Adult Dosing

Anemia

• Start: 1 mg/day IM/IV/SC; may increase in resistant cases
• Maintenance: 0.4 mg/day IM/IV/SC; Pregnant and lactating women: 0.8 mg/day IM/IV/SC
• Notes:
• The usual therapeutic dose is up to 1 mg daily
• Do not give doses greater than 0.1 mg unless anemia due to vitamin B12 deficiency has been ruled out or is being adequately treated with a cobalamin
• Patients should be closely supervised. Adjustment of the maintenance level should be done if relapse appears imminent
• The maintenance level may need to be increased in the presence of alcoholism, hemolytic anemia, anticonvulsant therapy, or chronic infection

Pediatric Dosing

Anemia

Infants

• Start: 1 mg/day IM/IV/SC
• Maintenance: 0.1 mg/day IM/IV/SC

Child <4 yrs

• Start: 1 mg/day IM/IV/SC
• Maintenance: 0.3 mg/day IM/IV/SC

Child >4 yrs

• Start: 1 mg/day IM/IV/SC
• Maintenance: 0.4 mg/day IM/IV/SC
• Notes:
• The usual therapeutic dose is up to 1 mg daily
• Do not give doses greater than 0.1 mg unless anemia due to vitamin B12 deficiency has been ruled out or is being adequately treated with a cobalamin
• Patients should be closely supervised. Adjustment of the maintenance level should be done if relapse appears imminent
• The maintenance level may need to be increased in the presence of alcoholism, hemolytic anemia, anticonvulsant therapy, or chronic infection

[Outline]

• Adult Dosing
• Pediatric Dosing

• Megaloblastic anemia due to a deficiency of folic acid
• Anemias of nutritional origin, pregnancy, infancy, or childhood

• Hypersensitivity to any of the ingredients of the product

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment:

• Hepatic impairment: Dose adjustments not defined

• Cautiously administer in patients with kidney failure, because therapy contains aluminum which may be toxic
• As therapy contains benzyl alcohol, it may lead to fatal gasping syndrome in premature infants
• Administration of therapy for pernicious anemia and other megaloblastic anemias in which vitamin B12 is deficient is not recommended
• Do not administer in doses above 0.1 mg/day in patients with pernicious anemia as hematologic remission can occur when neurologic manifestations remain progressive
• Do not administer in patients with undiagnosed anemia, since therapy may obscure the diagnosis of pernicious anemia. Administer adequate doses of vitamin B12

Cautions: Use cautiously in

• Undiagnosed anemia

Pregnancy Category:A

Breastfeeding: Safe. This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776last accessed 11 May 2011). According to manufacturer data therapy is safe with breastfeeding.

• CNS: Malaise, altered sleep patterns, difficulty in concentrating, irritability, over-activity, excitement, mental depression, confusion, impaired judgment, increased incidence of seizures
• RESP: Dysnea, bronchospasm
• GI: Anorexia, nausea, abdominal distention, flatulence, bitter or bad taste
• DERM: Erythema, skin rash, itching
• LABTESTS: Decreased vitamin B12 serum levels, decreased diphenylhydantoin serum levels
• HYPERSENSITIVITY: Allergic sensitization

• Water soluble vitamin; required for nucleoprotein synthesis and the maintenance or normal erythropoiesis
• Well absorbed after parenteral administration
• Metabolized to dihydrofolate reductase by liver
• Excess amounts excreted unchanged in urine
• Half-life: Unknown

US Trade Name(s)

• Only generic available

US Availability

folic acid (generic)

• INJ: 5 mg/mL (10 mL vial)

Canadian Trade Name(s)

• Only generic available

Canadian Availability

folic acid (generic)

• INJ: 5 mg/mL (10 mL vial)

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• Only generic available

Australian Availability

folic acid (generic)

• INJ: 5 mg/mL (1 mL vial)

[Outline]

Hematology/Oncology

Antianemics

Nutrition/Electrolytes

Vitamins