What happens if you take folic acid twice a day?
By
Dr Natalia Marceli Stephanes (PhD)
Author bio
Dr Natália Marcéli Stephanes PhD is a Pharmacist with expertise in Drugs Administration and Toxicity; Discovery of New Drugs; Cancer Treatment; Biochemical Analyzes and Hematological Analyzes. She writes and reviews content on these topics.
Dr Natália Marcéli Stephanes’ Highlights:
- Pharmacist at the Department of Health of Santa Catarina State, Brazil
- PhD with a focus on oncology treatment
- Years of experience in commercial pharmacy
- Bachelor, Master and PhD degrees in Pharmacy at the Federal University of Santa Catarina
Professional Experience:
From her undergraduate studies to her Master’s and Doctorate degrees in Pharmacy, Dr Natália Marcéli Stephanes has participated in numerous scientific studies in the field of oncology and onco-hematology at the University Hospital of the Federal University of Santa Catarina, Brazil. Her research has focused on understanding the molecular and biochemical bases of malignant neoplasms and investigating safer and more effective therapeutic alternatives.
Dr Natália Marcéli Stephanes has also served as an assistant professor of haematology for undergraduate students at the Federal University of Santa Catarina. Additionally, she held the position of professor of Hospital Pharmacy at the Qualificar Technical School in Brazil, where she developed instructional materials for use in the Pharmacy Postgraduate Program at the Leonardo Da Vinci University Center.
In addition to her academic experiences, Dr Natália Marcéli Stephanes possesses a strong expertise in commercial pharmacy, with in-depth knowledge of medications, their routes of administration, desired effects, adverse effects, and toxicity.
Currently, Dr Natália Marcéli Stephanes works as a Pharmacist at the Health Department of Santa Catarina State, where her role entails providing pharmaceutical scientific consulting services to judges.
Education:
- 2016 Bachelor in Pharmacy at the Federal University of Santa Catarina, Brazil
- 2018 Master in Pharmacy at the Federal University of Santa Catarina, Brazil
- 2023 PhD in Pharmacy at the Federal University of Santa Catarina, Brazil
The main publications of Dr Natália Marcéli Stephanes are:
Falchetti M ; Delgobo M, Zancanaro H, Almeida K, Das Neves RN, Dos Santos B, Stefanes NM, et al. Bishop Omics-based identification of an NRF2-related auranofin resistance signature in cancer: Insights into drug repurposing. Comput. Biol. Med [Internet]. 2023; 152:106347.
Feuser PM, Matos dos Santos PC, Cordeiro AP, Stefanes NM, Walter LO, Maioral MF, Santos-Silva MC, et al. Antineoplastic activity of free 4-nitrochalcone and encapsulated in poly(thioether-ester) nanoparticles obtained by thiol-ene polymerization in two human leukemia cell lines (Jurkat and K562). J Drug Deliv Sci Technol [Internet]. 2022; 67:102924.
Jacques AV, Stefanes NM, Walter LO, Perondi DM, Efe FL, Souza LFS, Sens L, et al. Synthesis of chalcones derived from 1-naphthylacetophenone and evaluation of their cytotoxic and apoptotic effects in acute leukemia cell lines. Bioorg. Chem [Internet]. 2021; 116:105315.
Duarte BF, Vieira DSC, Lisboa ML, Stefanes NM, Grando LJ, Santos-Silva MC. Características clínico-epidemiológicas de pacientes portadores de carcinoma de células escamosas de boca. Arquivos Catarinenses de Medicina. 2021; 50(2): 232–245.
Machado V, Jacques AV, Stefanes NM, Santos-Silva MC, Biavatti MW. Anti-leukemic activity of semisynthetic derivatives of Lupeol. Nat. Prod. Res. 2021; 35(22):4494-4501.
Bigolin A, Maioral MF, Stefanes NM, Mascarello A, Chiaradia-Delatorre LD, Nunes RJ, Yunes RA, et al. A novel sulfonamide derivative as a strong and selective apoptotic agent against hematological malignancies. Chem. Pap. 2020; 74:2965–2976.
