Indications
B-9 is indicated for the treatment of B-9 deficiency, megaloblastic anemia, and anemias of nutritional origins, pregnancy, infancy, or childhood.
Pharmacology
Folic acid, initially biochemically inactive, is converted to tetrahydrofolic acid and methyltetrahydrofolate by dihydrofolate reductase (DHFR). These folic acid congeners are transported across cells by receptor-mediated endocytosis to maintain normal erythropoiesis, synthesize purine and thymidylate nucleic acids, interconvert amino acids, methylate tRNA, and generate and use formate. With vitamin B12 as a cofactor, folic acid normalizes high homocysteine levels by remethylating homocysteine to methionine via methionine synthetase.
Dosage & Administration
For adults, the initial dose is 5 mg daily for 4 months, with a maintenance dose of 5 mg every 1-7 days depending on the underlying condition. For children up to 1 year, the dose is 500 mcg/kg daily, and for those over 1 year, the dosage is the same as for adults.
Interaction
No reported interactions.
Contraindications
Contraindicated in patients with previous intolerance to folic acid.
Side Effects
Generally well-tolerated. Gastrointestinal disturbances and rare hypersensitivity reactions have been reported.
Pregnancy & Lactation
No special precautions known.
Precautions & Warnings
Use cautiously in patients with folate-dependent tumors. It should not be used alone or with inadequate amounts of vitamin B12 for treating undiagnosed megaloblastic anemia. B-9 can produce a hematopoietic response in patients with megaloblastic anemia due to vitamin B12 deficiency but should not be given alone in these cases to avoid precipitating subacute combined degeneration of the cord. In elderly patients, a cobalamin absorption test should be conducted before long-term folate use. Short courses of folate have not shown harmful results.
Therapeutic Class
Drugs for Megaloblastic Anemia, Vitamin-B preparations
Storage Conditions
Store below 30°C in a dry place, away from light. Keep out of reach of children.
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