From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... In the presence of alcoholism, hemolytic anemia, anticonvulsant therapy, or chronic infection, the maintenance level may need to be increased. The usual therapeutic dosage in adults and children (regardless of age) is up to 1 mg daily. The maintenance level may need to be increased in the presence of alcoholism, but the exact dose is not specified.
- The usual therapeutic dosage is up to 1 mg daily.
- The maintenance level should be at least 0.1 mg/day and may need to be adjusted based on the patient's response. 1
From the Research
For alcohol withdrawal, the recommended dose of folic acid is typically 1 mg daily, which can be continued for several weeks during the withdrawal period and early recovery. This supplementation is important because chronic alcohol use depletes folate levels in the body, which can lead to various health problems including anemia and neurological issues. Alcohol interferes with folate absorption, metabolism, and storage, and many people with alcohol use disorder have poor dietary intake of folate-rich foods. Folic acid supplementation helps restore normal levels and supports red blood cell production and nervous system function. While treating alcohol withdrawal primarily involves medications like benzodiazepines to manage symptoms and prevent complications like seizures and delirium tremens, nutritional support including folic acid is an essential complementary approach. Patients may also benefit from thiamine (vitamin B1) supplementation, typically 100 mg daily, to prevent Wernicke-Korsakoff syndrome, another common complication of chronic alcohol use 2.
Some key points to consider when managing alcohol withdrawal include:
- Benzodiazepines are the first-line treatment for alcohol withdrawal syndrome, as recommended by major guidelines 2
- Thiamine should be administered to all patients to prevent Wernicke-Korsakoff encephalopathy 2
- Maintaining a high level of suspicion for alcohol withdrawal syndrome is important across all clinical settings, and it should be promptly treated 2
- Anticonvulsants, adrenergic alpha-2 agonists, betablockers, and antipsychotics may be used as adjunctive therapy, but are not recommended as monotherapy 3
- Individualizing therapy with withdrawal scales results in administration of significantly less medication and shorter treatment 3
It's worth noting that the evidence for folic acid supplementation in alcohol withdrawal is not as strong as for other aspects of treatment, such as benzodiazepine use. However, given the potential benefits and low risk of harm, folic acid supplementation is still a reasonable approach, especially in patients with suspected or confirmed folate deficiency 4. In general, the management of alcohol withdrawal should prioritize reducing symptoms, preventing complications, and facilitating continued abstinence from alcohol, with a comprehensive approach that includes pharmacological treatment, nutritional support, and ongoing care 5.