Folinic acid
Systematic (IUPAC) name
2-[4-[(2-amino-5-formyl-4-oxo-5,6,7,8- tetrahydro-1H-pteridin-6-yl)methylamino] benzoyl]aminopentanedioic acid
Identifiers
CAS number	1492-18-8
ATC code	V03AF03
PubChem	54575
DrugBank	APRD00698
Chemical data
Formula	C20H23N7O7
Mol. weight	473.44 g/mol
Pharmacokinetic data
Bioavailability	Dose dependent: 97% (25mg) 75% (50mg) 37% (100mg)
Protein binding	~15%
Metabolism	?
Half life	6.2 hours
Excretion	Urinary
Therapeutic considerations
Pregnancy cat.	A(AU) C(US) Image File history File links Folinic_acid. ... IUPAC nomenclature is a systematic way of naming organic chemical compounds. ... CAS registry numbers are unique numerical identifiers for chemical compounds, polymers, biological sequences and alloys. ... The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs. ... A section of the Anatomical Therapeutic Chemical Classification System. ... PubChem is a database of chemical molecules . ... DrugBank is a database available at the University of Alberta that provides information about thousands of products. ... A chemical formula (also called molecular formula) is a concise way of expressing information about the atoms that constitute a particular chemical compound. ... General Name, Symbol, Number carbon, C, 6 Chemical series nonmetals Group, Period, Block 14, 2, p Appearance black (graphite) colorless (diamond) Atomic mass 12. ... General Name, Symbol, Number hydrogen, H, 1 Chemical series nonmetals Group, Period, Block 1, 1, s Appearance colorless Atomic mass 1. ... General Name, Symbol, Number nitrogen, N, 7 Chemical series nonmetals Group, Period, Block 15, 2, p Appearance colorless Atomic mass 14. ... General Name, Symbol, Number oxygen, O, 8 Chemical series Nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Atomic mass 15. ... The molecular mass of a substance (less accurately called molecular weight and abbreviated as MW) is the mass of one molecule of that substance, relative to the unified atomic mass unit u (equal to 1/12 the mass of one atom of carbon-12). ... BIC pen cap, about 1 gram. ... The mole (symbol: mol) is the SI base unit that measures an amount of substance. ... In pharmacology, bioavailability is used to describe the fraction of an administered dose of medication that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. ... Many drugs are bound to Blood plasma proteins. ... Metabolism (from Greek μεταβολισμός metabolismos) is the biochemical modification of chemical compounds in living organisms and cells. ... The elimination half-life of a drug (or any xenobiotic agent) refers to the timecourse necessary for the quantity of the xenobiotic agent in the body (or plasma concentration) to be reduced to half of its original level through various elimination processes. ... Excretion is the biological process by which an organism chemically separates waste products from its body. ... The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical, if it is used as directed by the mother during pregnancy. ... Motto: None Anthem: Advance Australia Fair Royal anthem: God Save the Queen Capital Canberra Largest city Sydney English (de facto 1) Government Constitutional monarchy (federal)  - Queen Elizabeth II  - Governor-General Michael Jeffery  - Prime Minister John Howard Independence from the UK   - Constitution 1 January 1901   - Statute of Westminster 11 December 1931... United States is the current Good Article Collaboration of the week! Please help to improve this article to the highest of standards. ...
Legal status
Routes	Intravenous, oral

Folinic acid (INN) or leucovorin (USAN), generally administered as calcium folinate (or leucovorin calcium), is an adjuvant used in cancer chemotherapy involving the drug methotrexate. It is also used in synergistic combination with the chemotherapy agent 5-fluorouracil. The regulation of therapeutic goods, that is drugs and therapeutic devices, varies by jurisdiction. ... In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body 1. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... An International Nonproprietary Name (INN) is the official non-proprietary or generic name given to a pharmaceutical substance, as designated by the World Health Organization. ... There have been a number of attempts to coin an alternative to American as an adjective (a demonym) for United States nationals. ... In medicine, adjuvants are agents which modify the effect of other agents while having few if any direct effects when given by themselves. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these cells to invade other tissues, either by direct growth into adjacent tissue through invasion or by implantation into distant sites by metastasis. ... Chemotherapy is the use of chemical substances to treat disease. ... Methotrexate (rINN) (IPA: ), abbreviated MTX and formerly known as amethopterin, is an antimetabolite drug used in treatment of cancer and autoimmune diseases. ... Synergy or synergism (from the Greek synergos meaning working together, circa 1660) refers to the phenomenon in which two or more discrete influences or agents acting together create an effect greater than that predicted by knowing only the separate effects of the individual agents. ... Fluorouracil (5-FU) is a drug that is used in the treatment of cancer. ...

