Antidote: calcium folinate

Calcium folinate for a single acute methotrexate ingestion

Most cases of methotrexate poisoning due to a single acute ingestion do not require treatment with calcium folinate (also known as folinic acid or leucovorin) therapy. Calcium folinate is indicated if:

• the patient has normal kidney function and no systemic methotrexate toxicity, but the ingested dose of methotrexate was more than 1000 mg in an adult, or more than 5 mg/kg in a child
• the patient has impaired kidney function (ie estimated glomerular filtration rate [eGFR] less than 45 mL/min) or systemic toxicity.

For methotrexate ingestions of more than 1000 mg in adults, or more than 5 mg/kg in children, if the patient has normal kidney function and no systemic toxicity, use:

For methotrexate ingestions of any amount in adults and children with impaired kidney function (ie eGFR less than 45 mL/min) or systemic toxicity, use:

Calcium folinate for repeated supratherapeutic ingestions of methotrexate

If the patient has taken a weekly methotrexate dose daily for 3 or more consecutive days, or twice daily for more than 36 hours, whether or not they have signs of systemic toxicity, for adults and children, use: