Which of the following medications should be taken with folic acid to reduce risk of neural tube defects?

• A. Sulfasalazine
• B. Paroxetine
• C. Amitriptyline
• D. Gabapentin

Answer: (A)

Folic acid is essential in early pregnancy to help prevent neural tube defects, and some medications can interfere with folate levels. Sulfasalazine, a sulfa-containing drug used for inflammatory bowel disease and some rheumatologic conditions, inhibits intestinal folate absorption. Because folate deficiency during the early weeks of pregnancy increases the risk of neural tube defects, women taking sulfasalazine are typically advised to take folic acid alongside the medication to maintain adequate folate levels. The other drugs listed do not have this folate-absorption issue and thus do not specifically require folic acid co-supplementation for neural tube defect prevention.