folic acid (folacin, pteroylglutamic acid, folate) (foe' lik) Folvite Pregnancy Category A: Adequate and well-controlled studies

have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). Drug class: Folic acid, Vitamin supplement Therapeutic actions: Required for nucleoprotein synthesis and maintenence of normal erythropoiesis. Indications Treatment of megoblastic anemias due to sprue, nutritional deficiency, pregnancy, infancy, and childhood Contraindications and cautions Contraindicated with allergy to folic acid preparations; pernicious, aplastic, normocytic anemias. Use cautiously during lactation. Available forms Tablets0.4, 0.8, 1 mg; injection5 mg/mL Dosages Administer orally unless patient has severe intestinal malabsorption. ADULTS Therapeutic dose: Up to 1 mg/day PO, IM, IV, or subcutaneously. Larger doses may be needed in severe cases. Maintenance dose: 0.4 mg/day. Pregnancy and lactation: 0.8 mg/day.

Pharmacokinetics
Route Onset Varies Peak 30-60 min

Oral, IM, IV, or SC

Metabolism: Hepatic; T1/2: Unknown Distribution: Crosses placenta; enters breast milk Excretion: Urine

Adverse effects Hypersensitivity: Allergic reactions Local: Pain and discomfort at injection site

Interactions Drug-drug Decrease in serum phenytoin and increase in seizure activity with folic acid preparations Decreased absorption with sulfasalazine, aminosalicyclic acid Nursing considerations CLINICAL ALERT! Name confusion has been reported between folinic acid (leucovorin) and folic acid; use extreme caution. Assessment History: Allergy to folic acid preparations; pernicious, aplastic, normocytic anemias; lactation Physical: Skin lesions, color; R, adventitious sounds; CBC, Hgb, Hct, serum folate levels, serum vitamin B12 levels, Schilling test Interventions Administer orally if at all possible. With severe GI malabsorption or very severe disease, give IM, IV, or subcutaneously. Test using Schilling test and serum vitamin B12 levels to rule out pernicious anemia. Therapy may mask signs of pernicious anemia while the neurologic deterioration continues. WARNING: Use caution when giving the parenteral preparations to premature infants. These preparations contain benzyl alcohol and may produce a fatal gasping syndrome in premature infants.

WARNING: Monitor patient for hypersensitivity reactions, especially if drug previously taken. Keep supportive equipment and emergency drugs readily available in case of serious allergic response.

Teaching points When the cause of megaloblastic anemia is treated or passes (infancy, pregnancy), there may be no need for folic acid because it normally exists in sufficient quantities in the diet. Report rash, difficulty breathing, pain or discomfort at injection site. Adverse effects in Italic are most common; those in Bold are life-threatening.