M-FOLATE TABLET

Indications

• Folate deficiency
• Hyperhomocysteinemia
• Supporting treatment in certain neurological disorders
• Prevention of neural tube defects during pregnancy

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations.

Adults: Refer to the BNF for specific dosing recommendations.

Mechanism of action

Levomefolic acid acts as a methyl donor in the conversion of homocysteine to methionine, a reaction that is catalyzed by vitamin B12-dependent methionine synthase. This process is essential for reducing homocysteine levels and facilitating the production of S-adenosylmethionine (SAMe), which participates in various methylation reactions, including neurotransmitter synthesis.

Pharmacodynamics

Levomefolate serves as an active metabolite in one-carbon metabolism, regulating key cellular functions such as DNA synthesis, gene expression, and amino acid metabolism. By acting as a cofactor in the synthesis of neurotransmitters like dopamine, serotonin, and norepinephrine, it plays a vital role in maintaining mental health and cognitive function. Additionally, it contributes to red blood cell formation and myelin synthesis.

Pharmacokinetics

Levomefolate is absorbed efficiently from the gastrointestinal tract and is known to cross the blood-brain barrier, which is significant for its role in neurological functions. It is metabolized in the liver and excreted through urine. Its pharmacokinetic profile is influenced by individual variations in folate metabolism and transport pathways.

Pregnancy

Levomefolic acid is generally considered safe during pregnancy as it is a natural form of folate.

Breast-feeding

Levomefolic acid is compatible with breastfeeding, as it is a natural metabolite of folate.

Storage

Store in a cool, dry place away from direct sunlight.

Mechanism of action

Levomefolic acid plays a critical role in methylating homocysteines into methionine by acting as a methyl donor in a reaction catalyzed by vitamine B12-dependent methionine synthase. Homocysteine must either be further metabolized via transulfuration to become cysteine, taurine, and glutathione via a B6-dependent process, or re-methylated to become methionine again. Methionine formed from remethylation of homocysteine by levomefolic acid forms the downstream metabolite S-adenosylmethionine (SAMe), which is involved in numerous biochemical methyl donation reactions, including reactions forming monoamine neurotransmitters. Studies suggest that high plasma levels of homocysteine is associated with increased incidences of arterial plaque formation.

Pharmacodynamics

Levomefolic acid is an active metabolite of folic acid and a methyl group donor in one-carbon metabolism reactions. It regulates important cellular functions such as DNA biosynthesis, gene expression regulation, amino acid synthesis and metabolism, and myelin synthesis and repair. As a only form of folate that can cross the blood-brain barrier, it acts as a cofactor in the production of monoamine neurotransmitters such as dopamine, serotonin and norepinephrine. Levomefolic acid is also involved in red blood cell formation.