Bigolin A, Maioral MF, Stefanes NM, Zatelli GA, Philippus AC, Falkenberg MB, Santos-Silva MC. Cytotoxic mechanisms of primin, a natural quinone isolated from Eugenia hiemalis, on hematological cancer cell lines. Anticancer Drugs. 2020; 31(7):709-717.
Maioral MF, Stefanes NM, Neufeldt PD, Chiaradia-Delatorre LD, Nunes RJ, Santos-Silva MC. Aldehyde biphenyl chalcones induce immunogenic apoptotic-like cell death and are promising new safe compounds against a wide range of hematologic cancers. Future Med. Chem. 2020; 12(8):673–688.
Perondi DM, Jacques AV, Stefanes NM, Maioral MF, Sens L, Pacheco LA, Cury NM, et al. A novel thiosemicarbazone as a promising effective and selective compound for acute leukemia. Anticancer Drugs. 2019; 30(8):p 828-837.
Rengifo AFC, Stefanes NM, Toigo J, Mendes C, Argenta DF, Dotto MER, Santos-Silva MC, et al. PEO-chitosan nanofibers containing carboxymethyl-hexanoyl chitosan/dodecyl sulfate nanoparticles loaded with pyrazoline for skin cancer treatment. Eur. Polym. J. 2019; 119:335-343.
Rengifo AFC, Stefanes NM, Toigo J, Mendes C, Santos-Silva MC, Nunes RJ, Parize AL, et al. A new and efficient carboxymethyl-hexanoyl chitosan/dodecyl sulfate nanocarrier for a pyrazoline with antileukemic activity. Mater. Sci. Eng. C [Internet]. 2019; 105:110051.
Maioral MF, Stefanes NM, Bigolin A, Zatelli GA, Philippus AC, Falkenberg MB, Santos-Silva MC. Miconidine acetate, a new selective and cytotoxic compound with synergic potential, induces cell cycle arrest and apoptosis in leukemia cells. Invest. New Drugs. 2019; 37:912–922.
Srefanes NM, Toigo J, Maioral MF, Jacques AV, Chiaradia-Delatorre LD, Perondi DM, Ribeiro AAB, et al. Synthesis of novel pyrazoline derivatives and the evaluation of death mechanisms involved in their antileukemic activity. Bioorg. Med. Chem. 2019; 27(2):375-382.
Maioral MF, Bodack CN, Stefanes NM, Bigolin A, Mascarello A, Chiaradia-Delatorre LD, Yunes RA, et al. Cytotoxic effect of a novel naphthylchalcone against multiple cancer cells focusing on hematologic malignancies. Biochim. 2017; 140:48-57.
You can view some of Dr Natália’s work below and links to her professional profile below.
Research Gate: https://www.researchgate.net/profile/Natalia-Stephanes
Linkedin: https://www.linkedin.com/in/nataliamarceli/
In this brief article, we will discuss, “What happens if you take folic acid twice a day?”. We will talk about the potential health concerns of taking folic acid twice a day and the best possible way to take folic acid to make the most out of it.
What happens if you take folic acid twice a day?
Taking folic acid twice a day or taking a higher-than-recommended dose may cause side effects like rash, itching, nausea, gas, bloating, stomach pain, etc (1). However, oral folic acid is not considered toxic and taking it accidentally twice will most likely not subject you to disturbing side effects (2).
Folic acid is a type of vitamin B that is essential for various bodily functions. Being water-soluble, any excess amount of folic acid is usually removed from the body through urine – which is why overdoses are not considered that harmful (3).
However, it is important to note that people may react differently to higher doses of folic acid. Some individuals might experience side effects like nausea, bloating, gas, or even skin rashes. If you suspect any adverse reactions, it’s crucial to consult your healthcare provider.
What are the dosage recommendations for folic acid?
