Folate is one of the natural forms of vitamin B. Foods such as okra, beans, spinach, lettuce and other leafy greens have this form of vitamin in excess. It is also present in liver of beef, organ meats such as kidneys, etc. Manmade form of folate is called folic acid; this is prescribed as a supplement to people who take deficient amount of folate in their diet. Folic acid plays an important role in ensuring safe and successful pregnancies. This supplement of folate is also prescribed for the management of mental conditions such as memory lapses and depression. Folic acid is also prescribed along with other types of vitamins to ensure your overall wellbeing. If you are taking folic acid, you need to know the side effects or other adverse reactions it may trigger.
Folate is a form of B-type vitamin, naturally present in a few foods. It ensures cellular health, and is important for the health of red cells in your blood. Deficiency of folate can often lead to blood related conditions such as anemia. Deficiencies are often triggered when a well-planned and balanced diet is not available, excessive dependence on alcohol, abdominal dysfunction or stomach-based disorders. Such deficiencies are also seen in people who need to do dialysis as well as those living with liver related problems. Women may develop inadequate supply of folate during the time of their pregnancy. Women who fail to take ample amounts of folate may give birth to babies with congenital problems – especially, problems with the spine or spinal cord.
Use of folic acid
Folic acid is taken orally, and can be taken either before or after a meal. The commonly prescribed dose is once every day. If you are self-medicating, you need to take needful inputs from your pharmacist or a qualified medical practitioner. Your doctor may prescribe a safer level of consuming this supplement; the safe level is influenced by your clinical condition as well as how well your body responds to intake of this supplement. It is not a good practice to enhance the strength of this supplement without taking the advice of your doctor. According to medical studies, people who took folic acid regularly (i.e., without any breaks) and those who took it at the same timeslot every day benefitted the most.
Folic acid is used in the case management of renal disorders – especially advanced level of kidney problems. Almost 3/4th of people with such advanced-stage of renal dysfunction report a pronounced level of homocysteine; this is often associated with incidence of cardiac arrests as well as strokes. Intake of folic acid is known to reduce the level of homocysteine. In many instances, its levels have been brought down by more than 25%. Your doctor may prescribe folic acid when homocysteine level is seen to exceed 11 micromoles / L.
Folic acid supplementation is also advised for pregnant women to avoid brain or spine related congenital problems. Doctors recommend an intake of about 700 mcg every day all through the time of your pregnancy. Dosages are started as early as 30 days prior to the confirmation of pregnancy.
Side effects of folic acid
The quantum of intake of folic acid remains a key factor behind the types of side effects it can trigger. When its dosage level is limited to 1 milligram (mg) each day, folic acid is less likely to trigger any major discomforts, adverse reactions or side effects. However, people who took folic acid supplements in excess of 1 mg per day regularly have reported a few discomforts. Commonly experienced discomforts and side effects include indigestion, cramping of abdominal muscles, being in a confused state of mind, etc. Side effects may also include insomnia, convulsions, flatulence, a few skin related problems, nausea or mood shifts. Scientific studies also show that intake of folic acid for a longer duration may trigger risks of likely cardiac arrests. These studies also indicate the likelihood of cancerous growth in the urinary tract or your respiratory tract. This supplement of folate is also available as an injectable form. In case of shots administered, they are considered to be safe if the strength is below 1 mg per day.
People living with cardiac conditions as well as autoimmune conditions
People who are living with cardiac conditions need to be additionally cautious while taking folic acid. This is because of the likely contraction (shrinking) of blood vessels upon taking the supplement. For the same reason, vitamins B12 as well as vitamins B6 are also not recommended to people who have a cardiac condition. Of all the means of dosage, shots of these supplements are likely to trigger more risks of contracting or shrinking the arteries. If you have had prior conditions of autoimmune disorders – such as cancers – you are not advised to take folic acid. As the risks associated with incidence of cancers are high, intake of folic acid – especially, in high doses – can enhance the chances of cancers.
Women who are pregnant and those who are nursing a baby
For pregnant women, it is considered safe if the dosage levels are below 350 mcg per day. The upper limit of intake of folic acid by pregnant women is 750 mcg; especially for women aged 18 years. In case of women aged more than 19 years, the daily dosage must not exceed 900 mcg. For women who are nursing a baby, the upper limit is 800 mcg – for those aged 18 years. Women who are aged above 20 years – and are nursing an infant – the daily intake must never exceed 950 mcg.
