Phenytoin-Folic Acid Interaction

1995 ◽  
Vol 29 (7-8) ◽  
pp. 726-735 ◽  
Author(s):  
Dale P Lewis ◽  
Don C Van Dyke ◽  
Laurie A Willhite ◽  
Phyllis J Stumbo ◽  
Mary J Berg
Keyword(s):  
Folic Acid ◽  
Steady State ◽  
Case Reports ◽  
Folic Acid Supplementation ◽  
Serum Folate ◽  
Folic Acid Deficiency ◽  
Folate Supplementation ◽  
Acid Therapy ◽  
Acid Supplementation ◽  
Patients With Epilepsy

Objective: To review information regarding the dual and interdependent drug-nutrient interaction between phenytoin and folic acid and other literature involving phenytoin and folic acid. Data Sources: Information was retrieved from a MEDLINE search of English-language literature conducted from 1983 (time of the last review) to March 1995. Search terms included folic acid, phenytoin, and folic acid deficiency. Additional references were obtained from Current Contents and from the bibliographies of the retrieved references. Study Selection: All human studies examining the effects of phenytoin on serum folate concentrations and folic acid supplementation on serum phenytoin concentrations were selected. These included studies of patients with epilepsy and healthy volunteers as well as case reports. Case reports were included because of the extensive length of time needed to study this drug interaction. Data Extraction: Data extracted included gender, dosing, serum folate concentrations if available, pharmacokinetics, and adverse events. Data Synthesis: Serum folate decreases when phenytoin therapy is initiated alone with no folate supplementation. Folic acid supplementation in folate-deficient patients with epilepsy changes the pharmacokinetics of phenytoin, usually leading to lower serum phenytoin concentrations and possible seizure breakthrough. Folate is hypothesized to be a cofactor in phenytoin metabolism and may be responsible for the “pseudo-steady-state,” which is a concentration where phenytoin appears to be at steady-state, but in reality, is not. Phenytoin and folic acid therapy initiated concomitantly prevents decreased folate and phenytoin obtains steady-state concentrations sooner. Conclusions: Folic acid supplementation should be initiated each time phenytoin therapy commences because of the hypothesized cofactor mechanism, decreased adverse effects associated with folate deficiency, and better seizure control with no perturbation of phenytoin pharmacokinetics.

Folate: In Vitro and in Vivo Effects on VLDL and LDL Oxidation

2007 ◽  
Vol 77 (1) ◽  
pp. 66-72 ◽  
Author(s):  
McEneny ◽  
Couston ◽  
McKibben ◽  
Young ◽  
Woodside
Keyword(s):  
Folic Acid ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Folic Acid Supplementation ◽  
Serum Folate ◽  
Ldl Oxidation ◽  
Low Density ◽  
Acid Supplementation

Raised total homocysteine (tHcy) levels may be involved in the etiology of cardiovascular disease and can lead to damage of vascular endothelial cells and arterial wall matrix. Folic acid supplementation can help negate these detrimental effects by reducing tHcy. Recent evidence has suggested an additional anti-atherogenic property of folate in protecting lipoproteins against oxidation. This study utilized both an in vitro and in vivo approach. In vitro: Very-low-density lipoprotein (VLDL) and low density lipoprotein (LDL) were isolated by rapid ultracentrifugation and then oxidized in the presence of increasing concentrations (0→ μmol/L) of either folic acid or 5-methyltetrahydrofolate (5-MTHF). In vivo: Twelve female subjects were supplemented with folic acid (1 mg/day), and the pre- and post-VLDL and LDL isolates subjected to oxidation. In vitro: 5-MTHF, but not folic acid, significantly increased the resistance of VLDL and LDL to oxidation. In vivo: Following folic acid supplementation, tHcy decreased, serum folate increased, and both VLDL and LDL displayed a significant increase in their resistance to oxidation. These results indicated that in vitro, only the active form of folate, 5-MTHF, had antioxidant properties. In vivo results demonstrated that folic acid supplementation reduced tHcy and protected both VLDL and LDL against oxidation. These findings provide further support for the use of folic acid supplements to aid in the prevention of atherosclerosis.

