Folvite Tablet: Uses, Benefits, Dosage And Side Effects

Folvite Tablet is a folic acid tablet. Each uncoated tablet contains folic acid IP 5 mg - the man-made form of vitamin B9, also called folate.

Doctors prescribe it when the body is short of folate, and they decide the dose and how long it is taken for.

Folvite is a folic acid tablet. Each uncoated tablet contains folic acid IP 5 mg - vitamin B9 in the form the body absorbs most easily.

Folic acid belongs to a group of medicines called haematinics, which help the body build healthy red blood cells. It is not a painkiller and not an antibiotic. It replaces one specific vitamin that the body is short of.

• Active ingredient - Folic acid 5 mg in each tablet
• What it is - The man-made form of vitamin B9 (folate)
• Group - Haematinic vitamin
• Pack size in India - Strips of 45 tablets
• Shelf life - 18 months

Check the pack before you take a tablet. More than one medicine is sold under the Folvite name, and they are not interchangeable. Use only the Folvite tablet your doctor prescribed, and check the strength printed on the foil.

Folic acid 5 mg tablets are also made by other companies under other brand names. If your doctor has prescribed folic acid 5 mg, the brand on the strip is not what matters — the strength is.

Folic acid does not block or switch off anything in the body. It is a vitamin, and the body converts it into a working molecule called tetrahydrofolate.

Tetrahydrofolate is a cofactor - something the body needs in order to build the building blocks of DNA and RNA. Cells that divide quickly depend on this step, and the cells in the bone marrow that make red blood cells divide constantly. When folate is in short supply, those cells cannot copy their DNA properly. Instead of maturing into normal red blood cells, they stay large and immature. That is the change doctors call megaloblastic anaemia.

Replace the missing folate, and the bone marrow can mature red blood cells normally again, so the blood count gradually recovers.

Folate works closely with vitamin B12. Both are needed to make red blood cells, but only vitamin B12 is needed to keep the nerves healthy. This is why giving folic acid alone to someone who is also short of vitamin B12 can correct the blood picture while the nerve damage quietly gets worse.

Folate is not stored in the body for long, so it has to come in regularly from food or from a supplement.

Folvite is prescribed to correct a shortage of folate and to treat the problems that shortage causes. It is commonly prescribed for:

• confirmed folate deficiency
• megaloblastic anaemia, given together with vitamin B12
• tropical sprue and non-tropical sprue - conditions in which the gut does not absorb nutrients properly
• folate deficiency caused by long-term heavy drinking
• nutritional anaemia, and the anaemia of pregnancy, infancy and childhood, as part of a wider treatment plan
• pregnancy and pregnancy planning, when a doctor has decided the 5 mg strength is the one needed

What the benefit looks like in practice:

• The vitamin the body is short of is replaced, so the bone marrow can make normal red blood cells again. Symptoms such as tiredness, breathlessness and paleness ease as the blood count recovers.
• Taken before conception and through the first 12 weeks of pregnancy, folic acid reduces the risk of neural tube defects such as spina bifida. The neural tube closes very early — often before a woman knows she is pregnant — which is why starting before pregnancy matters.
• The body's need for folate goes up during pregnancy and breastfeeding, in people on dialysis, in long-term treatment with some epilepsy medicines, and with heavy alcohol use. Folvite keeps the level from falling further in these situations.
• Some medicines, including methotrexate and sulfasalazine, work partly by interfering with folate. Folic acid is often prescribed alongside them to stop folate from dropping too low.

What Folvite Tablet is not for:

• It is not a stand-alone treatment for every kind of anaemia. Some types need other treatment as well, and your doctor will look for those before or alongside prescribing Folvite.
• It does not correct the fall in blood cells caused by cancer chemotherapy. A different form of folate, folinic acid, is used for that, and it is given by injection under medical supervision.
• It is not a general energy booster or a tonic. It helps only where folate is genuinely low.

