folic acid (Rx, OTC)

Brand and Other Names:Folvite
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 400mcg
  • 800mcg
  • 1mg

injectable solution

  • 5mg/mL

Nutritional Supplementation

Recommended daily allowance (RDA)

Males: 400 mcg/day PO

Females: 400-800 mcg/day PO

Pregnant women: 600 mcg/day PO

Nursing women: 500 mcg/day PO

Upper limit: 1 mg/day PO

Neural Tube Defects Prophylaxis

Females of childbearing potential: 400 mcg/day PO

Pregnancy women: 600 mcg/day PO

Females with high risk or family history of neural tube defects: 4 mg/day PO

Folic Acid Deficiency

0.4-1 mg PO/IV/IM/SC once daily

Methanol Toxicity

50-75 mg IV q4hr for 24 hr

Methotrexate Toxicity Prophylaxis (Off-label)

1 mg PO qDay; may increase up to 5 mg/day if toxicity emerges

Dosage Forms & Strengths

tablet

  • 400mcg
  • 800mcg
  • 1mg

injectable solution

  • 5mg/mL

Nutritional Supplementation

RDA

0-6 months: 65 mcg/day PO

7-12 months: 80 mcg/day PO

1-4 years: 150 mcg/day PO

4-9 years: 200 mcg/day PO

9-14 years: 300 mcg/day PO

14-18 years: 400 mcg/day PO

Upper limit: 1-4 years, 300 mcg/day PO; 4-8 years, 400 mcg/day PO

Folic Acid Deficiency

Infants: 15 mcg/kg/day or 50 mcg/day IV/PO/IM/SC  

1-10 years: 1 mg/day IV/PO/IM/SC initially, then 0.1-0.4 mg/day

Methanol Toxicity

1 mg/kg IV q4hr for 24 hr  

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Interactions

Interaction Checker

and folic acid

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                Monitor Closely (5)

                • glucarpidase

                  glucarpidase will decrease the level or effect of folic acid by increasing metabolism. Modify Therapy/Monitor Closely. Leucorvorin, reduced folates, and folate antimetabolites are substrates for glucarpidase (hydrolyzes glutamate residue from folic acid and antifolates)

                • green tea

                  green tea, folic acid. Other (see comment). Use Caution/Monitor. Comment: Concomitant consumption of green tea with folic acid is not recommended in pregnant women, megaloblastic anemia, or when a reduction in folic acid may have clinical consequences. A folate transporter interaction has been described, leading to decreases in bioavailability of folic acid.

                • omadacycline

                  folic acid will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

                • pancrelipase

                  pancrelipase decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. folic deficiency may occur.

                • pyrimethamine

                  folic acid, pyrimethamine. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.

                Minor (44)

                • aspirin

                  aspirin decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • aspirin rectal

                  aspirin rectal decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • aspirin/citric acid/sodium bicarbonate

                  aspirin/citric acid/sodium bicarbonate decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • balsalazide

                  balsalazide decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • bazedoxifene/conjugated estrogens

                  bazedoxifene/conjugated estrogens decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                • bendroflumethiazide

                  bendroflumethiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • bumetanide

                  bumetanide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • carbamazepine

                  carbamazepine decreases levels of folic acid by unspecified interaction mechanism. Minor/Significance Unknown.

                • chloramphenicol

                  chloramphenicol decreases effects of folic acid by pharmacodynamic antagonism. Minor/Significance Unknown.

                • chlorothiazide

                  chlorothiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • chlorthalidone

                  chlorthalidone decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • choline magnesium trisalicylate

                  choline magnesium trisalicylate decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • colestipol

                  colestipol decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • conjugated estrogens

                  conjugated estrogens decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                • conjugated estrogens, vaginal

                  conjugated estrogens, vaginal decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                • cyclopenthiazide

                  cyclopenthiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • diflunisal

                  diflunisal decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • estradiol

                  estradiol decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                • estrogens conjugated synthetic

                  estrogens conjugated synthetic decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                • estrogens esterified

                  estrogens esterified decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                • estropipate

                  estropipate decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                • ethacrynic acid

                  ethacrynic acid decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • ethotoin

                  folic acid decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown. Large doses of folic acid (>10 mg/day).

                • fosphenytoin

                  folic acid decreases levels of fosphenytoin by increasing metabolism. Minor/Significance Unknown. Large doses of folic acid (>10 mg/day).

                • furosemide

                  furosemide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • hydrochlorothiazide

                  hydrochlorothiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • indapamide

                  indapamide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • mesalamine

                  mesalamine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • mestranol

                  mestranol decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

                • metformin

                  metformin decreases levels of folic acid by unspecified interaction mechanism. Minor/Significance Unknown.

                • methotrexate

                  folic acid decreases effects of methotrexate by pharmacodynamic antagonism. Minor/Significance Unknown. Vitamin preparations containing folic acid or its derivatives may decrease responses to systemically administered methotrexate.

                • methyclothiazide

                  methyclothiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • metolazone

                  metolazone decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • pentamidine

                  pentamidine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • phenobarbital

                  folic acid decreases levels of phenobarbital by increasing metabolism. Minor/Significance Unknown.

                  phenobarbital decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • phenytoin

                  folic acid decreases levels of phenytoin by increasing metabolism. Minor/Significance Unknown. Large doses of folic acid (>10 mg/day).