Folic acid attenuates homocysteine and enhances antioxidative capacity in atherosclerotic rats

2017 ◽  
Vol 42 (10) ◽  
pp. 1015-1022 ◽  
Author(s):  
Shanshan Cui ◽  
Wen Li ◽  
Xin Lv ◽  
Pengyan Wang ◽  
Guowei Huang ◽  
...  
Keyword(s):  
Folic Acid ◽  
Antioxidant Capacity ◽  
Wistar Rats ◽  
Folic Acid Supplementation ◽  
Plasma Homocysteine ◽  
Serum Folate ◽  
Antioxidative Capacity ◽  
High Fat ◽  
Acid Supplementation ◽  
Atherosclerotic Lesions

Atherosclerosis is a chronic disease that can seriously endanger human life. Folic acid supplementation modulates several disorders, including atherosclerosis, via its antiapoptotic and antioxidative properties. This study investigated whether folic acid alleviates atherogenesis by restoring homocysteine levels and antioxidative capacity in atherosclerosis Wistar rats. To this end, 28 Wistar rats were randomly divided into 4 groups (7 rats/group) as follows: (i) wild-type group, fed only the AIN-93 semi-purified rodent diet (folic acid: 2.1 mg/kg); (ii) high-fat + folic acid-deficient group (HF+DEF) (folic acid: 0.2 mg/kg); (iii) high-fat + normal folic acid group (folic acid: 2.1 mg/kg); and (iv) high-fat + folic acid-supplemented group (folic acid: 4.2 mg/kg). After 12 weeks, histopathological changes in the atherosclerotic lesions of the aortic arch were determined. In addition, serum folate levels, plasma homocysteine levels, plasma S-adenosyl-homocysteine levels, antioxidant status, oxidant status, and lipid profiles were evaluated. The results show aggravated atherosclerotic lesions in the HF+DEF group. Folic acid supplementation increased concentrations of serum folate. Further, folic acid supplementation increased high-density lipoprotein-cholesterol, decreased plasma homocysteine levels, and improved antioxidant capacity in atherogenic rats. These findings are consistent with the hypothesis that folic acid alleviates atherogenesis by reducing plasma homocysteine levels and improving antioxidant capacity in rats fed a high-fat diet.

Folic Acid Supplementation and Twin Pregnancy in Patients with Sickle Cell Disease.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3744-3744
Author(s):  
Samir K. Ballas ◽  
Jason Baxter ◽  
Gaye Riddick
Keyword(s):  
Folic Acid ◽  
Sickle Cell Disease ◽  
Pregnant Women ◽  
Sickle Cell ◽  
Folic Acid Supplementation ◽  
Multiple Births ◽  
Cell Disease ◽  
Folate Supplementation ◽  
Acid Supplementation ◽  
Twin Pregnancies

Abstract Patients with sickle cell disease (SCD) usually take 1mg of folic acid daily. The rationale for this approach is to maintain effective erythropoiesis with a stable hemoglobin level. Other potential advantages of folate therapy in patients with SCD include the prevention of hyperhomocysteinemia that may predispose to thrombotic events, which, in turn, may lead to painful episodes. Moreover, folate supplementation during pregnancy is known to prevent neural tube defects in infants. The major disadvantage of folate supplementation in patients with SCD is that it may mask vitamin B12 deficiency. Another controversial effect of folic acid supplementation pertains to its potential effect on the number of twins coming to term. We reviewed our database on patients with SCD to determine the effect, if any, of folic acid supplementation on twin pregnancies. The data were collected prospectively since 1981. All patients routinely took 1.0 mg of folic acid orally on a daily basis. Random testing of the level of folic acid in the steady state in women with SCD including those who became pregnant showed increased levels to > 20ng/ml (Normal range: 3.0–18.0 ng/ml) in most patients. Pregnant patients also took additional perinatal vitamins that also contained folic acid. We selected those pregnant patients in whom the outcome of pregnancy was either a liveborn or stillborn at or after 20 weeks’ gestation. We found that 46 patients with SCD became pregnant 60 times between 1981 and 2002 and who met the defined criteria mentioned above. The average maternal age at delivery was 26 years. Fifty-six pregnancies (93%) ended in liveborn and the remaining four (7%) in intrauterine fetal death. Five pregnancies (8.3%) resulted in the delivery of twins. This is a significantly higher rate of multiple births compared to other pregnant women. The reported rate of multiple births is between 0.34 and 1.1% both in Black and Caucasian women respectively. All twin births were dizygotic in nature. Patients with SCD take higher amounts of folic acid on a regular basis for a longer period of time before and after pregnancy than other pregnant women. This may explain why twin pregnancies are higher in these patients. The reason why folate therapy is associated with twinning is unknown at the present. Further studies may clarify the pathogenetic pathway of this phenomenon.

