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Medications that are folic acid antagonists raise the risk not only of neural tube defects but also of cardiovascular, urinary tract, and orofacial defects, according to Dr. Sonia Hernandez-Diaz of Boston University and her associates.
One group of such agents is dihydrofolate reductase inhibitors, which block the conversion of folate to its more active metabolites. These drugs include aminopterin sulfasalazine, pyrimethamine, triamterene, trimethoprim, and methotrexate (N. Engl. J. Med. 343[22]:1608-14, 2000).
A second group acts by affecting other enzymes in folate metabolism, impairing folate absorption, or enhancing folate degradation. These agents include ...