General dosage recommendations for folic acid are: (4,2)
| Condition | Adult doses | Administration |
| Megaloblastic anemia | 1 mg | Oral, IM, SC, IV, once a day. May continue until symptoms improve. |
| Folic acid deficiency | 400 to 800 mcg | Oral, IM, SC, IV, once a day. |
| Pregnant or Lactating women/women of childbearing age | 400 to 800 mcg | Oral, IM, SC, IV, once a day. |
| People using Methotrexate (Option 1) | 5 mg once a week | Taken 24 hours after Methotrexate dose |
| People using Methotrexate (Option 2) | 1 mg daily | Take orally daily, except on the day of Methotrexate dose. |
*IM: Intramuscular, SC: Subcutaneous, IV: Intravenous.
What are the health risks associated with persistent folic acid overdosing?
Persistent folic acid overdosing can lead to several health risks, especially when consistently taking higher-than-recommended doses. While folic acid is water-soluble and generally considered safe in appropriate amounts, excessive intake can have negative consequences (5).
Long-term folic acid overdosing may cause gastrointestinal discomfort, including bloating, gas, and nausea. These symptoms can be bothersome and affect daily life (1,5).
Another concern is the masking of vitamin B12 deficiency (6). High folic acid levels may hide the symptoms of vitamin B12 deficiency, which is crucial for nerve function and red blood cell production. If left untreated, vitamin B12 deficiency can lead to nerve damage and anaemia.
In some cases, excessively high folic acid intake may result in unmetabolized folic acid circulating in the bloodstream. This could be linked to potential health risks, though more research is needed to fully understand the implications.
How to ensure the proper use of folic acid?
Ensuring the proper use of folic acid is essential for maintaining good health, as this vital vitamin plays a crucial role in various bodily functions.
To use folic acid properly, it’s important to follow general guidelines that apply to everyone. Take the recommended dose at the same time each day to ensure a consistent intake of the vitamin. Avoid taking more than the prescribed dosage, as excessive folic acid intake may lead to potential health risks
If you happen to miss a dose, take it as soon as you remember, but do not double up on doses to make up for the missed one. If you have any concerns or questions about folic acid supplementation, consult your healthcare provider.
If you’re pregnant, taking the recommended dose is especially crucial to prevent birth defects in your baby’s brain and spine (4). For certain health conditions like anaemia, your doctor might prescribe higher doses, but follow their instructions to avoid taking too much.
Not taking folic acid properly or missing doses can lead to deficiency-related issues like anaemia, fatigue, and weakness. It’s especially important during pregnancy to avoid complications (2).
Using folic acid the right way supports healthy cell division, DNA, and RNA formation, which is essential for your overall well-being. So, be sure to follow your healthcare provider’s advice and take folic acid as directed to stay healthy and strong.
Conclusion
In this brief article, we have discussed the potential side effects of taking folic acid twice, the proper dosage recommendation, and the proper use of folic acid supplements.
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References
1.-
National Library of Medicine. Folic Acid: MedlinePlus Drug Information [Internet]. Bethesda (MD): U.S. National Library of Medicine. Available from: https://medlineplus.gov/druginfo/meds/a682591.html
2.-
National Health Service. How and when to take folic acid. [Internet]. London: National Health Service (NHS). Available from: https://www.nhs.uk/medicines/folic-acid/how-and-when-to-take-folic-acid/
3.-
Butterworth CE Jr, Tamura T. Folic acid safety and toxicity: a brief review. Am J Clin Nutr. 1989 Aug;50(2):353-8. doi: 10.1093/ajcn/50.2.353. PMID: 2667316. https://pubmed.ncbi.nlm.nih.gov/2667316/
4.-
Centers for Disease Control and Prevention, CDC. Folic Acid [Internet]. Available from: https://www.cdc.gov/ncbddd/folicacid/about.html
5.-
Merrell BJ, McMurry JP. Folic Acid. 2022 Dec 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32119374. https://www.ncbi.nlm.nih.gov/books/NBK554487
6.-
Mills JL, Molloy AM, Reynolds EH. Do the benefits of folic acid fortification outweigh the risk of masking vitamin B12 deficiency? BMJ. 2018 Mar 1;360:k724. doi: 10.1136/bmj.k724. Erratum in: BMJ. 2018 Mar 21;360:k1334. PMID: 29496696; PMCID: PMC6889897. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889897/