                • primidone

                  folic acid decreases levels of primidone by increasing metabolism. Minor/Significance Unknown.

                  primidone decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • salicylates (non-asa)

                  salicylates (non-asa) decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • salsalate

                  salsalate decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • sulfamethoxazole

                  sulfamethoxazole decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • sulfasalazine

                  sulfasalazine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • torsemide

                  torsemide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • triamterene

                  triamterene decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

                • willow bark

                  willow bark decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

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                Adverse Effects

                Frequency Not Defined

                Bronchospasm

                Erythema

                Malaise

                Pruritus

                Rash

                Slight flushing

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                Warnings

                Contraindications

                Hypersensitivity

                Cautions

                Undiagnosed anemias

                May mask anemia at dosages >0.1 mg/day

                In presence of vitamin B12 deficiency, not appropriate for monotherapy in pernicious, normocytic, or aplastic anemia

                Vials must be protected from heat and light

                Injection contains benzyl alcohol as preservative (benzyl alcohol is associated with gasping syndrome in neonates)

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                Pregnancy & Lactation

                Pregnancy category: A

                Lactation: Drug enters breast milk; safe for nursing

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Necessary for formation of coenzymes in metabolic systems (purine and pyrimidine synthesis required for maintenance in erythropoiesis); stimulates platelet production in folate deficiency anemia

                Enhances elimination of formic acid in methanol toxicity via provision of coenzyme to folate dehydrogenase

                Absorption

                Absorbed in proximal part of small intestine

                Onset: PO, 0.5-1 hr

                Metabolism

                Metabolized in liver

                Elimination

                Excretion: Urine

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                Administration

                IV/IM/SC Administration

                Administer by IV/IM/SC injection only when PO administration is not feasible or when malabsorption is suspected

                Most individuals with malabsorption can absorb oral folic acid

                For IM use, administer by deep injection

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                folic acid oral
                -
                400 mcg tablet
                folic acid oral
                -
                1 mg tablet
                folic acid oral
                -
                1 mg tablet
                folic acid oral
                -
                1 mg tablet
                folic acid oral
                -
                400 mcg tablet
                folic acid oral
                -
                1 mg tablet
                folic acid oral
                -
                1 mg tablet
                folic acid oral
                -
                400 mcg tablet
                folic acid oral
                -
                800 mcg tablet
                folic acid oral
                -
                400 mcg tablet
                folic acid oral
                -
                1 mg tablet
                folic acid oral
                -
                1 mg tablet
                folic acid oral
                -
                1 mg tablet
                folic acid oral
                -
                400 mcg tablet
                folic acid oral
                -
                800 mcg tablet
                folic acid oral
                -
                400 mcg tablet
                folic acid oral
                -
                800 mcg tablet
                folic acid injection
                -
                5 mg/mL vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

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                Patient Education
                folic acid oral

                FOLIC ACID - ORAL

                (FOE-lik AS-id)

                USES: Folic acid is the man-made form of folate. Folate is a B-vitamin naturally found in some foods. It is needed to form healthy cells, especially red blood cells.Folic acid supplements may come in different forms (such as L-methylfolate, levomefolate, methyltetrahydrofolate). They are used to treat or prevent low folate levels. Low folate levels can lead to certain types of anemia. Conditions that can cause low folate levels include poor diet, pregnancy, alcoholism, liver disease, certain stomach/intestinal problems, kidney dialysis, among others. Women of childbearing age should receive adequate amounts of folic acid either through their diet or supplements to prevent infant spinal cord birth defects.

                HOW TO USE: Take this product by mouth with or without food as directed by your doctor, usually once daily. If you are taking the over-the-counter product, follow all directions on the product package. If you have any questions, ask your doctor or pharmacist.Dosage is based on your medical condition and response to treatment. Do not increase your dose or take this product more often than directed.Take this product regularly to get the most benefit from it. To help you remember, take it at the same time each day. Follow the diet plan recommended by your doctor or dietician. See also Notes section.If your condition persists or worsens, or if you think you may have a serious medical problem, get medical help right away.

                SIDE EFFECTS: Folic acid usually has very few side effects. If you have any unusual effects from taking this product, tell your doctor or pharmacist promptly.If your doctor has directed you to use this product, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this product do not have serious side effects.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Before taking this product, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this product, tell your doctor or pharmacist your medical history, especially of: vitamin B-12 deficiency (pernicious anemia).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Folic acid is safe to take during pregnancy when used as directed. It is included in prenatal vitamin products. Certain spinal cord birth defects may be prevented by taking adequate amounts of folic acid during pregnancy. Consult your doctor for more details.Folic acid passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

                DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: mental/mood changes.

                NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as complete blood count, folate blood level, vitamin B-12 blood level) should be performed periodically to monitor your progress. Consult your doctor for more details.Folate is naturally found in leafy green vegetables, organ meats (liver, kidney), citrus fruits, and other foods. Folic acid is added to enriched grain products such as bread, pasta, and cereal. Consult your doctor or dietician for a diet plan rich in folate/folic acid.

                MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

                STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

                Information last revised June 2018. Copyright(c) 2021 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.