What is oral cyanocobalamin?

Cyanocobalamin, also known as Vitamin B12, is a form of vitamin B found in foods. Vitamin B12 is important for growth, cell reproduction and energy, healthy red blood cell formation and to keep your nerve cells healthy.

Cyanocobalamin is likely effective in alternative medicine as an aid in treating or preventing low levels of vitamin B12 in your body. Low levels of Vitamin B12 can be caused by an autoimmune disease, pernicious anemia, certain types of surgery, stomach disorders, or malnutrition.

Cyanocobalamin has been used in alternative medicine as a possibly effective aid in treating canker sores, and may help lower homocysteine levels in blood (a risk factor for heart disease).

Cyanocobalamin has also been used to treat memory and thinking problems, Alzheimer’s disease, reduce falls, help with bone health, cataracts, and sleep disorders. However, research has shown that cyanocobalamin may not be effective in treating these conditions.

Cyanocobalamin may also be used for purposes not listed in this medication guide.

Oral cyanocobalamin side effects

Get emergency medical help if you have signs of an allergic reaction: hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Less serious side effects may be more likely, and you may have none at all.

This is not a complete list of side effects and others may occur.

Warnings

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use cyanocobalamin if you are allergic to vitamin B12, cobalamin, or cobalt.

Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have ever had:

• any condition that makes it hard for your body to absorb nutrients from food (malabsorption);
• cancer; or
• if you use a blood thinner (such as warfarin).

Ask a doctor before using cyanocobalamin if you are pregnant or breastfeeding.

Do not give cyanocobalamin to a child without medical advice.

How should I use oral cyanocobalamin?

When considering the use of cyanocobalamin, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use cyanocobalamin, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

Do not use different forms of cyanocobalamin (pills, liquids, and others) at the same time or you could have an overdose.

Carefully follow instructions about whether to take your cyanocobalamin with or without food.

Swallow the extended-release tablet whole and do not crush, chew, or break it.

You must chew the chewable tablet thoroughly before you swallow it.

Measure cyanocobalamin liquid with the supplied measuring device (not a kitchen spoon).

Do not swallow a lozenge, disintegrating tablet, or sublingual tablet whole. Allow it to dissolve in your mouth without chewing. sublingual tablet or liquid should be placed under your tongue.

If you need surgery, tell the surgeon ahead of time that you are using cyanocobalamin. You may need to stop using cyanocobalamin for a short time.

Cyanocobalamin can affect the results of certain lab tests. Tell any doctor who treats you that you are using cyanocobalamin.

The recommended daily dose of cyanocobalamin changes with age. Follow your healthcare provider’s instructions. You may also consult the Office of Dietary Supplements of the NIH, or the USDA Nutrient Database of recommended daily allowances for more information.

Call your doctor if the condition you are treating with cyanocobalamin does not improve, or if it gets worse while using this product.

Store at room temperature away from moisture, heat, and light.

Store the cyanocobalamin liquid in the refrigerator after opening for best results.

Cyanocobalamin dosing information

Usual Adult Dose for Pernicious Anemia:

Initial dose: 100 mcg intramuscularly or deep subcutaneous once a day for 6 to 7 days
If clinical improvement and reticulocyte response is seen from the above dosing:
-100 mcg every other day for 7 doses, then:
-100 mcg every 3 to 4 days for 2 to 3 weeks, then:
Maintenance dose: 100 to 1000 mcg monthly
Duration of therapy: Life

Comments:
-Administer concomitant folic acid if needed.
-Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption.

Usual Adult Dose for B12 Nutritional Deficiency:

25 to 2000 mcg orally daily

Usual Adult Dose for Schilling Test:

1000 mcg intramuscularly is the flushing dose

Usual Pediatric Dose for B12 Nutritional Deficiency:

0.5 to 3 mcg daily

What happens if I miss a dose?

Use cyanocobalamin as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while using oral cyanocobalamin?

Avoid drinking large amounts of alcohol. Heavy drinking can make it harder for your body to absorb cyanocobalamin.

What other drugs will affect oral cyanocobalamin?

