Names and pronunciation
(foe′lik a′sid) FA-8, Folvite
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Drug reference
(foe′lik a′sid) FA-8, Folvite
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Func. class.: Vit B complex group, water-soluble vitamin
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ACTION: Needed for erythropoiesis; increases RBC, WBC, platelet formation with megaloblastic anemias
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USES: Megaloblastic or macrocytic anemia caused by folic acid defi- ciency; hepatic disease, alcoholism, hemolysis, intestinal obstruction, pregnancy to reduce risk for neural tube defects
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Unlabeled uses: Methotrexate toxicity prophylaxis, in those receiving metho- trexate for RA
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CONTRAINDICATIONS: Hyper sensitivity Precautions: Pregnancy, anemias other than megaloblastic/macrocytic anemia, vit B12 deficiency anemia, uncorrected pernicious anemia
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SIDE EFFECTS CNS: Confusion, depression, excitability, irritability GI: Anorexia, nausea, bitter taste INTEG: Pruritus, rash, erythema RESP: Bronchospasm SYST: Anaphylaxis (rare)
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INTERACTIONS Increase: need for folic acid—estrogen, hydantoins, carBAMazepine, glucocorticoids Decrease: folate levels—methotrexate, sul- fonamides, sulfaSALAzine, trimethoprim Decrease: phenytoin levels, fosphenyt- oin, may increase seizures
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DOSAGE AND ROUTES RDA • Adult and child ≥14 yr: PO 400 mcg • Adult (pregnant/lactating): PO 600 mcg/day • Child 9-13 yr: PO 300 mcg • Child 4-8 yr: PO 200 mcg • Child 1-3 yr: PO 150 mcg • Infant 6 mo-1 yr: PO 80 mcg • Neonate/infant <6 mo: PO 65 mcg Megaloblastic/macrocytic anemia due to folic acid or nutritional deficiency • Pregnant/lactating: PO 800-1000 mcg Therapeutic dose • Adult and child: PO/IM/SUBCUT/IV up to 1 mg/day Maintenance dose • Adult and child >4 yr: PO/IM/SUB- CUT/IV 0.4 mg/day • Pregnant and lactating: PO/IM/SUB- CUT/IV 0.8-1 mg/day • Child <4 yr: PO/IM/SUBCUT/IV up to 0.3 mg/day • Infant: PO/IM/SUBCUT/IV up to 0.1 mg/day Prevention of neural tube defects during pregnancy • Adult: PO 0.6 mg/day Prevention of megaloblastic anemia during pregnancy • Adult: PO/IM/SUBCUT up to 1 mg/day during pregnancy Tropical sprue • Adult: PO 3-15 mg/day Methotrexate toxicity • Adult: PO/IM/SUBCUT 1 mg daily or 5 mg weekly
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Available forms: Tab: 400, 800 mcg; cap 0.8, 5, 20 mg; solution, injection 5 mg/mL (10 mL)
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Administer: SUBCUT route • Do not inject intradermally IM route • Inject deeply in large muscle mass, aspirate Direct IV route • Direct undiluted ≤5 mg/1 min or more Continuous IV INFUSION route • May be added to most IV sol or TPN Y-site compatibilities: Alfentanil, aminophyl line, ascorbic acid injection, atracurium, atropine, azaTHIOprine, aztreonam, benz- tropine, bumetanide, calcium gluconate, ceFAZolin, cefonicid, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRI- AXone, cefuroxime, chloramphenicol, cimetidine, clindamycin, cyanocobalamin, cycloSPORINE, dexamethasone, digoxin, diphenhydrAMINE, DOPamine, enalaprilat, ePHEDrine, EPINEPHrine, epoetin alfa, erythromycin, esmolol, famotidine, fen- taNYL, fluconazole, furosemide, ganciclovir, glycopyrrolate, heparin, hydrocortisone, hydrOXYzine, imipenem-cilastatin, indo- methacin, insulin (regular), ketorolac, labetalol, lidocaine, LR, magnesium sulfate, mannitol, meperidine, methicillin, methyl- PREDNISolone, metoclopramide, metopro- lol, mezlocillin, midazolam, moxalactam, multiple vitamins injection, naloxone, nitro- glycerin, nitroprusside, ondansetron, oxa- cillin, oxytocin, penicillin G potassium/ sodium, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, potassium chloride, procainamide, pro- pranolol, ranitidine, Ringer’s, ritodrine, sodium bicarbonate, succinylcholine, SUF- entanil, theophylline, ticarcillin, ticarcillin- clavulanate, TPN, trimetaphan, urokinase, vancomycin, vasopressin
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Assess: • Megaloblastic anemia: fatigue, dys- pnea, weakness • HB, Hct, reticulocyte count • Nutritional status: bran, yeast, dried beans, nuts, fruits, fresh vegetables, as- paragus • Products currently taken: estrogen, car- BAMazepine, methotrexate, trimethoprim, hydantoins; these products may cause in- creased folic acid use by the body and contribute to a deficiency if taking other neurotoxic products • Pregnancy/breastfeeding: may be used in pregnancy/breastfeeding
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Evaluate: • Therapeutic response: increased weight, oriented, well-being; absence of fatigue; increase in reticulocyte count within 5 days of beginning treatment, absence of fetal neural tube defect
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: F • To take product exactly as prescribed; that periodic lab work is required • To alter nutrition to include foods high in folic acid: organ meats, vegetables, fruit • That urine will turn bright yellow • To notify prescriber of allergic reaction • To avoid breastfeeding HIGH ALERT
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PHARMACOKINETICS PO: Peak 1⁄2-1 hr, bound to plasma pro- teins, excreted in breast milk, metabolized by liver, excreted in urine (small amounts)
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• Infant 6 mo-1 yr: PO 80 mcg
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• Neonate/infant <6 mo: PO 65 mcg Megaloblastic/macrocytic anemia due to folic acid or nutritional deficiency
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• Infant: PO/IM/SUBCUT/IV up to 0.1 mg/day Prevention of neural tube defects during pregnancy
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