Folvite (Folic Acid (Folate, Vitamin B9))
Also sold as: Folvite, Dolfol, Fol 5, Gynafol, Falic
Pregnancy
Cat A
Lactation
Safe
Schedule
OTC
Forms
Tablet 0.4mg (400 mcg), 0.5mg (500 mcg), 5mg +2
Indications
- Neural tube defect prevention (periconceptional supplementation — most critical indication)
- Megaloblastic anaemia due to folate deficiency
- Folate deficiency (malnutrition, malabsorption, excessive alcohol)
- Methotrexate-induced folate depletion (weekly low-dose MTX — rescue therapy)
- Haemolytic anaemia with rapid RBC turnover (increased folate demand)
- Prevention in women on anti-epileptics (carbamazepine, valproate — enzyme inducers deplete folate)
Adult Dosing
Neural tube defect prevention (periconceptional)
0.4–0.5 mg (400–500 mcg) PO daily for at least 1 month before conception and throughout 1st trimester (12 weeks)
HIGH RISK (previous NTD, anti-epileptics, diabetes, BMI > 30): 4–5 mg/day prescribed by doctor. Start as soon as planning pregnancy — NTD occurs at Day 21–28 of embryo (before many women know they are pregnant).
Folate deficiency / megaloblastic anaemia
5 mg PO once daily for 4 months
IMPORTANT: Rule out B12 deficiency first — treating B12 deficiency with high-dose folate alone can mask haematological signs while neurological damage progresses.
Methotrexate-induced depletion
1–5 mg PO once daily (on non-MTX days) or 5 mg weekly (the day after MTX)
Ongoing — concurrent with MTX therapy (improves tolerability, reduces side effects)
Pediatric Dosing
Premature infants: 50 mcg/kg/day. Haemolytic anaemia (sickle cell, thalassaemia): 5 mg/day supplementation.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No dose adjustment — water-soluble, renally excreted |
Hepatic Adjustment
No dose adjustment required
Pregnancy & Lactation
Pregnancy: Category A
THE MOST IMPORTANT PRE-PREGNANCY SUPPLEMENT. Reduces neural tube defects (spina bifida, anencephaly) by 70% with periconceptional supplementation. Required from BEFORE conception through 1st trimester. All women of childbearing age who might become pregnant should take 0.4 mg/day (ICMR, WHO, USPSTF Grade A recommendation).
Lactation: Safe
Safe and recommended during breastfeeding — lactating women need 500 mcg/day (increased from 400 mcg). Widely present in breast milk.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Methotrexate | MTX is a folate antagonist — folic acid supplementation reduces MTX toxicity (especially GI and hepatic) without significantly reducing anti-inflammatory efficacy in rheumatoid arthritis or psoriasis | Minor |
| Anti-epileptics (phenytoin, carbamazepine, valproate, phenobarbital) | Reduce folate levels (enzyme induction, folate antagonism). High-dose folic acid may REDUCE phenytoin levels — complex interaction; use caution. Ensure adequate folate supplementation with anti-epileptics in women of childbearing age. | Moderate |
| Trimethoprim-sulfamethoxazole, pyrimethamine | Folate antagonists — reduce folate utilisation (but NOT absorption; folinic acid/leucovorin needed if competing for DHFR) | Moderate |
| Zinc | High-dose zinc may reduce folate absorption — separate doses | Minor |
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Side Effects
Common
- Generally very well tolerated
- Mild GI symptoms (nausea, bloating — at high doses)
- Bitter taste
Serious / Discontinue If
- Masking of vitamin B12 deficiency (critical — neurological damage can progress while anaemia is masked by folate supplementation; always check B12 before high-dose folic acid)
- Seizure threshold lowering (very high doses — theoretical)
- Possible increase in cancer risk (unmetabolised folic acid from supplementation — debated; stay within recommended doses)
Contraindications
- Folate-dependent tumours (theoretical — no established absolute contraindication in practice)
- Untreated vitamin B12 deficiency (treat B12 concurrently)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Folvite 5mg | Wyeth | 30 tab ₹42 |
| Dolfol 5mg | Elder | 30 tab ₹38 |
| Fol 5 (5mg) | Cipla | 30 tab ₹35 |
| IFA (Iron + Folic Acid) 60mg+500mcg | HLL (Govt) | Govt supply |
Monitoring Required
- Serum folate (baseline; target > 7 nmol/L)
- Serum B12 (ALWAYS check before starting high-dose folic acid — to avoid masking B12 deficiency)
- Full blood count (MCV, Hb — response at 4–8 weeks)
- Homocysteine (elevated in both B12 and folate deficiency)
- Reticulocyte count (early therapeutic response)
Patient Counseling Points
- ⚠️ ALL WOMEN PLANNING PREGNANCY: start folic acid 0.4 mg BEFORE becoming pregnant — the baby's spine closes very early (day 21–28, before you know you are pregnant)
- Previous baby with spina bifida or neural tube defect: need HIGH dose (5 mg/day) — must discuss with your doctor
- Folate is found in green leafy vegetables, legumes, citrus fruits — eat these foods AND take supplements
- Folic acid for methotrexate: take on non-methotrexate days — it reduces nausea and liver side effects from methotrexate without reducing its effect
- Taking anti-epileptic medications: always tell your neurologist if planning pregnancy — higher dose folic acid may be needed, and anti-epileptic dose adjustment may also be required
- Never take folic acid instead of checking for B12 deficiency — B12 deficiency can have serious neurological consequences
Stop Googling drug references mid-consultation
EasyClinic auto-flags Folvite interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Suresh Menon, DM (Endocrinology), Consultant Endocrinologist
Last reviewed: 2026-04-01
References
- ICMR RDA Folic Acid 2020
- USPSTF Folic Acid Supplementation Grade A (2017)
- WHO Neural Tube Defect Prevention Guidelines
- BNF — Folic Acid
- FOGSI Guidelines on Pre-conceptional Care