Do not use cyanocobalamin without medical advice if you are using any of the following medications:

• vitamin C supplements;
• folic acid;
• potassium supplements;
• oral diabetes medicine that contains metformin; or
• medicines that reduce stomach acid, such as cimetidine, omeprazole, lansoprazole, Nexium, Prevacid, Prilosec, Zantac, and others.

Cholecalciferol is vitamin D3. Vitamin D helps your body absorb calcium.

Cholecalciferol is used as a dietary supplement in people who do not get enough vitamin D in their diets to maintain adequate health.

Cholecalciferol may also be used for purposes not listed in this guide.

Cholecalciferol side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking cholecalciferol and call your doctor at once if you have:

• chest pain, feeling short of breath;
• growth problems (in a child taking cholecalciferol); or
• early signs of vitamin D overdose–weakness, metallic taste in your mouth, weight loss, muscle or bone pain, constipation, nausea, and vomiting.

Less serious side effects may be more likely, and you may have none at all.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

You should not take cholecalciferol if you have had an allergic reaction to vitamin D, or if you have high levels of calcium or vitamin D in your body, or any condition that makes it hard for your body to absorb nutrients from food (malabsorption).

Before taking this medicine

You should not use cholecalciferol if you have had an allergic reaction to vitamin D, or if you have:

• high levels of vitamin D in your body (hypervitaminosis D);
• high levels of calcium in your blood (hypercalcemia); or
• any condition that makes it hard for your body to absorb nutrients from food (malabsorption).

Tell your doctor if you have ever had:

• heart disease;
• kidney disease; or
• an electrolyte imbalance.

Certain forms of cholecalciferol may contain ingredients you should know about, such as peanut or soybean oil, sugar, aspartame (phenylalanine), or certain food dyes. Ask a doctor before using cholecalciferol if you have allergies, diabetes, or phenylketonuria (PKU).

Too much vitamin D could harm an unborn baby or a nursing baby. Ask a doctor before using cholecalciferol if you are pregnant or breastfeeding. Your dose needs may be different during pregnancy or while you are nursing.

Do not give cholecalciferol to a child without medical advice. Your child’s dose will depend on age, weight, diet, and other factors.

How should I take cholecalciferol?

Follow all directions on your prescription label and read all the guides or instruction sheets. Use only the recommended dose of cholecalciferol.

It may be best to take cholecalciferol after a meal, but you may take it with or without food.

Measure liquid cholecalciferol carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

The chewable tablet must be chewed before you swallow it.

To take a disintegrating (Quick-Melt) tablet, place it on your tongue and do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. If desired, you may drink liquid to help swallow the dissolved tablet.

The cholecalciferol wafer is usually taken only once per week or once per month. Follow your doctor’s dosing instructions very carefully. The wafer must be chewed before you swallow it.

While using cholecalciferol, you will need frequent blood tests. You may also need x-rays.

Your doctor will determine how long to treat you with cholecalciferol.

Cholecalciferol may be only part of a complete program of treatment that also includes dietary changes and taking calcium and vitamin supplements. Follow your doctor’s instructions very closely.

Learn about the foods you should eat to make sure you get enough calcium and vitamin D in your diet. Your cholecalciferol dose may need to be adjusted as you make changes to your diet.

Store at room temperature away from moisture, light, and heat.

Cholecalciferol dosing information

Usual Adult Dose for Vitamin/Mineral Supplementation:

US Recommended Dietary Allowance (RDA) for vitamin D:
18 to 70 years: 15 mcg (600 international units) daily
Tolerable Upper Intake Level: 100 mcg (4000 international units)

Usual Geriatric Dose for Vitamin/Mineral Supplementation:

US Recommended Dietary Allowance (RDA) for vitamin D:
70 years and older: 20 mcg (800 international units) daily
Tolerable Upper Intake Level: 100 mcg (4000 international units)

Usual Pediatric Dose for Vitamin/Mineral Supplementation:

US Recommended Dietary Allowance (RDA) for vitamin D:

0 to 6 months: 10 mcg (400 international units) daily
Tolerable Upper Intake Level (UL): 25 mcg (1000 international units)

7 to 12 months: 10 mcg (400 international units) daily
UL: 38 mcg (1500 international units)

1 to 3 years: 15 mcg (600 international units) daily
UL: 63 mcg (2500 international units)

4 to 8 years: 15 mcg (600 international units) daily
UL: 75 mcg (3000 international units)

9 to 18 years: 15 mcg (600 international units) daily
UL: 100 mcg (4000 international units)

What happens if I miss a dose?

