From the FDA Drug Label
Although most patients with malabsorption cannot absorb food folates, they are able to absorb folic acid given orally. The usual therapeutic dosage in adults and children (regardless of age) is up to 1 mg daily. In the presence of alcoholism, hemolytic anemia, anticonvulsant therapy, or chronic infection, the maintenance level may need to be increased.
The usual therapeutic dosage of folic acid for treating folate deficiency, including in patients with cirrhosis of the liver (often associated with alcoholism), is up to 1 mg daily 1.
From the Research
For treating folate deficiency in patients with cirrhosis of the liver, the recommended dosage is typically 1 mg (1000 mcg) of folic acid daily, as supported by the most recent and highest quality study 2. This dosage is based on the understanding that liver disease impairs folate storage and metabolism, and alcohol, a common cause of cirrhosis, interferes with folate absorption and utilization. The treatment should continue until clinical improvement is observed, usually for at least several months, with some patients requiring indefinite supplementation. In severe deficiency cases, doses may be increased to 5 mg daily initially. Oral administration is preferred, but parenteral forms are available for patients with malabsorption or those unable to take oral medications. Regular monitoring of folate levels is recommended during treatment, and patients should be counseled about dietary sources of folate such as leafy greens, fruits, and fortified grains to complement supplementation. Addressing underlying alcohol use, if present, is also essential for successful treatment, as highlighted in studies focusing on the role of folate in liver diseases 3, 4, 5. It's also important to note that folic acid supplementation has been associated with a decreased mortality and reduced hospital readmission in patients with decompensated alcohol-related liver cirrhosis 4. Overall, the goal of treatment is to improve morbidity, mortality, and quality of life for patients with cirrhosis of the liver and folate deficiency. Key points to consider in treatment include:
- Monitoring folate levels regularly
- Adjusting dosage based on severity of deficiency and patient response
- Combining supplementation with dietary counseling
- Addressing underlying causes of cirrhosis, such as alcohol use
- Considering the potential benefits of folic acid supplementation on liver disease outcomes, as suggested by recent research 2.