Folinic acid is not folic acid. Folic acid and folate (the anion form) are forms of a water-soluble B vitamin. ...

Mechanism of action

Folinic acid is a 5-formyl derivative of tetrahydrofolic acid. It is readily converted to other reduced folic acid derivatives (e.g. tetrahydrofolate). Since it does not require the action of dihydrofolate reductase for its conversion, it will be unaffected by inhibition of this enzyme by drugs such as methotrexate. Folic acid and folate (the anion form) are forms of a water-soluble B vitamin. ... Categories: Biochemistry stubs | EC 1. ... It has been suggested that this article or section be merged with enzyme induction. ...

This, therefore, allows for purine/pyrimidine synthesis to occur; so normal DNA replication and RNA transcription processes can proceed. Purine is a heterocyclic aromatic organic compound, consisting of a pyrimidine ring fused to an imidazole ring. ... Pyrimidine is a heterocyclic aromatic organic compound similar to benzene and pyridine, containing two nitrogen atoms at positions 1 and 3 of the six-member ring. ... The general structure of a section of DNA Deoxyribonucleic acid (DNA) is a nucleic acid that contains the genetic instructions for the biological development of a cellular form of life or a virus. ... Ribonucleic acid (RNA) is a nucleic acid polymer consisting of nucleotide monomers. ...

Therapeutic use

Folinic acid is administered at the appropriate time following methotrexate as part of a total chemotherapeutic plan, where it may "rescue" bone marrow and gastrointestinal mucosa cells from methotrexate. There is no apparent effect on preexisting methotrexate-induced nephrotoxicity. (Therapeutic Information Resources Australia, 2004) Grays Anatomy illustration of cells in bone marrow. ... Nephrotoxicity is a poisonous effect of some substances, both toxins and medication, on the kidney. ...

Whilst not specifically an antidote for methotrexate, folinic acid may also be useful in the treatment of acute methotrexate overdose.

Folinic acid is also used in combination with the chemotherapy agent 5-fluorouracil in treating colon cancer. In this case, folinic acid is not used for "rescue" purposes; rather, it enhances the effect of 5-fluorouracil on inhibiting thymidylate synthase. Fluorouracil (5-FU) is a drug that is used in the treatment of cancer. ... Diagram of the stomach, colon, and rectum Colorectal cancer includes cancerous growths in the colon, rectum and appendix. ... Fluorouracil (5-FU) is a drug that is used in the treatment of cancer. ...

Folinic acid is also sometimes used to prevent toxic effects of high doses of antimicrobial dihydrofolate reductase inhibitors such as trimethoprim and pyrimethamine. An antimicrobial is a substance that kills or slows the growth of microbes like bacteria (antibacterial activity), fungi (antifungal activity), viruses (antiviral activity), or parasites (antiparasitic activity). ... Trimethoprim is a bacteriostatic antibiotic mainly used in the prophylaxis and treatment of urinary tract infections (cystitis). ... Pyrimethamine (Daraprim®) is a medication used for protozoal infections. ...

Note on administration

Folinic acid should not be administered intrathecally. This may produce severe adverse effects or even death.^[1] Intrathecal: Delivered into the spinal canal (intrathecal space surrounding the spinal cord), as in a spinal anaesthesia. ...

Footnotes

References

• Therapeutic Information Resources Australia (2004). Calcium Folinate (Systemic) in AUSDI: Australian Drug Information for the Health Care Professional. Castle Hill: Therapeutic Information Resources Australia.