What is folic acid?
Folic acid is a naturally occurring substance that is important for the formation of red and white blood cells. Folic acid is present in foods such as dried beans, peas, lentils, oranges, whole-wheat products, liver, asparagus, beets, broccoli, brussels sprouts, and spinach. As a medication, folic acid is used to treat folic acid deficiency and megaloblastic anemia caused by folic acid deficiency. Folic acid may also be used for purposes other than those listed in this medication guide.
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What are the possible side effects of folic acid?
Side effects from folic acid are not common.
Stop taking folic acid and seek emergency medical treatment if you experience an allergic
reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives).
Continue taking folic acid and talk to your doctor if you experience any of the following less
serious side effects, which have occurred with large doses of folic acid:
Side effects other than those listed here may also occur. Talk to your doctor
about any side effect that seems unusual or that is especially bothersome.
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How should I take folic acid?
Take folic acid exactly as directed by your doctor. If you do not understand these instructions, ask your doctor, nurse, or pharmacist to explain them to you. Take each dose with a full glass of water. Folic acid is usually taken every day. Follow your doctor's instructions. Sometimes, it may be necessary to receive folic acid by injection. Store folic acid at room temperature away from moisture and heat.
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What is the most important information I should know about folic acid?
Take this medication only under the supervision of your doctor.
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What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed, and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor.
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What other drugs will affect folic acid?
Large doses of folic acid may decrease the effects of phenytoin (Dilantin). Your doctor may need to adjust your dose of phenytoin to prevent seizures during treatment with folic acid. Drugs other than those listed here may also interact with folic acid. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?
Folic acid has been assigned to pregnancy category A by the FDA when used in doses that are advocated by the FDA. Higher doses of folic acid have been assigned to category C. Because of increased plasma clearance of folate during pregnancy, folic acid requirements are increased. Folic acid therapy or adequate dietary folic acid BEFORE conception may significantly decrease the risk of neural tube defects among pregnancies in women, even those with previously affected children.
The recommended daily allowance of folic acid during pregnancy is 400 to 800 mcg/day. Some experts recommend daily doses of 1 mg for twin pregnancies. The Centers of Disease Control (CDC) in the US have recommended 4 mg/day of folic acid at least 4 weeks BEFORE conception through the first 3 months of pregnancy for women who have had an infant or fetus with a neural tube defect and 400 mcg/day for all women of childbearing age.
Interestingly, neonates with normal serum folate concentrations have been born to folate-deficient mothers. It appears that the fetus can extract folate from maternal plasma, convert folate to a form that is not available for reverse transfer, and use it for its own advantage.
Dietary folic acid is available from green leaves, such as asparagus, broccoli, spinach, and lettuce--each of which contains > 1 mg folic acid per 100 grams dry weight. Excessive cooking can remove or destroy the food content of folate.
Folic acid is actively excreted into human milk. No adverse effects in nursing infants have been associated with the use of folic acid during lactation. Folic acid is considered compatible with breast-feeding by the American Academy of Pediatrics. The recommended maternal daily allowance of folic acid during lactation is 500 mcg. Supplementation is not typically needed in mothers with good nutritional habits.
In one study, lactating mothers were given 1 mg of folic acid per day. There were significant correlations between the maternal and infant plasma and RBC folate concentrations. The average maternal plasma folic acid concentration was 5.9 ng/mL, which correlated with an average milk folic acid level of 141.4 ng/mL and an average infant plasma folic acid concentration of 29 ng/mL. The calculated total intake of folic acid by nursing infants was 14 to 25 mcg/kg/day. Colostrum is relatively low in folate, but milk folate increases as lactation proceeds. Folate levels in breast-fed infants are significantly higher than in the mothers.
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Who should NOT use this medication?
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What does my medication look like?
Folic acid is available with a prescription and over the counter under several brand and generic names. Tablet and injection formulations are both available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.
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What happens if I overdose?
A folic acid overdose is unlikely to threaten life. Call an emergency room or poison control center for advice. Symptoms of a folic acid overdose are not known.
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What should I discuss with my healthcare provider before taking folic acid?
Folic acid should not be taken to treat undiagnosed anemia. Folic acid may hide the symptoms of pernicious anemia, leading to neurologic damage. Treatment of anemia during folic acid therapy may also require vitamin B12. Folic acid is in the FDA pregnancy category A. This means that it is safe to take folic acid during pregnancy. In fact, increased amounts of folic acid are recommended during pregnancy to reduce the risk that a folic acid deficiency will cause complications. Talk to your doctor about taking folic acid during pregnancy.
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Can I stop taking the medication if I feel better?
As a general rule, you should always take your medications exactly as prescribed and do not change the dosage or stop taking the medication without first discussing it with your healthcare provider.
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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.
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Where can I get more information?
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