Take cholecalciferol as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of vitamin D can cause serious or life-threatening side effects.

Overdose symptoms may include nausea, loss of appetite, thirst, urinating more or less than usual, body aches, stiffness, confusion, or irregular heartbeats.

What should I avoid while taking cholecalciferol?

Ask a doctor or pharmacist before taking any multivitamins, mineral supplements, or antacids while you are taking cholecalciferol.

What other drugs will affect cholecalciferol?

Certain medications can make it harder for your body to absorb vitamin D. If you take other medications, take them at least 2 hours before or 2 hours after you take cholecalciferol.

Other drugs may affect cholecalciferol, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

Calcitriol is a form of vitamin D3. Vitamin D helps your body absorb calcium from the stomach.

Calcitriol is used to treat hyperparathyroidism (overactive parathyroid glands) and metabolic bone disease in people who have chronic kidney failure and are not receiving dialysis.

Calcitriol is also used to treat calcium deficiency in people with hypoparathyroidism (underactive parathyroid glands) caused by surgery, disease, or other conditions.

Calcitriol is also used to treat calcium deficiency (hypocalcemia) and metabolic bone disease in people who are receiving dialysis.

Calcitriol may also be used for purposes not listed in this medication guide.

Calcitriol side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Calcitriol may cause serious side effects. Stop using calcitriol and call your doctor at once if you have:

• dehydration symptoms–feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin;
• high calcium levels–nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, confusion, lack of energy, or tired feeling; or
• low calcium level–muscle spasms or contractions, numbness or tingly feeling (around your mouth, or in your fingers and toes).

Calcitriol can affect growth in children. Tell your doctor if your child is not growing at a normal rate while using calcitriol.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

You should not use this medicine if you have high levels of calcium or vitamin D in your blood, or if you have ever had an allergic reaction to calcitriol or other forms of vitamin D.

Before taking this medicine

You should not use calcitriol if:

• you have high levels of calcium or vitamin D in your blood; or
• you have had an allergic reaction to calcitriol or other forms of vitamin D.

Tell your doctor about all your medical conditions or allergies.

It is not known whether calcitriol will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

You should not breastfeed while using calcitriol.

Do not give this medicine to a child without medical advice.

How should I use calcitriol?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Calcitriol oral is taken by mouth.

Measure oral liquid carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Calcitriol injection is given as an infusion into a vein. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.

Read and carefully follow any Instructions for Use provided with your medicine. Prepare an injection only when you are ready to give it. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.

You will need frequent medical tests.

Drink plenty of fluids unless your doctor has told you to restrict your fluid intake.

You may need to follow a special diet while using calcitriol. Follow all instructions of your doctor or dietitian. Learn about the foods to eat or avoid to help control your condition.

Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking calcitriol. This can lead to very low blood pressure, a serious electrolyte imbalance, or kidney failure.

If you need major surgery or will be on long-term bed rest, your dose or testing needs may change. Follow your doctor’s instructions.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Early signs of overdose may include headache, weakness, drowsiness, dry mouth, metallic taste, nausea, vomiting, constipation, stomach pain, loss of appetite, muscle pain, or bone pain.

Late signs of overdose may include increased thirst, itching, increased urination (especially at night), severe stomach pain spreading to your back, irregular heartbeats, loss of appetite, weight loss, feeling hot, decreased interest in sex, or being unable to urinate.

What should I avoid while using calcitriol?

Do not take other vitamin or mineral supplements unless your doctor has told you to.

Ask your doctor before using an antacid or laxative, especially if you are on dialysis. Taking antacids or laxatives that contain magnesium may increase your blood levels of magnesium, which could affect your heart or blood pressure.

What other drugs will affect calcitriol?

Tell your doctor about all your other medicines, especially:

• cholestyramine;
• digoxin, digitalis;
• ketoconazole;
• a diuretic or “water pill”–hydrochlorothiazide, HCTZ, Diovan HCT, Hyzaar, Maxzide, Tenoretic, Zestoretic, and others;
• seizure medicine–phenobarbital, phenytoin; or
• steroid medicine–prednisone, dexamethasone, fluticasone, and others.

