Refolinon

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How does it work?

Refolinon tablets and injection contain the active ingredient calcium folinate, also known as calcium leucovorin. This is the calcium salt of a vitamin called folinic acid, which is related to folic acid. It is usually referred to simply as folinic acid. Folinic acid is a vitamin that has various uses. It is used to treat anaemia caused by a deficiency of folic acid in the body. It can also be used to reduce the side effects from high doses of the anticancer medicine methotrexate. In the treatment of anaemia due to folate deficiency, folinic acid works by replacing the body's stores of folate. Normally, we get folate from our diet in the form of folic acid. The body converts folic acid to a compound called tetrahydrofolic acid, and this plays an important role in the formation of red blood cells. Deficiency causes a decreased production of red blood cells (anaemia). Folinic acid is a derivative of tetrahydrofolic acid, so it is used to correct the deficiency. This allows the body to produce more red blood cells and corrects the anaemia. In cancer treatment with the chemotherapy medicine methotrexate, calcium folinate is given for 'folinic acid rescue therapy'. It helps healthy cells recover from the effects of the methotrexate. Methotrexate works by blocking the action of an enzyme in the body called dihydrofolate reductase. Cancer cells in the body use this enzyme to convert folic acid consumed in the diet into tetrahydrofolic acid. They then use tetrahydrofolic acid to make new genetic material, which allows the cancer cells to grow and multiply. However, healthy body cells also use this enzyme to make tetrahydrofolic acid. So while methotrexate can stop cancer cells from producing tetrahydrofolic acid to grow and multiply, it also has the same effect in healthy body cells. This is what causes the side effects of the chemotherapy, for example, decreased numbers of white blood cells. Folinic acid is a derivative of tetrahydrofolic acid and is usually given 24 hours after the methotrexate. It doesn't need to be converted by dihydrofolate reductase to be used by the body cells, so it bypasses the action of the methotrexate and allows the cells to grow and multiply again. Normal healthy cells recover faster than cancer cells and this helps to prevent the side effects of the methotrexate. The aim is to progressively shrink the cancer over several cycles of chemotherapy, allowing normal healthy cells to recover in between.

What is it used for?

- Folate deficiency anaemia
- Reducing the side effects of the chemotherapy medicine methotrexate

Warning!

- When given for folinic acid rescue therapy this medicine should not be given at the same time as the methotrexate, as the medicines may then cancel out each others effects.

Not to be used in

- Vitamin B12 deficiency.
- Refolinon tablets contain lactose and should not be taken by people with rare hereditary problems of galacatose intolerance, the Lapp lactose deficiency or glucose-galactose malabsorption.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- This medicine should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the foetus. Seek medical advice from your doctor.
- It is not known if this medicine passes into breast milk. It should be used with caution in nursing mothers, and only if the benefits to the mother outweigh any risks to the nursing infant. Discuss this with your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

- Allergic reaction to active ingredient
- Fever (pyrexia)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Large doses of this medicine may counteract the effects of the following antiepileptic medicines, which may increase the risk of seizures in people taking these medicines: - phenobarbital - phenytoin - primidone.

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