Folic acid

CLINICAL USE

Folate-deficient megaloblastic anaemia Supplement in

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : patients

DOSE IN NORMAL RENAL FUNCTION

5 mg daily for 4 months, then weekly according to responseMaintenance: 5 mg every 1–7 days

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :441.4

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :70

%Excreted unchanged in urine &nbsp &nbsp : Varies with daily dose

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :No data

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :2.5/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Dialysed. Dose as in normal renal function

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Dialysed. Dose as in normal renal function

HDF/high flux &nbsp :Dialysed. Dose as in normal renal function

CAV/VVHD &nbsp &nbsp &nbsp:Dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anti-epileptics: reduces phenytoin, primidone and phenobarbital levels

ADMINISTRATION

Reconstition

–

Route

Oral

Rate of Administration

–

Comments

–

OTHER INFORMATION

If seriously folate deficient, give 10 mg/day for 1 month, then 5 mg/dayDoses up to 15 mg daily have been used in cases of malabsorptionMost nutritionists recommend 0.5–1 mg folic acid daily for patients on

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : or

CAPD

; may accumulate in uraemic patientsDosage used by dialysis units varies from 5 mg daily to 5 mg once weekly.