Biotin, also known as Vitamin B7, is a form of vitamin B found in foods. Biotin helps the body break down fats, carbohydrates, and proteins into energy.

Biotin is likely effective in alternative medicine as an aid in treating or preventing low levels of biotin. Low levels of biotin can be caused by malnutrition, rapid weight loss, long-term tube feeding, and other medical conditions.

Biotin has also been used to treat the symptoms of multiple sclerosis (MS) and seborrhea (in babies). However, research has shown that biotin may not be effective in treating these conditions.

Other uses not proven with research have included treating brittle nails, hair loss, diabetes, nerve pain, depression, and other conditions.

Biotin may also be used in combination with other vitamins in adults and children as a dietary supplement.

It is not certain whether biotin is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Biotin should not be used in place of medication prescribed for you by your doctor.

Biotin is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Biotin may also be used for purposes not listed in this product guide.

Biotin side effects

Get emergency medical help if you have signs of an allergic reaction: hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Common side effects may include diarrhea or respiratory problems.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use this product if you are allergic to biotin.

Before using biotin, talk to your healthcare provider. Your dose needs may be different if you:

• have a deficiency of the enzyme called biotinidase;
• smoke; or
• kidney disease (or if you are on dialysis).

Ask a doctor before using this product if you are pregnant or breastfeeding.

Do not give any herbal/health supplement to a child without medical advice.

How should I take biotin?

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use biotin, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

Biotin is available in tablet, liquid, and capsule formulations. Do not use different formulations of biotin at the same time without medical advice. Using different formulations together increases the risk of an overdose of biotin.

Do not swallow the orally disintegrating tablet, or sublingual tablet. Allow the orally disintegrating tablet to dissolve in your mouth without chewing. The sublingual tablet should be placed under your tongue to allow it to dissolve.

Measure biotin liquid with the supplied measuring device (not a kitchen spoon). Biotin may also be given through a feeding tube. Ask your doctor or pharmacist if you don’t understand these instructions.

Eating 2 or more raw egg whites for several months may prevent the body from absorbing biotin.

Biotin can cause cause false results on a drug-screening urine test. Tell the laboratory staff that you use biotin.

The recommended daily dose of biotin changes with age. Follow your healthcare provider’s instructions. You may also consult the Office of Dietary Supplements of the NIH, or the USDA Nutrient Database of recommended daily allowances for more information.

Call your doctor if the condition you are treating with biotin does not improve, or if it gets worse while using this product.

What is folic acid?

Folic acid (vitamin B9) is a B vitamin supplement that may be used to prevent and treat folate deficiency (low blood levels of folate) that can cause megaloblastic anemia. Folic acid may also be used to control high levels of homocysteine, prevent serious birth defects in pregnant women or women who think they may be pregnant, and prevent methotrexate-induced folate deficiency in people prescribed methotrexate.

Folic acid has been FDA approved since 1947.

Folate vs folic acid

Folate is the natural form of vitamin B9 found in various foods. Folic acid is the man-made form of vitamin B9 created in a laboratory that is added to fortified foods or used as a supplement. Folic acid is more stable and easier to absorb than naturally occurring folate in food. When you take folic acid, your body turns it into folate.

Folic acid benefits

Vitamin B9 (folate, folic acid) plays a crucial role in healthy red blood cell production and is also vital for cell growth, repair, and DNA synthesis.

• Red blood cells carry oxygen throughout your body, and folate deficiency can lead to a type of anemia called folate-deficiency anemia. Symptoms of this anemia include fatigue, weakness, shortness of breath, and pale skin.
• Folate is especially important during periods of rapid cell division, such as pregnancy and fetal development.

Benefits of folic acid supplementation include:

Preventing and treating folate-deficiency anemia. Folate is vital for the production of red blood cells (RBCs) and low levels of folate can cause folate-deficiency anemia (known medically as megaloblastic anemia), characterized by RBCs that are unusually large, structurally abnormal, and do not function properly. There are also fewer of them.