scholarly journals Optimizing periconceptional folic acid supplementation: Steady‐state folate pharmacokinetics in pregnancy (LB416)

2014 ◽  
Vol 28 (S1) ◽  
Author(s):  
Mahvash Shere ◽  
Patricia Nguyen ◽  
Carolyn Tam ◽  
Seth Stern ◽  
Bhushan Kapur ◽  
...  
Keyword(s):  
Folic Acid ◽  
Steady State ◽  
Folic Acid Supplementation ◽  
Acid Supplementation ◽  
Pharmacokinetics In Pregnancy ◽  
In Pregnancy

scholarly journals B vitamins for stroke prevention

2018 ◽  
Vol 3 (2) ◽  
pp. 51-58 ◽  
Author(s):  
Graeme J Hankey
Keyword(s):  
Clinical Trials ◽  
Folic Acid ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Folic Acid Supplementation ◽  
Adverse Outcomes ◽  
B Vitamins ◽  
Vitamin B ◽  
Folate Supplementation ◽  
Acid Supplementation

Supplementation with B vitamins (vitamin B9(folic acid), vitamin B12 and vitamin B6) lowers blood total homocysteine (tHcy) concentrations by about 25% and reduces the relative risk of stroke overall by about 10% (risk ratio (RR) 0.90, 95% CI 0.82 to 0.99) compared with placebo. Homocysteine-lowering interventions have no significant effect on myocardial infarction, death from any cause or adverse outcomes. Factors that appear to modify the effect of B vitamins on stroke risk include low folic acid status, high tHcy, high cyanocobalamin dose in patients with impaired renal function and concurrent antiplatelet therapy. In regions with increasing levels or established policies of population folate supplementation, evidence from observational genetic epidemiological studies and randomised controlled clinical trials is concordant in suggesting an absence of benefit from lowering of homocysteine with folic acid for prevention of stroke. Clinical trials indicate that in countries which mandate folic acid fortification of food, folic acid supplementation has no significant effect on reducing stroke risk (RR 1.05, 95% CI 0.90 to 1.23). However, in countries without mandatory folic acid food fortification, folic acid supplementation reduces the risk of stroke by about 15% (RR 0.85, 95% CI 0.77 to 0.94). Folic acid alone or in combination with minimal cyanocobalamin (≤0.05 mg/day) is associated with an even greater reduction in risk of future stroke by 25% (RR 0.75, 95% CI 0.66 to 0.86), whereas the combination of folic acid and a higher dose of cyanocobalamin (≥0.4 mg/day) is not associated with a reduced risk of future stroke (RR 0.95, 95% CI 0.86 to 1.05). The lack of benefit of folic acid plus higher doses of cyanocobalamin (≥0.4 mg/day) was observed in trials which all included participants with chronic kidney disease. Because metabolic B12 deficiency is very common and usually not diagnosed, future randomised trials of homocysteine-lowering interventions for stroke prevention should probably test a combination of folic acid and methylcobalamin or hydroxocobalamin instead of cyanocobalamin, and perhaps vitamin B6.

scholarly journals Reviewing Anemia and Iron Folic Acid Supplementation Program in Bangladesh - A Special Article

1970 ◽  
Vol 39 (3) ◽  
Author(s):  
M Rashid ◽  
MS Flora ◽  
MA Moni ◽  
A Akhter ◽  
Z Mahmud
Keyword(s):  
Folic Acid ◽  
Holistic Approach ◽  
Folic Acid Supplementation ◽  
Deficiency Anemia ◽  
Family Welfare ◽  
Folic Acid Deficiency ◽  
Care Providers ◽  
Acid Supplementation ◽  
Iron Folic Acid Supplementation ◽  
Iron Folic Acid

