▶Sodiofolin(medac UK)
Folinic acid (as Disodium folinate) 50 mg per 1 mlSodiofolin
400 mg/ 8 ml solution for injection vials| 1 vialP£ 126. 25 (Hospital
only)
Sodiofolin 100 mg/ 2 ml solution for injection vials| 1 vialP£ 35. 09
(Hospital only)Levofolinic acid
lDRUG ACTIONLevofolinic acid is an isomer of folinic acid.lINDICATIONS AND DOSE
Reduction of methotrexate-induced toxicity
▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)
Methotrexate overdose
▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)lCONTRA-INDICATIONSIntrathecal injection
lCAUTIONSAvoid simultaneous administration of
methotrexate.notindicated for pernicious anaemia or
other megaloblastic anaemias caused by vitamin B 12
deficiency
lINTERACTIONS→Appendix 1 : folates
lSIDE-EFFECTS
▶Common or very commonDehydration.diarrhoea.mucosal
toxicity.nausea.vomiting
▶UncommonFever
▶Rare or very rareAgitation (with high doses).depression
(with high doses).epilepsy exacerbated.gastrointestinal
disorder.insomnia (with high doses).urticaria
lPREGNANCYNot known to be harmful; benefit outweighs
risk.
lBREAST FEEDINGPresence in milk unknown but benefit
outweighs risk.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Isovorin(Pfizer Ltd)
Levofolinic acid (as Calcium levofolinate) 10 mg per 1 mlIsovorin
175 mg/ 17. 5 ml solution for injection vials| 1 vialP£ 81. 33
(Hospital only)
Isovorin 25 mg/ 2. 5 ml solution for injection vials| 1 vialP£ 11. 62
(Hospital only)2.1a Hyperuricaemia associated
with cytotoxic drugs
DETOXIFYING DRUGS›URATE OXIDASES
Rasburicase
lINDICATIONS AND DOSE
Prophylaxis and treatment of acute hyperuricaemia with
initial chemotherapy for haematological malignancy
▶BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)lUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONSG 6 PD deficiency
lCAUTIONSAtopic allergies
lSIDE-EFFECTS
▶Common or very commonDiarrhoea.fever.headache.
nausea.skin reactions.vomiting▶UncommonBronchospasm.haemolysis.haemolytic
anaemia.hypersensitivity.hypotension.
methaemoglobinaemia.seizure
▶Rare or very rareRhinitis
▶Frequency not knownMuscle contractions involuntary
lPREGNANCYManufacturer advises avoid—no information
available.
lBREAST FEEDINGManufacturer advises avoid—no
information available.
lMONITORING REQUIREMENTSMonitor closely for
hypersensitivity.
lEFFECT ON LABORATORY TESTSMay interfere with test for
uric acid—consult product literature.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder and solvent for solution for infusion
▶Fasturtec(Sanofi)
Rasburicase 1.5 mgFasturtec 1. 5 mg powder and solvent for solution
for infusion vials| 3 vialP£ 208. 39 (Hospital only)
Rasburicase 7.5 mgFasturtec 7. 5 mg powder and solvent for solution
for infusion vials| 1 vialP£ 347. 32 (Hospital only)XANTHINE OXIDASE INHIBITORS
Allopurinol
lINDICATIONS AND DOSE
Prophylaxis of hyperuricaemia associated with cancer
chemotherapy|Prophylaxis of hyperuricaemic
nephropathy, enzyme disorders causing increased serum
urate e.g Lesch-Nyhan syndrome
▶BY MOUTH
▶Child 1 month–14 years: 10 – 20 mg/kg daily, dose to be
taken preferably after food; maximum 400 mg per day
▶Child 15–17 years:Initially 100 mg daily, taken
preferably after food; dose to be increased according to
response, up to 900 mg daily in divided doses (max. per
dose 300 mg)lCAUTIONSEnsure adequatefluid intake.for
hyperuricaemia associated with cancer therapy,
allopurinol treatment should be started before cancer
therapy
lINTERACTIONS→Appendix 1 : allopurinol
lSIDE-EFFECTS
▶Common or very commonRash (discontinue therapy; if
rash mild re-introduce cautiously but discontinue
immediately if recurrence)
▶UncommonHypersensitivity.nausea.vomiting
▶Rare or very rareAgranulocytosis.alopecia.angina
pectoris.angioedema.angioimmunoblastic T-cell
lymphoma.aplastic anaemia.asthenia.ataxia.boil.
bradycardia.cataract.coma.depression.diabetes
mellitus.drowsiness.erectile dysfunction.fever.
gastrointestinal disorders.gynaecomastia.haemorrhage.
hair colour changes.headache.hepatic disorders.
hyperlipidaemia.hypertension.infertility male.
maculopathy.malaise.oedema.paraesthesia.paralysis.
peripheral neuropathy.severe cutaneous adverse
reactions (SCARs).skin reactions.stomatitis.taste
altered.thrombocytopenia.vertigo.visual impairment
lPREGNANCYToxicity not reported. Manufacturer advises
use only if no safer alternative and disease carries risk for
mother or child.
lBREAST FEEDINGPresent in milk—not known to be
harmful.556 Cytotoxic responsive malignancy BNFC 2018 – 2019
Immune system and malignant disease8