Preventing neural tube and other birth defects in the developing fetus in pregnant women. Folic acid helps ensure the proper closure of the neural tube early in pregnancy. The neural tube forms the brain, spinal cord, and surrounding structures and closes 28 to 32 days after a baby is conceived, which is often before many women know they are pregnant. This is why the CDC recommends all people capable of becoming pregnant get 400 micrograms (mcg) of folic acid daily.

• This means women should start taking folic acid BEFORE they are pregnant, at the time they decide to try for a baby.

Lowering high levels of homocysteine in the blood (hyperhomocysteinemia). This can be caused by low dietary intake of folic acid, folate, vitamin B6, vitamin B12, thyroid disease, kidney disease, psoriasis, genetic reasons, or some medications. High homocysteine levels can damage the lining of the arteries and make blood clot more easily which can increase your risk of cardiovascular disease.

Reducing toxicity caused by the drug methotrexate. Methotrexate can cause low levels of folate in the body which can increase the risk of side effects such as nausea, vomiting, and mouth sores. Taking folic acid 5mg weekly, on a different day to the methotrexate dose seems to reduce these side effects.

Potential Other Benefits. Research is ongoing, but folic acid may have other benefits, such as reducing the risk of certain cancers, supporting mood and cognitive function, and possibly reducing the risk of dementia and the development of autism spectrum disorder (ASD).

What are the symptoms of folate deficiency?

Folate deficiency can be caused by not enough folate in the diet, a problem absorbing folate, or an increased need for folate (for example pregnant or breastfeeding women). Folate deficiency symptoms include:

• fatigue, feeling tired, or rundown
• heart palpitations or a fast heartbeat
• shortness of breath
• mouth ulcers, or an inflamed and painful tongue
• mood changes, such as depression or irritability
• sleep problems, such as insomnia,
• cognitive problems, such as a decline in thinking and memory.

Pregnant women who are folate deficient or do not consume enough daily dietary folate or folic acid during the first few weeks of pregnancy have an increased risk of their baby having a birth defect, such as spina bifida (incomplete closure of the spinal cord), anencephaly (misinformation of the brain or skull), congenital heart disease (malformation of the heart), cleft lip and palate (abnormal closure of the lip and palate), problems with the development of the arms and legs, or an abnormal formation of the kidneys or bladder (obstructive uropathies).

Folic acid foods

Folic acid is added to some staple foods to ensure broader access to this crucial vitamin and prevent birth defects.

• Since 1998, the United States has mandated the fortification of cereal grains with folic acid. Fortified foods high in folic acid are labeled “enriched” and include flour (including corn masa flour used to make corn tortillas) pasta, bread, rice, and breakfast cereal.
• Some other foods also have folic acid added under voluntary fortification rules, but these manufacturers need to follow the FDA food additive regulations.

Certain natural food sources remain excellent sources of folate. Folate-rich foods include:

• Leafy green vegetables such as spinach, kale, collard and mustard greens, and turnip greens.
• Other vegetables including okra, asparagus, and brussels sprouts are good choices.
• Fruits while not as high as vegetables, certain fruits like oranges, papayas, and strawberries contribute folate.
• Beans and legumes such as lentils, black beans, peanuts, black-eyed peas, kidney beans, and chickpeas
• Other folate-containing foods include yeast, mushrooms, animal liver and kidney, orange juice, and tomato juice.

Folic acid supplement side effects

Folic acid side effects are more likely to occur with higher dosages of folic acid (up to 15 mg/day) and include:

• nausea
• loss of appetite
• bloating or gas
• stomach pain
• bitter or unpleasant taste in your mouth
• confusion or trouble concentrating
• sleep problems
• mood changes, such as depression or excitement
• impaired judgment.

Low vitamin B12 levels may occur in patients receiving prolonged folic acid therapy.

Serious side effects and warnings

Folic acid is relatively nontoxic in humans but rare instances of an allergic reaction to folic acid have been reported. You should not use this medication if you have ever had an allergic reaction to folic acid. Get emergency medical help if you have signs of an allergic reaction to folic acid: hives, rash, itching, skin redness, wheezing, difficulty breathing, swelling of your face, lips, tongue, or throat.

May increase the risk of seizures in some people with epilepsy receiving phenobarbital, primidone, or diphenylhydantoin.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA .

Before taking this medicine

You should not use this medicine if you have ever had an allergic reaction to folic acid.

