Possible Interaction: Folic Acid and Valproic Acid

“Co-administration of folic acid with VPA reduced the rate of Neural Tube Defects (NTD) and other anomalies in rodents, but apparently not in pregnant women.”

“These results suggested that the increase in folic acid uptake after exposure to VPA can be attributed to the induction of FRα and PCFT expression.”

“Therefore, the avoidance of valproate or at least supplementation with a high dose prophylactic folic acid before and during pregnancy is highly recommended for women with epilepsy.”

“BackgroundAntiepileptic drugs (AEDs) like phenytoin (PHE), carbamazepine (CBZ), barbiturates and valproic acid (VPA) interfere with folic acid absorption and metabolism, which in turn can be the cause of adverse pregnancy outcome.”

“With regard to monotherapies, in the group of women taking VPA , supplementation of folic acid had significant benefit.”

“All women taking valproate and carbamazepine are advised to take 4 mg/day of folic acid at least one month before pregnancy and during the first trimester.”

“There are many reports of drugs which may increase (e.g. folic acid , dexamethasone and rifampicin) or decrease (e.g. valproic acid , sulthiame, isoniazid, cimetidine, phenylbutazone, chloramphenicol and some sulphonamides) the metabolism of phenytoin.”

“In conclusion, FA co-treatment can modulate ovarian follicular and hormonal disturbances induced by valproate , which needs further investigations to identify the precise mechanisms.”

“ Folic acid significantly reduces, and conversely, folate antagonist methotrexate (MTX) and valproic acid (VPA) increase the occurrence of NTDs, including MMC.”

“Therefore, we strongly recommend avoidance of valproic acid and supplementation of folic acid during pregnancy.”

“This article highlights a study by Pittschieler et al. that has suggested that supplementation with folic acid might be particularly important in women with epilepsy who are taking antiepileptic medications—especially valproate.”