Folic Acid

Introduction: Folic acid (Vitamin B9) is a water-soluble vitamin required for nucleoprotein synthesis and the maintenance of normal erythropoiesis. It is converted in the liver and plasma to its metabolically active form, tetrahydrofolic acid, by dihydrofolate reductase.

How it works: Folic acid aids in the production of DNA and RNA, and is essential for red blood cell formation. It prevents neural tube defects in women of childbearing potential and higher doses required during pregnancy.

Important Information: Folic acid may be taken with or without food. It prevents neural tube defects in women of childbearing potential and higher doses required during pregnancy.

• Folic acid deficiency
• Megaloblastic anemia
• Anemias of nutritional origins
• Anemia in pregnancy
• Anemia in infancy or childhood

Vitamin-B preparations, Drugs for Megaloblastic Anemia

Water-soluble vitamin

Folic acid, as it is biochemically inactive, is converted to tetrahydrofolic acid and methyltetrahydrofolate by dihydrofolate reductase (DHFR). These folic acid congeners are transported across cells by receptor-mediated endocytosis where they are needed to maintain normal erythropoiesis, synthesize purine and thymidylate nucleic acids, interconvert amino acids, methylate tRNA, and generate and use formate.

Folic acid is converted to tetrahydrofolic acid by dihydrofolate reductase enzyme, which aids in DNA synthesis and red blood cell formation.

Adult Dose (Oral):

• Folate-deficient megaloblastic anaemia: 5 mg daily for 4 months, up to 15 mg daily in malabsorption states.
• Maintenance: 5 mg every 1-7 days depending on underlying disease.
• Prophylaxis of megaloblastic anaemia in pregnancy: 0.2-0.5 mg daily.
• Prophylaxis of neural tube defect in pregnancy: 4 or 5 mg daily starting before pregnancy and continued through the 1st trimester.

Child Dose:

• Under 1 year: 500 mcg/kg daily.
• Over 1 year: Same as adult dose.

* Use as directed by the registered physician

Oral tablet. Can be taken with or without food. Swallow whole.

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and follow your regular schedule.

Common Side Effects:

• Gastro-intestinal disturbances
• Hypersensitivity reactions (rare)
• Bronchospasm
• Erythema
• Pruritus
• Rash

Precautions:

• Use with caution in patients who may have folate dependent tumours.
• Should not be given alone or with inadequate amounts of vitamin B12 for the treatment of undiagnosed megaloblastic anaemia.
• In elderly people, a cobalamin absorption test should be done before long term folate.

Contraindications:

• Previous intolerance to folic acid
• Untreated cobalamine deficiency

Drug Interactions:

• Antiepileptics, oral contraceptives, anti-TB drugs, alcohol, aminopterin, methotrexate, pyrimethamine, trimethoprim and sulphonamides may result in decrease in serum folate concentrations.
• Decreases serum phenytoin concentrations.

Food Interactions: None reported.

Use in Pregnancy: Pregnancy category A. Safe in pregnancy and recommended for neural tube defect prevention.

Use in Lactation: Drug enters breast milk; safe for nursing.

Pediatric Use: Specific dosage is available for children (see above).

Geriatric Use: In elderly people, a cobalamin absorption test should be done before long term folate.

Renal & Hepatic Impairment: No known restrictions.

Overdose: Folic acid is generally well tolerated. Overdose may cause gastrointestinal disturbances. Symptomatic treatment should be given.

Storage: Store below 30°C, in a dry place, away from light. Keep out of reach of children.

Folic Acid Tablet