Ask a doctor or pharmacist if this medicine is safe to use if you have ever had:

• epilepsy or other seizure disorder
• cirrhosis or other liver disease
• kidney disease (or if you are on dialysis)
• hemolytic anemia
• pernicious anemia
• anemia that has not been diagnosed by a doctor and confirmed with laboratory testing
• a condition that affects how well you absorb nutrients, such as celiac disease or inflammatory bowel disease
• an infection or
• alcoholism.

Tell your doctor if you are pregnant or breastfeeding.

These conditions may be causing folate deficiency, require additional medications or a higher dose of folic acid, or further laboratory investigation. For example:

• Folic acid in dosages above 0.4mg daily may hide laboratory changes caused by pernicious anemia without halting the progression of neurological changes. This may result in severe nervous system damage before the correct diagnosis is made.

Pregnancy

Folic acid requirements markedly increase during pregnancy and deficiency will cause harm to the unborn baby. Studies in pregnant women have not shown that folic acid increases the risk of fetal abnormalities if
administered during pregnancy.

Breastfeeding

Folic acid is excreted in the milk of breastfeeding mothers. During lactation, folic acid requirements are
markedly increased; however, amounts present in human milk are adequate to fulfill infant requirements,
although supplementation may be needed in low-birth-weight infants, in those who are breast-fed by
mothers with folic acid deficiency (50 mcg daily), or in those with infections or prolonged diarrhea.

Fertility

Long-term studies to evaluate the effect of folic acid on fertility have not been conducted.

How should I use folic acid supplements?

Take folic acid exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow all directions on your medicine label and package.

Oral administration of folic acid is preferred.

• Although most patients with malabsorption cannot absorb food folates, they can absorb folic acid given orally.
• Administration by injection is not usually recommended but may be necessary for some people receiving parenteral or enteral nutrition.

Folic acid tablets are usually taken by mouth with a full glass of water.

Folic acid injection is given into a muscle, under the skin, or into a vein. A healthcare provider will give you this injection.

Your doctor may occasionally change your dose depending on your blood tests to make sure you get the best results from this medication.

Folic acid is sometimes used in combination with other medications to treat pernicious anemia.

Folic Acid Dosing

Folic acid is an important nutrient and folate or folic acid should be consumed daily.

• The recommended dietary allowance (RDA) of folic acid for adults is 400 mcg DFE (dietary folate equivalents) daily.
  • 1 mcg DFE is the same as 1 mcg of folate in food or 0.6 mcg of folic acid supplements. This is because you absorb more from folic acid supplements than you do from food.
• In pregnancy, the RDA of folic acid is 600 mcg DFE daily (some sources recommend 400 to 800 mcg DFE)
• In breastfeeding, the RDA of folic acid is 500 mcg DFE daily.
• In children, the RDA depends on age.
  • Birth to 6 months: 65 mcg DFE
  • Infants 7–12 months: 80 mcg DFE
  • Children 1–3 years: 150 mcg DFE
  • Children 4–8 years: 200 mcg DFE
  • Children 9–13 years: 300 mcg DFE
  • Teens 14–18 years: 400 mcg DFE
  • Adults 19+ years: 400 mcg DFE.

Megaloblastic Anemia

• Adults: 1 mg folic acid once a day.
  • Rule out B12 deficiency.
  • Dosages of up to 5 mg may be used if indicated.
  • May continue until clinical symptoms of folate deficiency and the hematological profile have normalized.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Except during pregnancy and lactation, folic acid should not be given in dosages higher than 0.4 mg daily until pernicious anemia has been ruled out.

Call your healthcare provider, seek emergency medical attention, or call the Poison Help line if you take more folic acid than recommended.

What should I avoid while taking folic acid?

Follow your doctor’s instructions about any food, beverages, or activity restrictions.

What other drugs will affect folic acid?

Ask a doctor or pharmacist before using folic acid with any other medications, especially:

• methotrexate
• nitrofurantoin
• pyrimethamine
• tetracycline. False low serum and red cell folate levels may occur with some antibiotics that suppress the growth of Lactobacillus casei.
• a barbiturate such as phenobarbital or secobarbital
• seizure medicine such as phenytoin or primidone. The anticonvulsant action of some seizure medications can be antagonized by folic acid and increased dosages of the anticonvulsant may be needed
• sulfasalazine. May reduce the body’s ability to absorb folate.

