Pregnancy Risk Category A
How supplied
Tablets: 0.4 mg, 0.8 mg, 1 mg
Injection: 10-ml vials (5 mg/ml with 1.5% benzyl alcohol, 5 mg/ml with 1.5% benzyl alcohol and 0.2% EDTA)
Action
Stimulates normal erythropoiesis and nucleoprotein synthesis.
Indications & dosage
RDA--
Neonates and infants up to age 6 months: 25 mcg.
Infants ages 6 months to 1 year: 35 mcg.
Children ages 1 to 3: 50 mcg.
Children ages 4 to 6: 75 mcg.
Children ages 7 to 10: 100 mcg.
Children ages 11 to 14: 150 mcg.
Men ages 15 and older: 200 mcg.
Women ages 15 and older: 180 mcg.
Pregnant women: 800 mcg.
Breast-feeding women: 800 mcg.
Megaloblastic or macrocytic anemia secondary to folic acid or other nutritional deficiency, hepatic disease, alcoholism, intestinal obstruction, excessive hemolysis--
Adults and children over age 4: 0.4 to 1 mg P.O., S.C., or I.M. daily. After anemia secondary to folic acid deficiency is corrected, proper diet and RDA supplements are needed to prevent recurrence.
Children under age 4: up to 0.3 mg P.O., S.C., or I.M. daily.
Pregnant and breast-feeding women: 0.8 mg P.O., S.C., or I.M. daily.
Prevention of megaloblastic anemia during pregnancy to prevent fetal damage--
Adults: up to 1 mg P.O., S.C., or I.M. daily throughout pregnancy.
Nutritional supplement--
Adults: 0.1 mg P.O., S.C., or I.M. daily.
Children: 0.05 mg P.O. daily.
Test for folic acid deficiency in patients with megaloblastic anemia without masking pernicious anemia--
Adults and children: 0.1 to 0.2 mg P.O. or I.M. for 10 days while maintaining a diet low in folate and vitamin B12.
Tropical sprue--
Adults: 3 to 15 mg P.O. daily.
Adverse reactions
CNS: altered sleep pattern, general malaise, difficulty concentrating, confusion, impaired judgment, irritability, overactivity.
GI: anorexia, nausea, flatulence, bitter taste.
Respiratory: bronchospasm.
Skin: allergic reactions including rash, pruritus, and erythema.
Interactions
Drug-drug. Aminosalicylic acid, chloramphenicol, methotrexate, oral contraceptives, sulfasalazine, trimethoprim: antagonism of folic acid. Watch for decreased folic acid effect. Use together cautiously.
Phenytoin: increased anticonvulsant metabolism causing decreased blood levels of the anticonvulsant. Monitor closely.
Effects on diagnostic tests
Drug alters serum and RBC folate levels; falsely low serum and RBC folate levels may occur with Lactobacillus casei assay in patients receiving anti-infectives such as tetracycline that suppress growth of this organism.
Contraindications
Contraindicated in patients with undiagnosed anemia (it may mask pernicious anemia) and in those with B12 deficiency.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING