Folic acid derivatives and vitamin B12
*Folic acid (leucovorin)
Brand name:
*Leucovorin (wellcovorin) - is a reduced form of folic acid that is available for oral, intramuscularly, and intravenous use.
*Hydroxocobalamin (Hydro-crysti 12) - is the traditional treatment for pernicious anemia and vitamin B12 deficiency. It must be given intramuscularly every day for 5 to 10 days to build up levels, then once a month for life. It cannot be taken orally, because the problem with pernicious anemia is the in ability to absorb vitamin B12 to low the levels of intrinsic factors. It can be used in states of increased demand or dietary deficiency, but oral vitamins are preferred in most of those cases
*Cyanocobalamin (nascobal) >is not as tightly bound to proteins and does not last in the body as long as hydroxocobalamin does. It is available as an intranasal gel that allows vitamin B12 absorption directly through the nasal mucosa. > Is used once a week as an intranasal spray in one nostril.
Pharmacokinetics: These vitamins are well absorbed after injection, metabolized mainly in the liver, and excreted in urine. Much of the hydroxocobolamin is highly protein bound and slowly released for use in the body. Cyanocobalamin is primarily stored in the liver and slowly released as needed for metabolic functions. The vitamins are considered essential during pregnancy and lactation because of the increase demand of the mother’s metabolism
Action: Reduced form of folic acid, required for nucleoprotein synthesis and maintenance of normal erythropoieses.
SIDE EFFECTS: Allergic sensitization has been reported following both oral and parenteral administration of folic acid.
ADVERSE EFFECT: Allergic reactions, pain and discomfort of injection sites. Allergic sensitization has been reported following both oral and parenteral administration of folic acid.
CONTRAINDICATION: These drugs are contraindicated in the presence of known allergies to these drugs or to the components. They should be used cautiously in patients who are pregnant or lactating or who have other anemias. Nasal cyanocobalamin should be use with caution in the presence of nasal erosion or ulcers.
DRUG INTERACTIONS: If you are taking this medication under your doctor's direction, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially have certain antibiotics (chloramphenicol, nitrofurantoin), methotrexate, pyrimethamine, and sulfasalazine. This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
NURSING RESPONSIBILITIES:
* Monitor Acute pain related to injection or nasal irritation
*Risk for fluid volume imbalances related to cardiovascular effects
*Deficient knowledge regarding drug therapy
