Folic Acid: Liquid Preparation

Folic acid is manufactured only in 1-mg tablets in the United States. A liquid preparation of 5 mg/ml is more convenient and less expensive than the tablet form. Most patients who respond will demonstrate improvement on a dose of 10-50 mg/day. Many pharmacies will prepare the liquid preparation after a special request. Pharmacies can obtain folic acid powder U.S.P. through Tanabe U.S.A., Inc., 7930 Conroy Ct., San Diego, California 92111 (1-619-571-8410) or Mike Jones at Gallipot (1-800-423-6967). The following formula can be used to mix the folic acid solution to a dilution of 5 mg/ml (provided by Rob Rodgers, Pharm.D., at The Children's Hospital in Denver, Colo.): 10 g folic acid, 2,000 ml H₂O (sterile), 15 ml NaOH 20%--add by titration until mixture clarifies in solution. Folic acid solution is sensitive to heat and photodegradation, and it must be refrigerated and protected from light in a covered or brown bottle. A syringe can be used to measure a typical dose of 5 mg or 1 ml twice a day. As folic acid is relatively tasteless, it can be squirted directly in the mouth or added to juice. The dose is usually given twice a day to avoid stomach irritation or diarrhea, which occasionally occurs.

Folic Acid: Medical Follow-up

The medical follow-up of patients treated with high-dose folic acid includes a periodic physical and neurologic examination and at least annual blood work including a complete blood count (CBC): serum glutamic-oxaloacetic transaminase (SGOT); blood urea nitrogen (BUN); creatinine; urine analysis; and serum levels of zinc, vitamin B₆, and folate. A trial of folic acid therapy should last at least three months because improvements in behavior or attention may not begin until the second month. If folate is helpful, it should be continued, and it can be used together with stimulant medication. At least once every one to two years, the folic acid can be discontinued to assess whether it remains effective. There is some evidence to suggest a mild withdrawal effect in a limited number of patients, characterized by mood lability lasting one to two weeks. This is not uncommon in megavitamin therapy, and it has been described in pyridoxine and ascorbic acid therapy (American Psychiatric Association 1973; Gualtieri et al. 1987).

This article is not intended to give medical advice for individual cases.  Any change in medical treatment should be done in consultation with appropriate medical personnel. This article is written for medical professionals.  Some of the terms will be unfamiliar to those who are not trained in medical fields. *This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002.  It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in the book which are not included as part of this website. The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling 1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.

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