Folvite (folic Acid) Dosing, Indications, Interactions, Adverse Effects ...

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Tools & Referencefolic acid (Rx, OTC)Brand and Other Names:Folvite

• Classes: Vitamins, Water-Soluble

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Sections

• Sections folic acid
• Dosing & Uses
• Interactions
• Adverse Effects
• Warnings
• Pregnancy
• Pharmacology
• Administration
• Formulary

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

Next:

Interactions

Interaction Checker

Enter a drug name to check for any interactions. and folic acid

No Results

No Interactions Found Interactions Found

Contraindicated

Serious

Significant - Monitor Closely

Minor

All Interactions Sort By: SeverityName

Contraindicated (0)

Serious (1)

• pafolacianine

  folic acid decreases effects of pafolacianine by receptor binding competition. Avoid or Use Alternate Drug. Avoid coadministration with folic acid or folic acid-containing supplements for 48 hr before administering pafolacianine. Use of folate, folic acid, or folate-containing supplements may reduce binding of pafolacianine to folate receptors overexpressed on ovarian cancer cells and could reduce the detection of malignant lesions with. .

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.

• bumetanide intranasal

  bumetanide intranasal 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.

• 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.

• aspirin

  Minor (1)aspirin decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• aspirin rectal

  Minor (1)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

  Minor (1)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

  Minor (1)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

  Minor (1)bazedoxifene/conjugated estrogens decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

• bendroflumethiazide

  Minor (1)bendroflumethiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• bumetanide

  Minor (1)bumetanide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• bumetanide intranasal

  Minor (1)bumetanide intranasal decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• carbamazepine

  Minor (1)carbamazepine decreases levels of folic acid by unspecified interaction mechanism. Minor/Significance Unknown.

• chloramphenicol

  Minor (1)chloramphenicol decreases effects of folic acid by pharmacodynamic antagonism. Minor/Significance Unknown.

• chlorothiazide

  Minor (1)chlorothiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• chlorthalidone

  Minor (1)chlorthalidone decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• choline magnesium trisalicylate

  Minor (1)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

  Minor (1)colestipol decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• conjugated estrogens

  Minor (1)conjugated estrogens decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

• conjugated estrogens, vaginal

  Minor (1)conjugated estrogens, vaginal decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

• cyclopenthiazide

  Minor (1)cyclopenthiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• diflunisal

  Minor (1)diflunisal decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• estradiol

  Minor (1)estradiol decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

• estrogens conjugated synthetic

  Minor (1)estrogens conjugated synthetic decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

• estrogens esterified

  Minor (1)estrogens esterified decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

• estropipate

  Minor (1)estropipate decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

• ethacrynic acid

  Minor (1)ethacrynic acid decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• fosphenytoin

  Minor (1)folic acid decreases levels of fosphenytoin by increasing metabolism. Minor/Significance Unknown. Large doses of folic acid (>10 mg/day).

• furosemide

  Minor (1)furosemide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• glucarpidase

  Monitor Closely (1)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

  Monitor Closely (1)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.

• hydrochlorothiazide

  Minor (1)hydrochlorothiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• indapamide

  Minor (1)indapamide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• mesalamine

  Minor (1)mesalamine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• mestranol

  Minor (1)mestranol decreases levels of folic acid by altering metabolism. Minor/Significance Unknown.

• metformin

  Minor (1)metformin decreases levels of folic acid by unspecified interaction mechanism. Minor/Significance Unknown.

• methotrexate

  Minor (1)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

  Minor (1)methyclothiazide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• metolazone

  Minor (1)metolazone decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• omadacycline

  Monitor Closely (1)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.

• pafolacianine

  Serious - Use Alternative (1)folic acid decreases effects of pafolacianine by receptor binding competition. Avoid or Use Alternate Drug. Avoid coadministration with folic acid or folic acid-containing supplements for 48 hr before administering pafolacianine. Use of folate, folic acid, or folate-containing supplements may reduce binding of pafolacianine to folate receptors overexpressed on ovarian cancer cells and could reduce the detection of malignant lesions with. .

• pancrelipase

  Monitor Closely (1)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.

• pentamidine

  Minor (1)pentamidine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• phenobarbital

  Minor (2)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

  Minor (1)folic acid decreases levels of phenytoin by increasing metabolism. Minor/Significance Unknown. Large doses of folic acid (>10 mg/day).

• primidone

  Minor (2)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.

• pyrimethamine

  Monitor Closely (1)folic acid, pyrimethamine. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.

• salicylates (non-asa)

  Minor (1)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

  Minor (1)salsalate decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• sulfamethoxazole

  Minor (1)sulfamethoxazole decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• sulfasalazine

  Minor (1)sulfasalazine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• torsemide

  Minor (1)torsemide decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• triamterene

  Minor (1)triamterene decreases levels of folic acid by increasing renal clearance. Minor/Significance Unknown.

• willow bark

  Minor (1)willow bark decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

PreviousNext:

Adverse Effects

Frequency Not Defined

Bronchospasm

Erythema

Malaise

Pruritus

Rash

Slight flushing

PreviousNext:

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)

PreviousNext:

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.

PreviousNext:

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

PreviousNext:

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

PreviousNext:

Formulary

FormularyPatient Discounts

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View explanations for tiers and restrictions

Tier	Description
1	This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2	This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
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5	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC	NOT COVERED – Drugs that are not covered by the plan.

Code	Definition
PA	Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL	Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST	Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR	Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.

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