Despite supplementation of iron folic acid tablets over the past few decades, no marked improvement has been noticed in the magnitude of anemia in Bangladesh. It has been a felt need to have a fresh look at the problem of iron/folic acid deficiency anemia prevailing in Bangladesh and the perspective of the supplementation program. Data were collected through a review of a good number of available documents and in-depth interviews of concerned policy makers, stakeholders and care providers. An iron folic acid supplementation component is formally in place in the Health, Nutrition, and Population Sector Program (HNPSP) and implemented by both the health and family planning wings of the Ministry of Health and Family Welfare (MoHFW). The iron folic acid component primarily focuses on the pregnant and lactating women and fails to focus other groups who also are equally affected. Tablets are provided on a weekly basis, thus not completing the required dose. A holistic approach is required to combat this long standing problem.DOI: http://dx.doi.org/10.3329/bmj.v39i3.9952 BMJ 2010; 39(3)

scholarly journals The Effect of Albendazole Administration and Iron-Folic Acid Supplementation on Hemoglobin Level in Primary Schoolchildren with Soil-transmitted Helminth Infections

2020 ◽  
Vol 8 (B) ◽  
pp. 938-942
Author(s):  
Willhans Wijaya ◽  
Ayodhia Pitaloka Pasaribu ◽  
Erwin Suteno ◽  
Nirmala Husin ◽  
Syahril Pasaribu
Keyword(s):  
Single Dose ◽  
Folic Acid ◽  
Folic Acid Supplementation ◽  
Hemoglobin Level ◽  
Deficiency Anemia ◽  
Folic Acid Deficiency ◽  
Acid Supplementation ◽  
Primary Schoolchildren ◽  
Iron Folic Acid Supplementation ◽  
Iron Folic Acid

BACKGROUND: Soil-transmitted helminth (STH) infections were the highest infection in children aged 5–15 years old. They lead to iron deficiency anemia and folic acid deficiency. One of the strategies to treat the issues is anthelmintic administration with iron-folic acid supplementation. AIM: This study aims to evaluate the effectiveness of single-dose albendazole and albendazole with iron-folic acid supplementation on hemoglobin (Hb) levels in children with STHs. METHODS: This was an open-label randomized clinical trial conducted in Batubara Regency from September to November 2018. Subjects were primary schoolchildren with STH infections. They were grouped into albendazole and albendazole with iron-folic acid supplementation groups. The data were analyzed by independent t-test and Mann–Whitney U-test. RESULTS: From 139 children, 72 children received albendazole single dose and 67 children received albendazole with 30 mg iron and 250 μg folic acid weekly for 3 months. The median of baseline hemoglobin level was 12.2 gr/dL, whereas after intervention was 12.7 gr/dL. The hemoglobin level increases did not differ significantly between the two groups (p > 0.05). However, clinical improvement was observed. CONCLUSION: Iron-folic acid supplementation in addition to albendazole did not show any benefit for primary schoolchildren with STH infection in Batubara Regency, North Sumatera, Indonesia.

Obesity is associated with folate metabolism

2020 ◽  
Vol 90 (3-4) ◽  
pp. 353-364 ◽  
Author(s):  
Süleyman Köse ◽  
Saniye Sözlü ◽  
Hatice Bölükbaşi ◽  
Nüket Ünsal ◽  
Makbule Gezmen-Karadağ
Keyword(s):  
Folic Acid ◽  
Folic Acid Supplementation ◽  
Normal Weight ◽  
Folate Intake ◽  
Serum Folate ◽  
Systemic Review ◽  
Lower Serum ◽  
Cross Sectional ◽  
Acid Supplementation ◽  
Supplement Use

Abstract. Objective: The aim of the present study is to perform a systemic review of the previous studies executed on the association between obesity and folate. Method: In the present research, the selected keywords were scanned on the PubMed, Web of Science, Cochrane and Lilac databases between May and June, 2017 through Gazi University’s network. In total, 4236 clinical, randomized controlled, cross-sectional and prospective studies were determined and 17 of these that specifically fit the aims of the present research were reviewed. This study involved an electronic literature search of databases on folic acid and obesity published in the English language between 2000 and 2016. Results: Of the 17 studies, 5 were based on folic acid supplementation and 12 were related with participants’ folate status. As a general consequence of both intake and serum/status measurements of folic acid supplementation: It was found that obesity-associated metabolic changes might affect individual folate use and obese individuals had lower serum folate levels, although there was no change in folate intake. Conclusion: Overweight and obese individuals have lower serum folate concentrations when compared with individuals with normal weight. It is explained by increased use of folic acid, urinary excretion, dilution of blood volume, different levels in different tissues and changes in the endocrine functions of folate. Individuals with higher Body Mass Indexes have less supplement use, unhealthier diets and donot consume sufficient vegetables and fruits, all of which can affect decrease in folate levels. Furthermore, adiposity may affect folate absorption by intestinal epithelium.

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