Folic acid
Folic acid (Apo-Folic)
Folic Acid
( FOH-lik AH-sid)
Pregnancy Category: A Apo-Folic Folvite Novo-Folacid (Rx) (OTC)

Classification: Vitamin B complex

Action/Kinetics: Folic acid (which is converted to tetrahydrofolic acid) is necessary for normal production of RBCs and for synthesis of nucleoproteins. Tetrahydrofolic acid is a cofactor in the biosynthesis of purines and thymidylates of nucleic acids. Megaloblastic and macrocytic anemias in folic acid deficiency are believed to be due to impairment of thymidylate synthesis. Natural sources of folic acid include liver, dried beans, peas, lentils, whole-wheat products, asparagus, beets, broccoli, brussels sprouts, spinach, and oranges. Synthetic folic acid is absorbed from the GI tract even if the client suffers from malabsorption syndrome. Peak plasma levels after an oral dose: 1 hr. It is stored in the liver.

Uses: Treatment of megaloblastic anemias due to folic acid deficiency (e.g., tropical and nontropical sprue, pregnancy, infancy or childhood, nutritional causes). Diagnosis of folate deficiency.

Contraindications: Use in aplastic, normocytic, or pernicious anemias (is ineffective). Folic acid injection that contains benzyl alcohol should not be used in neonates or immature infants.

Special Concerns: Daily folic acid doses of 0.1 mg or greater may obscure pernicious anemia. Prolonged folic acid therapy may cause decreased vitamin B ₁₂ levels.

Side Effects: Allergic: Skin rash, itching, erythema, general malaise, respiratory difficulty due to bronchospasm. GI: Nausea, anorexia, abdominal distention, flatulence, bitter or bad taste (in those taking 15 mg/day for 1 month). CNS: In doses of 15 mg daily, altered sleep patterns, irritability, excitement, difficulty in concentration, overactivity, depression, impaired judgment, confusion.

Drug Interactions: Aminosalicylic acid / Serum folate levels Corticosteroids (chronic use) / Folic acid requirements Methotrexate / Folic acid antagonist Oral contraceptives / Risk of folate deficiency Phenytoin / Seizure frequency; serum folic acid levels. Pyrimethamine / Pyrimethamine effect in toxoplasmosis; also, a folic acid antagonist Sulfonamides / Absorption of folic acid Triamterene / Utilization of folic acid as it is a folic acid antagonist Trimethoprim / Utilization of folic acid as it is a folic acid antagonist

How Supplied: Injection: 5 mg/mL; Tablet: 0.4 mg, 0.8 mg, 1 mg

Dosage
?Tablets Dietary supplement.
Adults and children: 100 mcg/day (up to 1 mg in pregnancy); may be increased to 500-1,000 mcg if requirements increase.
Treatment of deficiency.
Adults, initial: 250-1,000 mcg/day until a hematologic response occurs; maintenance: 400 mcg/day (800 mcg during pregnancy and lactation). Pediatric, initial: 250-1,000 mcg/day until a hematologic response occurs. Maintenance, infants: 100 mcg/day; children up to 4 years: 300 mcg/day; children 4 years and older: 400 mcg/day.
?IM, IV, Deep SC Treatment of deficiency.
Adults and children: 250-1,000 mcg/day until a hematologic response occurs.
Diagnosis of folate deficiency.
Adults, IM: 100-200 mcg/day for 10 days plus low dietary folic acid and vitamin B ₁₂.