What is niacin?

Niacin, also called nicotinic acid, is a B vitamin (vitamin B3). It occurs naturally in plants and animals, and is also added to many foods as a vitamin supplement. It is also present in many multiple vitamins and nutritional supplements.

Niacin is used to lower blood levels of “bad” cholesterol (low-density lipoprotein, or LDL) and triglycerides, and increase levels of “good” cholesterol (high-density lipoprotein, or HDL).

Niaspan is used to lower the risk of a heart attack in people who have high cholesterol and who have a history of heart attacks. Niaspan can also be used with another cholesterol medicine to slow down the build-up of fatty deposits in your arteries.

Warnings

You should not take niacin if you have severe liver disease, a stomach ulcer, or active bleeding.

Niacin can cause certain side effects, such as flushing (warmth, itching, redness, or tingly feeling under your skin). These effects can be made worse if you drink alcohol or hot beverages shortly after you take this medicine. These effects should disappear over time as you keep taking the medication.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid taking colestipol (Colestid) or cholestyramine (Locholest, Prevalite, Questran) at the same time you take niacin. If you take either of these other medications, take them at least 4 to 6 hours before or after you take this medicine.

Niacin is only part of a complete program of treatment that may also include diet, exercise, weight control, and other medications. Follow your diet, medication, and exercise routines very closely.

Before taking this medicine

You should not take niacin if you are allergic to it.

To make sure you can safely take niacin, tell your doctor if you have ever had:

• severe liver disease;
• a stomach ulcer; or
• active bleeding.

Tell your doctor if you have ever had:

• liver disease;
• kidney problems;
• heart disease, chest pain (angina);
• gout; or
• diabetes.

It is not known whether niacin will harm an unborn baby. You may not be able to use this medicine during pregnancy. Tell your doctor right away if you become pregnant.

You should not breastfeed while using this medicine.

Do not give niacin to a child without medical advice.

How should I take niacin ?

Use niacin exactly as directed on the label, or as prescribed by your doctor. Read all medication guides or instruction sheets.

Niacin can cause flushing (warmth, itching, redness, or tingly feeling under your skin). These effects should disappear over time as you keep taking the medicine. Flushing may be worse if you drink alcohol or hot beverages shortly after taking niacin.

Swallow the capsule or tablet whole and do not crush, chew, break, or open it.

Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Avoid medication errors by using only the form and strength your doctor prescribes.

If you stop taking niacin for any length of time, talk with your doctor before starting the medication again. You may need to restart the medication at a lower dose.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using this medicine.

Niacin is only part of a complete treatment program that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

Your doctor may recommend you take aspirin or an NSAID (such as ibuprofen, Advil, or Aleve) to help prevent flushing. Keep using these medicines for as long as your doctor has prescribed.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What to avoid

Avoid drinking alcohol. It may increase your risk of liver damage, and can also worsen the flushing effects of niacin.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Avoid eating foods high in fat or cholesterol, or niacin will not be as effective.

Niacin side effects

Get emergency medical help if you have signs of an allergic reaction to niacin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• heart attack symptoms – chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;
• high blood sugar – increased thirst, increased urination, dry mouth, fruity breath odor;
• unexplained muscle pain, tenderness or weakness;
• a light-headed feeling, like you might pass out;
• irregular heartbeats;
• severe warmth or redness under your skin;
• vision problems; or
• jaundice (yellowing of the skin or eyes).

Common niacin side effects may include:

• flushing (sudden warmth, redness, or tingly feeling);
• upset stomach, nausea, vomiting, diarrhea;
• abnormal liver function tests;
• itching, rash, dry skin;
• cough;
• skin discoloration; or
• headache.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA

What other drugs will affect niacin?

You should not take colesevelam, colestipol, or cholestyramine within 4 hours before or 4 hours after taking niacin.

Tell your doctor about all your other medicines, especially:

• other medicines to lower cholesterol or triglycerides;
• aspirin;
• blood pressure medicine; or
• a blood thinner – warfarin, Coumadin, Jantoven.