folic acid (folacin, pteroylglutamic acid, folate)

(foe' lik)
Folvite

Pregnancy Category A

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
Tablets—0.4, 0.8, 1 mg; injection—5 mg/mL

Dosages
Administer orally unless patient has severe intestinal malabsorption.
ADULTS
• Therapeutic dose: Up to 1 mg/day PO, IM, IV, or SC. Larger doses may be
needed in severe cases.
• Maintenance dose: 0.4 mg/day.
• Pregnancy and lactation: 0.8 mg/day.
PEDIATRIC PATIENTS
• Maintenance dose:
Infants: 0.1 mg/day.
< 4 yr: Up to 0.3 mg/day.
> 4 yr: 0.4 mg/day.

Pharmacokinetics
Route Onset Peak
Oral, IM, SC, IV Varies 30–60 min

Metabolism: Hepatic; T1/2: Unknown

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

IV facts
Preparation: Solution is yellow to yellow-orange; may be added to hyperalimentation
solution or dextrose solutions.
Infusion: Infuse at rate of 5 mg/min by direct IV injection; may be diluted in
hyperalimentation for continuous infusion.

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, SC, or IV.
• 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.
• 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.
• 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.