FOLIC ACID

INTRODUCTION-
Folic acid occurs as yellow crystals insoluble in water ,its sodium salt is soluble in water . chemically
folic acid is pteroyl glutamic acid.mitchell in 1941 isolated folic acid from spinach and called it folic
acid means from leaf , it is also called as vitamin B9.

Folic acid (pteroyglutamic acid) is a vitamin that is transformed to tetrahydrofolate polyglutamate in

the body. In the form of a co-enzyme it is a donor for groups with a single carbon unit (e.g. methyl
groups). The co-enzyme assists, amongst others, the purine synthesis. Food groups that contain high
amounts of folic acid are vegetables (particularly leafy vegetables), grain and fruit.

Folic acid are essential constituents of the human diet, being necessary for DNA synthesis and
consequently for cell proliferation. Their biochemical actions are interdependent.

Deficiency of folic acid affects tissues with a rapid cell turnover, particularly bone marrow.

Deficiency of either vitamin causes megaloblastic hemopoiesis, in which there is disordered

erythroblast differentiation and defective erythropoiesis in the bone marrow due to diminished
synthesis of purines and pyrimidines. Large abnormal erythrocyte precursors appear in the marrow,
each with a high RNA: DNA ratio as a result of decreased DNA synthesis. The circulating
erythrocytes (macrocytes) are large fragile cells, often distorted in shape. Folic Acid Mechanism of
action

Folic acid (pteroylglutamic acid) consists of a pteridine ring, para-aminobenzoic acid and glutamic
acid. Various forms of folic acid are present in a wide variety of plant and animal tissues; the richest
sources are green vegetables, yeast, liver, and kidney.

DIETARY SOURCE OF FOLIC ACID:-

Spinach , green leafy vegetable, liver , egg, meat, milk product.

BRAND NAME:-
Folic acid: Tablet folacid, Folix ,Folson, Folictin ,Folinal ,5mg folic acid tablets.

MECHANISM OF ACTION
Reduction of folic acid, catalysed by dihydrofolate reductase in two stages yields dihydrofolate (FH2)
and tetrahydrofolate (FH4), co-factors which transfer methyl groups (1-carbon transfers) in several
important metabolic pathways. FH4 is essential for DNA synthesis because of its role as co-factor in
the synthesis of purines and pyrimidines. It is also necessary for reactions involved in amino acid
metabolism.

DOSAGE AND ROUTE OF ADMINISTRATION :-

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 subcutaneously. 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.

INDICATIONS:-
 Megaloblastic or macrocytic anemia during pregnancy to prevent fetal damage
 Prevent fetal neural tube defect during pregnancy
 Liver disease
 Alcoholism
 Intestinal obstruction

CONTRAINDICATIONS –
 Untreated vitamin B12 deficiency
 Hypersensitivity
 Uncorrected pernicious anaemia

SIDE EFFECTS-

 Flushing
 Bronchospasm
 Oral folic acid is non toxic

PHARMACOKINETICS:
Folic acid is readily and completely absorbed in the jejunum.

Because body stores of folates are relatively low and daily requirements high, folic acid deficiency
and megaloblastic anemia can develop within 1–6 months after the intake of folic acid stops.

Therapeutically, folic acid is given orally since oral folic acid is well absorbed even in patients with
malabsorption syndromes. Methyl-FH4 is the form in which folate is usually carried in blood and
which enters cells. It is functionally inactive until it is demethylated in a vitamin B12-dependent
reaction.

Folate is taken up into hepatocytes and bone marrow cells by active transport. Within the cells, folic
acid is reduced and formylated before being converted to the active polyglutamate form. Folinic acid,
a synthetic FH4, is converted much more rapidly to the polyglutamate form.

ADVERSE EFFECTS:-
 1.Abdominal cramps
 2. Diarrhea
 3. Rash
 4. Irritability
 5. nausea or bloating

SYMPTOMS OF FOLIC ACID DEFICIENCY-

 Symptoms of deficiency are glossitis , enteritis, diarrhoes, steatorrhoea.

 Weakness, weight loss, sterility, neurological symptoms rarely appear in folic
acid deficieny
 There are neural tube defects including spina bifida.

DRUG INTERACTION:-
 There is evidence that the anticonvulsant action of phenytoin is antagonized by folic acid.
A patient whose epilepsy is completely controlled by phenytoin may require increased
doses to prevent convulsions if folic acid is given.
 Folate deficiency may result from increased loss of folate, as in renal dialysis and/or
interference with metabolism (e.g., folic acid antagonists such as methotrexate); the
administration of anticonvulsants, such as diphenylhydantoin, primidone, and barbiturates;
alcohol consumption and, especially, alcoholic cirrhosis; and the administration of
pyrimethamine and nitrofurantoin.
 False low serum and red cell folate levels may occur if the patient has been taking
antibiotics, such as tetracycline, which suppress the growth of Lactobacillus casei.

Chloramphenical decrease folic acid level. Hydantoins , phenobarbitone increase metabolism of

folate. Do not use folic acid with metho-trexate

NURSES RESPONSIBILITIES :
  Ensure the correct drug is administered by theright route and in the right dose.
 History of allergy should be taken particularly before parentral administration of the drugs.
 Moniter the adverse effect.
 Drugs should be kept in safe place.
 Check the prescription ,drug label and the patients name before the administration of drugs.
 To asses symptoms of megaloblast anaemia such as weakness, fatigue ,dyspnea, short
breath.
 To advice the patient to take diet containing yeast , fresh vegetables, nuts ,fruits,dried
beans ,green leafy vegetables as dietary source of folic acid.
 To check haemoglobin, complete blood cell count, folate level
 To evaluate response of drug , decrease fatigue ,patient well oriented ,weight increase .
 To advice patient to take exact dose as prescribed avoid alcohol consumption.

CONCLUSION
 No drug should be administered to a woman during pregnancy, labor and birth,
unless the woman is fully informed of the known risks and the relevant areas of
uncertainty regarding the effects of the drug on the physiologic and neurologic
development of the woman or her baby
 The drugs that are used daily in obstetric can have a huge impact on the outcome of
both mother and child.
 Therefore, obstetric providers need to have a very clear understanding of the
mechanism of action, doses and side-effects of the most commonly used drugs.

BIBLIOGRAPHY
 Annamma Jacob “ A Comprehensive Textbook of Midwifery & Gynecological Nursing” 3rd
edition. Jaypee Brothers Medical Publishers (P) Ltd page no. 604-619

D.C.Dutta’s “Textbooks of Obstetrics” 7th edition. New Central Book Agency (P) Ltd page
no.666.

A.K Debdas “Drug handbook in Obstetrics”,3rd edition.Jaypee brothers and medical publishers
private limited, New Delhi.

wolter Kluwer “Drug handbook”32 edition.lippincot William &Wilkinson publisher ,London.

www.medicine.tcd.ie/pharmacology_therapeutics/....Obs&Gyn.pd