folic acid (folate) Nursing Considerations & Management

 Drug Name

Generic Name : folic acid (folate)

Brand Name: Folvite

Classification: Folic acid, Vitamin supplement

Pregnancy Category A

Dosage & Route

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.
Therapeutic actions
  • Folic acid is essential for the production of certain coenzymes in many metabolic systems such as purine and pyrimidine synthesis. It is also essential in the synthesis and maintenance of nucleoprotein in erythropoesis. It also promotes WBC and platelet production in folate-deficiency anaemia.
Indications
  • Treatment of megoblastic anemias due to sprue, nutritional deficiency, pregnancy, infancy, and childhood
Adverse effects
  • GI disturbances, hypersensitivity reactions; bronchospasm.
Contraindications
  • Undiagnosed megaloblastic anaemia; pernicious, aplastic or normocytic anaemias.
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, IV, or subcutaneously.
  • 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.
  • WARNING: 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.
  • WARNING: 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.