Administering folic acid to younger adults and children
Dosage of folic acid is determined by the age of younger adults as well as children. For younger adults aged between 15 to 18 years, a dosage level of 700 mcg is recommended per day. Always remember this is the highest dosage limit administered to this age group. Similarly, children aged between 10 to 14 years are never administered with doses more than 550 mcg each day. Dosage level of folic acid is reduced to 350 mcg each day for those aged between 5 to 9 years. A basic dosage level of 250 mcg is given to children aged between 2 to 4 years. You are advised to consult a qualified medical practitioner before giving it to younger adults or children.
Those living in regions where malarial attacks are common need to exert an added level of caution. If you are taking iron supplements due to blood related conditions like anemia, additional precautions are required. These precautions can help avoid serious ailments needing care in a clinical setting or other fatal outcomes. You are advised to talk to your doctor and pharmacist if you are already having malaria. Also, those who are living with epileptic fits may need to stay away from taking large doses of folic acid (i.e., doses in the range of 1 mg or more per day). As this supplement can aggravate convulsions and muscular spasms, you need to consult your treating doctor before starting a medication plan.
Moreover, intake of folic acid can hide the common signs of anemia – especially, deficiency of red blood cells triggered by inadequate levels of vitamin B12. As these signs may show up in a delayed manner, it is likely to worsen your anemic condition and may need more intense treatment methods.
Likely side effects of folic acid due to interactions with other drugs
Supplements such as folic acid can react with other medications. It is a good practice to tell your treating physician about the drugs you are already taking. While sharing information about currently consumed meds, ensure that you have added over the counter (OTC) drugs, prescription medications, herbal supplements and other dietary aids.
Folic acid is likely to interact with drugs taken to treat muscular spasms or convulsions. If your current medication plan involves intake of anti-seizure meds such as phenobarbital, you need to inform your pharmacist about it. Co-administration of folic acid and phenobarbital is likely to lessen the efficacy of the meds and can make them less effective in treating convulsions or spasms. Similarly, folic acid may catalyse the breaking down of antiepileptic drugs such as phenytoin. As breaking down of phenytoin is accelerated, it would render the drug to become less efficient in treating muscular conditions such as convulsions.
Folic acid may also interact adversely with a few drugs taken to treat parasitic attacks as well as infections. For example, it is likely to work on drugs like daraprim (also referred as pyrimethamine) and can alter its potential to treat infections triggered by parasites. You also need to understand that supplements of folic acid are quickly absorbed than the natural forms (folate) found in foods. In some instances, the supplement is also used for topical applications. For example, pregnant women are advised to use it as a mouth-wash to keep gum-related diseases at bay. In such applications, it is a good practice to rinse your mouth with folic acid at least two times each day.
Allergies caused by intake of folic acid are very rare. However, if you notice signs such as rashes, excessive itchiness, breathing problems (like wheezing or gasping), etc. you are advised to talk to your treating doctor immediately. If you have a medical history of anemia (or other blood related problems), renal disorders wherein you are living on dialysis support, parasitic infections, etc. your medical team needs to be fully aware of such prior conditions.
Upon missing a dose, you are advised not to take a dual-dose or doubling the intake this supplement. Instead, you are advised to skip the dose that you forgot to take. Those who took a double dose are likely to witness risks of a likely overdose. Signs characteristic of an overdose are excessive weariness, being in a confused state of mind, inability to stay focused on things, pain in oral organs like tongue, a numbing sensation, etc. In such instances, it is recommended to get in touch with a local poison control center or call 911 immediately.
In sum, the common side effects of folic acid are convulsions, cramping of muscles, confusion, gas formation, abdominal discomforts such as nausea, indigestion, etc. Higher doses are linked to likely occurrence of heart attacks. In some cases, risks of cancerous growth have also been observed. It is important to take doses of folic acid at dosage levels prescribed by your treating doctor. If you need additional inputs about the side effects of folic acid, you are advised to get in touch with your doctor or pharmacist.
Education: Doctor of Physical Therapy (DPT) from New York University. Experience: 5 years of experience writing for physiotherapy and sports medicine blogs, providing expert insights on injury prevention and rehabilitation.
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