Folic Acid

About Folic Acid

Folic acid is a B vitamin the body needs to make red blood cells. The prescription label covers megaloblastic anemia from folate deficiency, as in tropical or nontropical sprue, and anemias of nutritional origin, pregnancy, infancy or childhood. The usual treatment dose is up to 1 mg a day; alcoholism, hemolytic anemia, anti-seizure treatment and chronic infection can raise the maintenance dose needed, and kidney dialysis increases folate loss.

People taking low-dose methotrexate are usually told to take folic acid to reduce some of its side effects, on a schedule the prescriber sets. MedlinePlus advises women who have had a pregnancy affected by a neural tube defect to take 4,000 mcg a day when planning a pregnancy and through the first trimester, far above typical over-the-counter strengths.

The main caution concerns vitamin B12. Folic acid can correct the blood count in pernicious anemia while nerve damage from the B12 deficiency progresses, so outside pregnancy and breastfeeding the label advises against doses above 0.4 mg a day until pernicious anemia has been ruled out. Allergic reactions such as rash, itching and breathing difficulty have been reported, and previous intolerance is the only contraindication.

Over-the-counter folic acid is sold as a dietary supplement, commonly 400 or 800 mcg. MedlinePlus advises against more than 1,000 mcg a day outside the neural tube defect situation, so mention any multivitamin or prenatal vitamin to the prescriber.

Taking Folic Acid

How to take it

Usually once a day, exactly as prescribed; with methotrexate, follow the schedule on your prescription. Keep lab appointments that check your blood count.

If you miss a dose

Take it as soon as you remember, unless it is nearly time for your next dose; in that case skip the missed dose and carry on as usual. Never take two doses at once to make up.

Storage

At room temperature in a tightly closed container, protected from light and moisture, and out of reach of children.

Interactions to know about

It can weaken the anti-seizure effect of phenytoin, and anti-seizure medicines can lower folate levels, so mention any seizure medicine. People taking methotrexate for cancer should check with their oncologist before taking folic acid. Tetracycline antibiotics can make a folate blood test read falsely low. Seek care for rash, itching or difficulty breathing.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Folic Acid differs from pharmacy to pharmacy

Folic acid 1 mg tablets cost pharmacies very little and come in bottles of 100 and 1,000, so the cash price is almost entirely the dispensing fee and mark-up. Pharmacies with a flat-price generic list often include it; others charge a standard minimum that sits well above what the tablets cost them.

Over-the-counter supplements carry no dispensing fee, but their strengths differ, and a prescribed dose is filled as written unless the prescriber agrees otherwise.

Ways to pay less for Folic Acid without insurance

• Ask whether folic acid is on the pharmacy’s flat-price generic list.
• For long-term use, ask for a ninety-day supply or more, since the fee is most of the cost.
• If your prescribed dose is 400 or 800 mcg, ask the prescriber whether an over-the-counter product would be acceptable.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Folic Acid

1. 1.Has vitamin B12 deficiency been ruled out before I start this dose?
2. 2.If I take methotrexate, which days should I take folic acid?
3. 3.Does my multivitamin or prenatal vitamin add to my folic acid dose?
4. 4.Does it affect my seizure medicine?
5. 5.When will my blood count be checked again?

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