L-Methyltetrahydrofolate Calcium

Usage

• L-Methyltetrahydrofolate Calcium is primarily prescribed to address metabolic imbalances associated with depression and schizophrenia. It is also used to treat low folate levels and anemia. It may also be used for major depressive disorder, schizophrenia, cardiovascular diseases, and cancer. Further, it can help prevent DNA changes that may lead to cancer.
• Pharmacological Classification: Medical food, vitamin supplement.
• Mechanism of Action: L-Methyltetrahydrofolate Calcium is the active form of folate, a B vitamin crucial for DNA synthesis, cell division, and neurotransmitter production. Unlike folic acid, it doesn’t require metabolic conversion and directly enters the central nervous system, supporting neurotransmitter function and potentially improving symptoms of mental disorders. It is also important for the formation of red blood cells.

Alternate Names

• L-Methylfolate Calcium
• L-5-MTHF-Ca
• Metafolin (brand name)
• Levomefolate calcium
• Mybro-LMF Tablet (this tablet contains additional vitamins)
• Fol-XT Tablet (this tablet contains additional vitamins)
• Deplin (brand name)

How It Works

• Pharmacodynamics: L-Methyltetrahydrofolate Calcium acts as a cofactor in one-carbon transfer reactions essential for DNA synthesis, repair, and methylation. It supports the synthesis of purines and pyrimidines (building blocks of DNA and RNA) and facilitates methylation reactions impacting gene expression and neurotransmitter metabolism.
• Pharmacokinetics: L-Methyltetrahydrofolate is absorbed readily in the gastrointestinal tract and is transported across the blood-brain barrier. It is thought that elimination pathways involve both hepatic and renal clearance after metabolism.
• Mode of Action: It is involved in single carbon unit transfer and is reduced to tetrahydrofolate to be active. It plays a role in nucleic acid synthesis and homocysteine remethylation and interconversion of serine and glycine amino acids.
• Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation: It doesn’t bind to specific receptors but acts as a cofactor for enzymes involved in DNA synthesis and neurotransmitter production, indirectly modulating neurotransmitter levels (e.g., serotonin, dopamine, norepinephrine). It corrects vitamin B12 deficiency, thereby helping in treating certain anemias and nerve problems.

Dosage

Standard Dosage

Adults:

• 7.5 mg to 15 mg daily, orally, with or without food, as directed by a physician.

Children:

• Dosage should be determined by a pediatrician based on the child’s weight, age, and medical condition.

Special Cases:

• Elderly Patients: Standard adult dosage, with close monitoring for potential side effects.
• Patients with Renal Impairment: Dosage adjustment may be necessary; consult a nephrologist.
• Patients with Hepatic Dysfunction: Dosage adjustment may be necessary; consult a hepatologist.
• Patients with Comorbid Conditions: Consider individual patient factors and comorbid conditions (e.g., diabetes, cardiovascular disease) when determining the optimal dosage.

Clinical Use Cases

• The provided sources do not specifically mention the dosage recommendations for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Dosage adjustments in these situations should be determined on a case-by-case basis under the guidance of a specialist.

Dosage Adjustments

• Modifications may be necessary depending on renal/hepatic function, metabolic disorders, and potential drug interactions.

Side Effects

Common Side Effects

• Nausea
• Stomach upset
• Confusion
• Sleeplessness

Rare but Serious Side Effects

• Allergic reactions (skin rash, hives, itching, swelling, difficulty breathing)

Long-Term Effects

• The available sources do not indicate specific long-term effects, but continuous monitoring is advised.

Adverse Drug Reactions (ADR)

• Allergic reactions necessitate immediate medical attention.

Contraindications

• Hypersensitivity to any component of the product.

Drug Interactions

• Antiepileptic drugs (e.g., phenytoin, carbamazepine, valproic acid): May reduce folate absorption or enhance antiepileptic metabolism, potentially leading to breakthrough seizures.
• Capecitabine: Folinic acid may increase its toxicity.
• Alcohol: May interfere with absorption.
• Other medications, OTC drugs, and supplements: Consult a physician to evaluate potential interactions.

Pregnancy and Breastfeeding

• Consult a physician before use during pregnancy and breastfeeding, though it is generally considered safe.
• Adequate folate intake is crucial during pregnancy for fetal development.

Drug Profile Summary

• Mechanism of Action: Active form of folate, vital for DNA synthesis, cell division, and neurotransmitter production.
• Side Effects: Nausea, stomach upset, confusion, sleeplessness, allergic reactions.
• Contraindications: Hypersensitivity.
• Drug Interactions: Antiepileptic drugs, capecitabine, alcohol.
• Pregnancy & Breastfeeding: Consult a physician before use.
• Dosage: 7.5mg to 15mg daily (adults), pediatric dosage needs to be determined by a pediatrician.
• Monitoring Parameters: Monitor folate levels, complete blood count (CBC), liver and kidney function if necessary.

Popular Combinations

• Methylcobalamin and Pyridoxal-5-phosphate: Often combined to address vitamin B deficiencies comprehensively.

Precautions

• General Precautions: Assess for allergies, metabolic disorders, and organ dysfunction.
• Specific Populations: Consult a physician before use during pregnancy and breastfeeding. Pediatric and geriatric dosages require careful consideration.
• Lifestyle Considerations: Limit alcohol intake.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for L-Methyltetrahydrofolate Calcium?

A: The usual adult dosage is 7.5 mg to 15 mg daily. Pediatric and special population dosages should be determined by a physician.

Q2: Can L-Methyltetrahydrofolate Calcium be taken during pregnancy?

A: Consult a physician before use during pregnancy; however, adequate folate is essential during pregnancy.

Q3: What are the potential drug interactions with L-Methyltetrahydrofolate Calcium?

A: Significant interactions can occur with antiepileptic drugs and capecitabine. Alcohol may also interfere with absorption.

Q4: What is the difference between L-Methyltetrahydrofolate Calcium and folic acid?

A: L-Methyltetrahydrofolate is the active form of folate and doesn’t require metabolic conversion, unlike folic acid. It may also be less likely to mask vitamin B12 deficiency.

Q5: Can L-Methyltetrahydrofolate Calcium be used to treat anemia?

A: Yes, it can treat anemia caused by folate deficiency.

Q6: Are there any long-term effects of using L-Methyltetrahydrofolate Calcium?

A: Current research does not indicate any specific long-term side effects, but regular monitoring is recommended.

Q7: Can patients with kidney or liver problems take this medication?

A: Dosage adjustments might be necessary. Consult a nephrologist or hepatologist, respectively, for guidance.

Q8: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember, unless it’s close to the next scheduled dose. Do not double the dose.

Q9: Can this be taken with other B vitamins?

A: Yes, it is often combined with methylcobalamin (B12) and pyridoxal-5-phosphate (B6) for comprehensive B vitamin supplementation. It is important to discuss your individual needs and potential drug interactions with your doctor.