequentially into a Y-site without flushing the Y-side arm between injections.

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Dose

Your doctor will work out the correct dose of Calcium Folinate Injection for you and how often it must be given. It will depend upon the medical condition which is being treated.

If you are given too much or too little Calcium Folinate Injection

This medicine will be given to you in a hospital, under the supervision of a doctor. It is unlikely that you will be given too much or too little, however, tell your doctor or nurse if you have any concerns.

4. Possible side effects

Like all medicines, Calcium Folinate Injection can cause side effects, although not everybody gets them.

Very rare: may affect up to 1 in 10,000 people

• severe allergic reaction - you may experience a sudden itchy rash (hives), swelling of the hands, feet, ankles, face, lips, mouth or throat (which may cause difficulty in swallowing or breathing), and you may feel you are going to faint. This is a serious side effect. You may need urgent medical attention.

Uncommon: may affect up to 1 in 100 people

• fever

Rare: may affect up to 1 in 1,000 people:

• an increase in convulsions (fits) in patients with epilepsy
• depression
• agitation
• problems with the digestive system
• difficulty sleeping (insomnia)

Combination therapy with 5-fluorouracil only:

If you receive calcium folinate in combination with an anticancer medicine containing fluoropyrimidines, it is more likely that you experience the following side effects of this other medicine:

Very common: may affect more than 1 in 10 people

• nausea
• vomiting
• severe diarrhoea
• drying out which may be due to diarrhoea
• inflammation of the lining of the intestine and mouth (life-threatening conditions have occurred)
• reduction in the number of blood cells (including life-threatening conditions)

Common: may affect up to 1 in 10 people

• redness and swelling of the palms of the hands or the soles of the feet which may cause the skin to peel (hand-foot syndrome)

Not known: frequency cannot be estimated from the available data

• elevated ammonia level in the blood

Your doctor may do tests to check for low levels of calcium in your blood. Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Calcium Folinate Injection

Keep out of the reach and sight of children.

Expiry

This medicine must not be used after the expiry date which is stated on the ampoule and carton after ‘EXP’. Where only a month and year is stated, the expiry date refers to the last day of that month.

Storage

The ampoules should be stored in the outer carton, in order to protect from light, in a refrigerator.

Visible signs of deterioration

Only clear, pale yellow solutions should be used. If cloudy in appearance or particles can be seen, the solution should be discarded.

6. Contents of the pack and other information

What Calcium Folinate Injection contains

The active substance is folinic acid. Each millilitre (ml) of solution contains 7.5 milligrams (mg) of folinic acid in the form of calcium folinate.

The other ingredients are sodium chloride and Water for Injections. See section 2 ‘Calcium Folinate Injection contains sodium’ for further information about the sodium content.

What Calcium Folinate Injection looks like and contents of the pack

Calcium Folinate Injection is a clear, pale yellow solution for injection which comes in glass containers called ampoules.

It is supplied in packs containing 5 x 15 mg/2 ml ampoules.

Marketing authorisation holder and manufacturer

Hospira UK Limited, Horizon, Honey Lane, Hurley, Maidenhead, SL6 6RJ

This leaflet was last revised in 02/2022

Ref: gxFO 4_0

Fluorouracil

Calcium folinate must not be mixed in the same infusion as 5-fluorouracil because a precipitate may form. Fluorouracil 50 mg/ml with calcium folinate 20 mg/ml, with or without dextrose 5% in water, has been shown to be incompatible when mixed in different amounts and stored at 4°C, 23°C, or 32°C in polyvinyl chloride containers.

Foscarnet

Foscarnet 24 mg/ml with calcium folinate 20 mg/ml; formation of a cloudy yellow solution reported.

Instructions for use and handling, and disposal

Calcium Folinate Injection is intended only for single use. Any unused portion of the solution should be disposed of in accordance with the local requirements.

For intravenous infusion, Calcium Folinate Injection may be diluted with 0.9 % sodium chloride or 5% glucose solution before use.

From a microbial point of view, the product should be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 24 hours at 2 to 8°C.

Prior to administration, calcium folinate should be inspected visually. The solution for injection or infusion should be a clear and yellowish solution. If cloudy in appearance or particles are observed, the solution should be discarded.

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