older woman with dementia, antipsychotic drugs, excess medicines, folate

Vitamin B9, or folate, is crucial for the normal development of human embryos. That is why pregnant women and those who may become pregnant are urged to take at least 400 mcg daily of folic acid, the synthetic form of this vitamin. Without adequate folate, women may miscarry or give birth to babies with devastating neural tube defects such as spina bifida.

Vitamin B9 is also important for those well beyond infancy. Without enough of this vitamin, people may develop anemia characterized by large red blood cells that expire quickly (megaloblastic macrocytic anemia). Low levels of folate may also lead to elevated amounts of homocysteine, increasing the possibility of strokes and heart attacks. High homocysteine levels have also been linked to cognitive difficulties among seniors; folic acid supplements appear to help.

A Serendipitous Discovery:

Q. My wife had been having widespread muscle pain for weeks, and I suggested taking some of my magnesium L-threonate. We got some out of my pill organizer and she took them; her muscle pain went away.

Given that success, we started to add some to her own box of meds and vitamins. We discovered that she had taken three of my L-methylfolate pills instead.

I searched the web for “deplete folic acid” and found a plethora of medicines that deplete folic acid. Four or five of her meds were listed! Fluticasone, aspirin, metformin, diuretics and other meds deplete folic acid. Luckily, the L-methylfolate we had on hand worked for her.

Drugs That Wipe Out Folate:

A. Folic acid is a crucial B vitamin that can be depleted by many medicines including aspirin, NSAIDs, anticonvulsants, methotrexate, metformin, diuretics, acid-suppressing drugs, oral contraceptives and corticosteroids like fluticasone and prednisone. We offer a list below, but be sure to discuss your concerns with your physician. The dose and duration of drug use have an impact on whether or not folate levels drop dangerously low.

We have not heard of folate deficiency causing terrible muscle pain, but some people find that taking folic acid can reverse restless legs syndrome. Your wife’s doctor should check her folate levels.

Medicines That Deplete Folic Acid:

  • Aluminum/magnesium hydroxide
  • Amiloride
  • Aspirin
  • Azithromycin
  • Beclomethasone (inhaled)
  • Budesonide (inhaled)
  • Bumetanide
  • Calcium carbonate
  • Carbamazepine
  • Cefprozil
  • Cefuroxime
  • Chlorothiazide
  • Cholestyramine
  • Cimetidine
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Colchicine
  • Colesevelam
  • Colestipol
  • Co-trimoxazole
  • Cycloserine
  • Erythromycin
  • Escitalopram
  • Esomeprazole
  • Ethacrynic acid
  • Famotidine
  • Flunisolide (inhaled)
  • Fluoxetine
  • Fluticasone (inhaled)
  • Fosphenytoin
  • Furosemide
  • Hydrochlorothiazide
  • Hydrochlorothiazide/triamterene
  • Hydrocortisone
  • Indapamide
  • Lansoprazole
  • Levofloxacin
  • Loracarbef
  • Magnesium hydroxide
  • Metformin
  • Methotrexate
  • Methychlothiazide
  • Methylprednisolone
  • Metolazone
  • Nizatidine
  • NSAIDs (ie diclofenac, etodolac, ibuprofen, indomethacin, naproxen, oxaprozin, piroxicam, sulindac)
  • Ofloxacin
  • Olanzapine
  • Omeprazole
  • Oral contraceptives
  • Pantoprazole
  • Paroxetine
  • Phenobarbital
  • Phenytoin
  • Prednisolone
  • Prednisone
  • Primidone
  • Quetiapine
  • Rabeprazole
  • Ranitidine
  • Risperidone
  • Sertraline
  • Sodium bicarbonate
  • Sparfloxacin
  • Spironolactone
  • Sulfamethoxazole
  • Sulfasalazine
  • Torsemide
  • Triamcinolone (inhaled)
  • Triamterene
  • Trimethoprim
  • Trovafloxacin
  • Valproic acid
  • Warfarin

Foods Rich in Folate:

  • Asparagus
  • Avocados
  • Bananas
  • Beef liver
  • Broccoli
  • Brussels sprouts
  • Lettuce
  • Kale
  • Oranges
  • Papayas
  • Spinach
  • Tomato juice

In general, dark green leafy vegetables of all sorts tend to be good sources of folate. Legumes, including beans and lentils, are also excellent. Fortified foods such as breads and cereals also supply folic acid.

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