Folic acid


Generic Medicine Info
Indications and Dosage
Oral
Prophylaxis in chronic haemolytic states
Adult: 5 mg every 1-7 days depending on the underlying disease.

Oral
Folate-deficient megaloblastic anaemia
Adult: 5 mg daily for up to 4 months; may increase to 15 mg daily in malabsorption states. Maintenance: 5 mg every 1-7 days. Alternatively, up to 1 mg daily; higher doses may be given in resistant cases. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.
Child: >1 years Same as adult dose.

Oral
Prophylaxis of neural tube defect in pregnancy
Adult: In women with positive history of previous neural tube defects (NTD): 5 mg daily starting before pregnancy and continued through the 1st trimester. In women with no previous history of foetal NTD and no other predisposing factors: 0.4 mg daily until 10-12 weeks after the last menstrual period.

Parenteral
Folate-deficient megaloblastic anaemia
Adult: In severe cases or if gastrointestinal absorption is impaired: Up to 1 mg daily via IM, IV, or SC inj. Maintenance: 0.4 mg daily.
Child: Up to 1 mg daily via IM, IV, or SC inj. Maintenance: Infants 0.1 mg daily; <4 years Up to 0.3 mg daily; ≥4 years 0.4 mg daily.
Administration
May be taken with or without food.
Contraindications
Untreated cobalamin deficiency (including untreated pernicious anaemia or other causes e.g. lifelong vegetarians), malignant disease.
Special Precautions
Patient with folate-dependent tumours, haemolytic anaemia, alcoholism. Women with pre-existing diabetes, obesity, family history of neural tube defects, or previous pregnancy affected by neural tube defect. Not appropriate for monotherapy in pernicious, aplastic, or normocytic anaemias when anaemia is present with vitamin B12 deficiency. Children. Pregnancy and lactation.
Adverse Reactions
Gastrointestinal disorders: Abdominal distension, flatulence, nausea, bitter or bad taste.
Immune system disorders: Rarely, allergic reactions (e.g. rash, pruritus, erythema, urticaria, dyspnoea, shock); allergic sensitisation.
Metabolism and nutrition disorders: Rarely, anorexia.
Monitoring Parameters
Establish cobalamin status in all megaloblastic states (not only in pregnancy).
Drug Interactions
May reduce the plasma concentrations of anticonvulsants (e.g. phenytoin, phenobarbital, carbamazepine, valproic acid). Enhances the efficacy of lithium. May decrease the therapeutic effect of methotrexate. Increased elimination with aspirin. Reduced absorption with sulfasalazine and triamterene. Chloramphenicol and sulfamethoxazole + trimethoprim may interfere with folate metabolism.
Food Interaction
Increased elimination with Alcohol.
Action
Description: Folic acid is essential for the formation of coenzymes in many metabolic systems such as purine, pyrimidine, and methionine synthesis. It is also essential in nucleoprotein synthesis, maintenance of erythropoiesis, and stimulation of WBC and platelet production in folate-deficiency anaemia.
Synonym: folate.
Pharmacokinetics:
Absorption: Rapidly absorbed from the gastrointestinal tract, primarily from the proximal portion of the small intestine. Bioavailability: Approx 100% (folic acid supplement); 50% (dietary folate). Time to peak plasma concentration: 1 hour.
Distribution: Widely distributed to body tissues and stored mainly in the liver. Actively concentrated in the CSF and enters breast milk. Plasma protein binding: 70%, to albumin.
Metabolism: Metabolised in the liver and plasma where it is converted to the active metabolite, 5-methyltetrahydrofolate (5MTHF); undergoes enterohepatic circulation.
Excretion: Via urine.
Chemical Structure

Chemical Structure Image
Folic acid

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 135398658, Folic acid. https://pubchem.ncbi.nlm.nih.gov/compound/Folic-acid. Accessed May 27, 2022.

Storage
Store between 20-25°C. Protect from light.
MIMS Class
Vitamins & Minerals (Pre & Post Natal) / Antianemics
ATC Classification
B03BB01 - folic acid ; Belongs to the class of folic acid and derivatives. Used in the treatment of anemia.
References
Anon. Folic Acid. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 06/05/2022.

Anon. Folic Acid. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/05/2022.

Buckingham R (ed). Folic Acid. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/05/2022.

Folic Acid 400 microgram Tablets (Alissa Healthcare Research Limited). MHRA. https://products.mhra.gov.uk. Accessed 06/05/2022.

Folic Acid Colonis 1 mg/mL Oral Solution (Colonis Pharma Limited). MHRA. https://products.mhra.gov.uk. Accessed 06/05/2022.

Folic Acid Injection, Solution (XGen Pharmaceuticals DJB, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/05/2022.

Folic Acid Tablet (Method Pharmaceuticals, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/05/2022.

Folic Acid Tablets BP 5 mg (Flamingo Pharma UK Ltd.). MHRA. https://products.mhra.gov.uk. Accessed 06/05/2022.

Joint Formulary Committee. Folic Acid. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/05/2022.

Royce Folic Acid Tablet (Royce Pharma Manufacturing Sdn.Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 10/05/2022.

Disclaimer: This information is independently developed by MIMS based on Folic acid from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2022 MIMS. All rights reserved. Powered by MIMS.com
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