DBL Calcium Folinate Dosage/Direction for Use

For intravenous and intramuscular administration only. In the case of intravenous administration, no more than 160 mg of calcium folinate hydrate should be injected per minute due to the calcium content of the solution.
For intravenous infusion, calcium folinate hydrate may be diluted with 0.9% sodium chloride solution or 5% glucose solution before use.
Impaired Methotrexate Elimination or Inadvertent Overdosage: Leucovorin calcium rescue should begin as soon as possible after an inadvertent overdosage and within 24 hours of methotrexate administration when there is delayed excretion. Leucovorin calcium 10 mg/m² should be administered IV or IM every 6 hours until the serum methotrexate level is less than 10^-8 M.
Serum creatinine and methotrexate levels should be determined at 24 hour intervals. If the 24 hours serum creatinine has increased 50% over baseline or if the 24 hour methotrexate level is greater than 5 x 10^-6 M or the 48 hour level is greater than 9 x 10^-7 M, the dose of Leucovorin calcium should be increased to 100 mg/m² IV every 3 hours until the methotrexate level is less than 10^-8 M.
Hydration (3 L/d) and urinary alkalinisation with sodium bicarbonate solution should be employed concomitantly. The bicarbonate dose should be adjusted to maintain the urine pH at 7.0 or greater.
Leucovorin Rescue After High-dose Methotrexate Therapy: The recommendations for Leucovorin rescue are based on a methotrexate dose of 12 to 15 gm/m² administered by intravenous infusion over 4 hours. Leucovorin rescue at a dose of 15 mg (approximately 10 mg/m²) every 6 hours for 10 doses starts 24 hours after the beginning of the Methotrexate infusion. Serum creatinine & methotrexate levels should be determined at least once daily. Leucovorin administration, hydration, and urinary alkalinisation (pH of 7.0 or greater) should be continued until the methotrexate level is below 5 x 10^-8 M (0.05 micromolar).
Megaloblastic Anaemia due to Folic Acid Deficiency: Up to 1 mg daily. There is no evidence that doses greater than 1 mg/day have greater efficacy than those of 1 mg, additionally loss of folate in urine becomes roughly logarithmic as the amount administered exceeds 1 mg.
Advanced Colorectal Cancer: Either of the following two regimens is recommended: Leucovorin is administered at 200 mg/m² by slow intravenous injection over a minimum 3 minutes, followed by 5-fluorouracil at 370 mg/m² by intravenous injection; Leucovorin is administered at 20 mg/m² by intravenous injection followed by 5-fluorouracil at 425 mg/m² by intravenous injection.
Treatment is repeated daily for 5 days. This 5-treatment course may be repeated at 4-week (28 days) intervals for two courses and then repeated at 4 to 5 week (28-35 days) intervals provided that the patient has completely recovered from toxic effects of the prior treatment course.
In subsequent treatment courses, the dosage of 5-fluorouracil should be adjusted based on patient intolerance of the prior treatment course. The daily dosage of 5-fluorouracil should be reduced by 20% for patients who experienced moderate haematologic or gastrointestinal toxicity in the prior treatment course and by 30% for patients who experienced severe toxicity. For patients who experienced no toxicity in prior treatment course, 5-fluorouracil dosage may be increased by 10%. Leucovorin dosage are not adjusted for toxicity.