Folate deficiency medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
During pregnancy or lactation
- low risk : 0.4 to 0.8 mg orally once daily starting 1-3 months before pregnancy and continuing until 6 weeks postpartum or the end of lactation
- medium risk: 1 mg orally once daily starting 1-3 months before pregnancy and continuing through the first 12 weeks of pregnancy, followed by 0.4 to 1 mg once daily from week 13 of pregnancy and continuing until 6 weeks postpartum or the end of lactation
- high risk: 4 mg orally once daily starting 1-3 months before pregnancy and continuing through the first 12 weeks of pregnancy, followed by 0.4 to 1 mg once daily from week 13 of pregnancy and continuing until 6 weeks postpartum or the end of lactation
Malabsorption or chronic hemolysis
- Correction of underlying disorder and oral folic acid supplementation (1mg orally once daily)
Congenital folate metabolism defect
- Treatment of children with inborn errors of folate metabolism requires extremely large doses of folic acid given parenterally.
Congenital folate malabsorption
- Folic acid or leucovorin (3-6 mg intramuscularly once daily)
Macrocytic anemia and pancytopenia
- folic acid with vitamin B9 : 1 mg orally once daily ; adults: 1-5 mg orally once daily
- Ruling out vitamin B12 deficiency is important because initiation of folic acid therapy may aggravate underlying neurologic manifestations due to vitamin B12 deficiency.
Pharmacotherapy
Folic acid supplements are normally given with sulfasalazine. The purpose of methotrexate is to inhibit dihydrofolate reductase and thereby reduce the rate de novo purine and pyrimidine synthesis and cell division. It may therefore be counter-productive to take a folic acid supplement with methotrexate. Although the folic acid inhibition of sulfasalazine is normally seen as a side effect, it is possible that it is a part of the therapeutic effect of the drug, given that methotrexate, a frank folic acid inhibitor, is often given if sulfasalazine fails. It would therefore be wise to consult with a physician before taking a folic acid supplement along with sulfasalazine or methotrexate.