Your prescription is the dose that counts. The ranges below are the usual prescribed ranges for this tablet in India. They are here to help you understand your prescription — not to let you set your own dose.

• Adults (18 years and over) - 1 to 4 tablets daily, in divided doses
• Children - 1 to 2 tablets daily in divided doses at any age - only when a doctor has prescribed it for your child
• Maintenance, once the blood picture is normal - Half the treatment dose, or as your doctor advises

Practical points:

• Swallow the tablet whole with a glass of water. If you have trouble swallowing tablets, ask your pharmacist for advice.
• Take it at the same time every day. A fixed time makes it far easier to remember.
• Do not change the dose on your own. How much you take and how long you take it for depend on why it was prescribed, and blood counts often need rechecking before the course is finished.
• Do not double up on supplements. If you take a multivitamin or a pregnancy supplement that also contains folic acid, tell your doctor so that the total is not more than intended.

Folvite 5 mg and pregnancy

For most women who are pregnant or trying to conceive, the standard recommendation is 400 micrograms (0.4 mg) of folic acid a day until the 12th week of pregnancy. Some women are advised a much higher dose — 5 mg a day — for example if a previous pregnancy or baby was affected by a neural tube defect.

Folvite contains 5 mg, so it is the strength used for that higher-dose prescription. Only your doctor can decide whether you are one of the women who needs it.

Stopping the tablets

Do not stop suddenly on your own. If you stop before the deficiency is corrected, or before the end of a pregnancy course, folate levels can fall again. Ask your doctor first, and follow their advice.

Missed dose and overdose

If you forget a dose, take it as soon as you remember. If it is nearly time for the next one, skip the missed dose and carry on as usual. Do not take two doses together to make up for one you missed.

Taking a little too much folic acid is unlikely to cause problems, but do not take extra tablets. If a large number of tablets has been taken, or the person feels unwell, get medical help at once and take the strip or pack with you. In India, call 108 for an ambulance, or 112 for any emergency.

Most people do not have problems with folic acid, and serious effects are uncommon.

Side effects that have been reported include:

• bloating or a full feeling in the abdomen
• gas (flatulence)
• feeling sick (nausea)
• loss of appetite
• a bitter or bad taste in the mouth
• feeling generally unwell

These have been reported mainly at high daily doses and usually settle. Tell your doctor or pharmacist if they bother you or do not go away.

Get medical help straight away if you notice any of these:

• swelling of the face, lips, tongue or throat
• a raised, itchy rash, or a rash that spreads
• difficulty in breathing or wheezing
• dizziness or feeling faint
• redness of the skin with itching

These are signs of a serious allergic reaction. Allergic reactions, including a reaction like anaphylaxis, have been reported with folic acid taken by mouth or given by injection. They are uncommon, and they need urgent treatment.

Long-term use

Prolonged treatment with folic acid can lower vitamin B12 levels in the blood. This is another reason your doctor may check your vitamin B12 during treatment.

Alcohol and driving

Limit or avoid alcohol while you are taking Folvite. Heavy drinking lowers folate levels and can work against the medicine.

Folic acid is not expected to affect your ability to drive or use machines. If you feel dizzy or unwell, do not drive until you feel normal again.

You must not take Folvite Tablet if:

• You have had an allergic reaction to folic acid, or to any of the other ingredients in the tablet. This includes a rash, itching, swelling or difficulty in breathing after a dose.
• Your doctor has told you that you are allergic to any ingredient in this tablet. Besides folic acid, the tablet contains lactose, colloidal silicon dioxide, microcrystalline cellulose, starch and magnesium stearate.

That is the only absolute reason not to take this medicine. Everything else is a reason to talk to your doctor first, not to refuse the medicine.

Tell your doctor before starting, or as soon as you can, if any of the following applies to you. In most of these situations the medicine is not forbidden - the decision and the monitoring have to be your doctor's.

