Paper II — 2023 July (Supplementary) (2010 Scheme) — Q14

Paper II

2023 July (Supplementary) (2010 Scheme)

Question

Folinic acid/folic acid in Methotrexate toxicity

Q140.3 marksShort Answers★✓

Answer

Folinic acid (leucovorin) is the appropriate choice — methotrexate blocks dihydrofolate reductase (DHFR), the enzyme needed to reduce folic acid to its active tetrahydrofolate form. Folinic acid is already a reduced folate, so it can bypass the DHFR block entirely and directly supply the active cofactor cells need for DNA synthesis (“leucovorin rescue”). Plain folic acid would be ineffective as an antidote, since it still requires DHFR — the very enzyme methotrexate has inhibited — to become active.

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1. 1Cancer Chemotherapy

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