What is the treatment for folic acid deficiency?

Treatment of Folic Acid Deficiency

The recommended treatment for folic acid deficiency is oral folic acid 5 mg daily for at least four months or until the cause of deficiency is corrected. 1

Diagnosis and Assessment

• Folate status should be assessed in plasma or serum (short-term status) or red blood cells (long-term status) using a method validated against microbiological assay 2
• Concurrent measurement of homocysteine improves interpretation of laboratory results 2
• After initiating supplementation, folate levels should be repeated within 3 months to verify normalization 2

Treatment Protocol

Dosage and Duration

• Standard treatment dose: 5 mg oral folic acid daily 1
• Treatment duration: Minimum 4 months or until the underlying cause of deficiency is corrected 1
• Alternative administration: If oral treatment is ineffective or not tolerated, folic acid can be given subcutaneously, IV, or IM at 0.1 mg/day 2

Special Populations

1. Dietary deficiency:

   • 1-5 mg folic acid daily orally 2
   • Continue until blood picture normalizes and clinical symptoms subside

2. Chronic hemodialysis patients:

   • Non-diabetic patients: 5 mg or more daily 2
   • Diabetic patients: 15 mg daily 2

3. Pregnant women:

   • Standard treatment dose: 5 mg daily
   • Maintenance: 600 μg DFE (Dietary Folate Equivalents) daily 2
   • For neural tube defect prevention: 400 μg daily periconceptionally 2, 3

4. IBD patients on specific medications:

   • Patients on methotrexate: 5 mg once weekly 24-72 hours after methotrexate, or 1 mg daily for 5 days per week 2
   • Patients on sulfasalazine: Supplementation with either folic or folinic acid (folinic acid may be more efficient) 2

Maintenance Therapy

After clinical symptoms have subsided and blood picture has normalized:

• Adults: 330 μg DFE daily 2
• Pregnant/lactating women: 600 μg DFE daily 2

Important Considerations and Precautions

Vitamin B12 Deficiency

• Critical warning: High-dose folic acid can mask vitamin B12 deficiency while allowing neurological damage to progress 1, 4
• If neurological involvement is suspected with B12 deficiency:
  • Treat B12 deficiency first with hydroxocobalamin 1 mg intramuscularly on alternate days 1
  • Seek urgent specialist advice from neurologist and hematologist 1

Monitoring

• Check complete blood count to confirm improvement in anemia 1
• Monitor for resolution of clinical symptoms such as fatigue, weakness, irritability, headache, palpitations, and shortness of breath 1

Safety

• Folic acid doses exceeding 1 mg/day may mask vitamin B12 deficiency 1
• Upper limit for folic acid is established at 1 mg/day for general population (higher therapeutic doses are used for treatment) 1
• Excess folic acid is excreted in urine 1

Treatment Efficacy

Folic acid is highly effective in treating megaloblastic anemias due to folate deficiency, as may be seen in:

• Tropical or nontropical sprue
• Nutritional anemias
• Pregnancy-related anemias
• Childhood anemias 5, 6

By following this treatment protocol, patients with folic acid deficiency should experience normalization of folate levels, resolution of anemia if present, and improvement in associated symptoms, significantly reducing morbidity and improving quality of life.