• Anaemia of unknown cause. Folic acid can improve the blood count before the cause is known, which can hide a serious problem. The cause needs to be found first.
• Vitamin B12 deficiency or pernicious anaemia. Folic acid alone can correct the blood picture while nerve damage from the vitamin B12 deficiency gets worse. Vitamin B12 must be replaced too, and your doctor will usually check your vitamin B12 level before or during treatment.
• You take medicines for epilepsy. Folic acid can change the blood levels of some of these medicines and can affect seizure control. Never adjust those doses yourself.
• Kidney disease, or you are on dialysis. Folate is lost during dialysis, and your doctor may need to plan your dose around your treatment schedule.
• Liver disease, or you drink heavily. Both lower folate levels and make deficiency more likely.
• You have cancer, or you are having chemotherapy. Folic acid may not be suitable, and a different form of folate is used for the blood count problem caused by chemotherapy.
• You have a coronary stent. Folic acid may not be suitable for some people with a stent. Your doctor will decide.
• You are 65 or older. Your doctor may want to check your vitamin B12 level as you get older.
• You cannot digest lactose. This tablet contains lactose.
• You are pregnant, planning a pregnancy, or breastfeeding. The strength and the timing matter, and both are your doctor's decision.

Pregnancy and breastfeeding

Folic acid is used widely in pregnancy. Studies in pregnant women have not shown that it increases the risk of abnormalities in the baby, and folate is needed for the baby's brain and spine to develop normally. Requirements rise sharply in pregnancy, so it is usually prescribed rather than left to diet alone.

If you are pregnant or planning a pregnancy, do not start or change a folic acid dose on your own - including any supplement you can buy without a prescription. Ask your doctor what strength you need and when to start.

Folic acid passes into breast milk. The amount in breast milk is normally enough for a baby, although supplements may be needed for some babies, such as those who are low birth weight or whose mothers are folate deficient. Folic acid is considered to carry minimal risk to the baby during breastfeeding, but the decision to take it should still be your doctor's.

Always tell your doctor and pharmacist about every medicine you take, including anything bought without a prescription, vitamins and herbal products.

• Medicines for epilepsy — phenytoin, fosphenytoin, phenobarbital, primidone, valproic acid and carbamazepine. High-dose folic acid can lower the blood levels of these medicines, and some of them lower folate levels in turn. Your doctor may need to check levels and adjust doses. In some people with epilepsy, folic acid has been reported to increase seizures when taken with these medicines.
• Methotrexate. This medicine works by interfering with folate, so it can push folate levels down. Folic acid is often prescribed alongside it at a dose your doctor sets, because the two have to be balanced carefully.
• Sulfasalazine. Used for ulcerative colitis, Crohn's disease and rheumatoid arthritis. It can lower folate levels.
• Trimethoprim and co-trimoxazole. Antibiotics that can lower folate levels.
• Pyrimethamine. High-dose folic acid can reduce its blood levels.
• Alcohol. Regular heavy drinking lowers folate levels and can make the treatment less effective.
• Warfarin. Long-term treatment can affect folate status after several months.
• Other things reported to affect folate levels include cholestyramine, colchicine, colestipol, levodopa, high-dose NSAIDs, pancreatic enzymes, pentamidine and triamterene. Smoking is also reported to lower folate.
• Some medicines that may not mix well with folic acid include lithium, aspirin (used for pain relief or for thinning the blood) and the antibiotic chloramphenicol. Long-term use of some contraceptive and antituberculosis medicines can also affect folate.

• Store the tablets below 30°C and protect them from light.
• Keep them in the original strip or pack, out of the reach of children.
• Do not use the tablets after the expiry date on the pack.
• Do not share your medicine with anyone else, even if their symptoms look the same.
• Ask your pharmacist how to dispose of tablets you no longer need, rather than throwing them in the bin or flushing them away.
• Keep a written list of all the medicines you take and show it to your doctor or pharmacist at every visit.