On this podcast episode of the top 200 drugs, I’m covering liraglutide, folic acid, clotrimazole, empagliflozin, and semaglutide.
Liraglutide is a GLP-1 agonist that can be used for weight loss as well as diabetes. The most common adverse effect of this medication is nausea.
Folic acid is a commonly used supplement in pregnancy as well as in those patients taking methotrexate. Deficiency of folic acid can lead to anemia.
Clotrimazole is an antifungal agent. It is mostly used for topical purposes such as athlete’s foot and vaginal yeast infections.
Empagliflozin was originally developed as a diabetes medication but can be helpful in patients with heart failure and CKD. I discuss this in greater detail in the podcast.
Semaglutide is another GLP-1 agonist that is used for diabetes care as well as weight loss. The formulation used for diabetes is Ozempic while the weight loss product is Wegovy.
Folic acid is a water-soluble vitamin; compared to fat-soluble vitamins, accumulation is not as much of an issue. It is responsible for the formation of coenzymes, DNA synthesis, erythropoiesis, and certain metabolic processes. Due to the mechanism of folic acid, if there is a deficiency present, anemia can manifest. Although the recommended dietary intake is 0.2 mg, supplementation may be necessary. Some situations where supplementation may be desired are prevention of neural tube defects in pregnancy, patients suffering from alcohol abuse disorder, bariatric surgery patients, and certain types of GI disorders where malabsorption may be present. If a patient is taking certain medications folic acid supplementation may be necessary as well. Notable drugs where a patient may require folic acid include methotrexate and phenytoin.
The dosages used most often when supplementing folic acid are in the 1-5 mg range, and most of the time it will be 1 mg. Folic acid has a relatively safe adverse drug reaction profile. Some possible adverse drug reactions are flushing, malaise, erythema, skin rash, and hypersensitivity reactions. Although uncommon, the chance for an adverse drug reaction occurring increases as the dose increases. For monitoring folic acid, the normal levels can vary between 2-20 ng/mL, but they can vary based upon the lab. A type of anemia that can manifest with a folic acid deficiency is megaloblastic anemia. When assessing megaloblastic anemia, vitamin B12 levels should also be assessed.
Folic acid levels can be impacted by phenytoin, methotrexate, trimethoprim and sulfamethoxazole, sulfasalazine, triamterene, and alcohol. When a patient is only taking trimethoprim and sulfamethoxazole for acute treatment of a UTI, folic acid levels aren’t as concerning. Whenever it changes from acute treatment to prophylaxis, folic acid levels should be monitored more closely. Theoretically, folic acid can lower concentrations of phenytoin, and phenobarbital, so closer monitoring may be warranted.
Show notes provided by Chong Yol G Kim, PharmD Student.
