Folate (folic acid) deficiency impairs DNA synthesis in rapidly dividing cells, which leads to megaloblastic anemia characterized by enlarged red blood cells, fatigue, pallor, and sometimes shortness of breath. Population studies have shown that folate deficiency and macrocytosis can be present for months before overt symptoms appear, and in some cohorts, up to roughly one quarter of anemic adults had an underlying folate or B12 deficiency rather than iron deficiency alone. The encouraging clinical point is that, once identified, folate‑responsive megaloblastic anemia often improves within weeks of adequate folic acid repletion, with reticulocyte counts rising in about 5–7 days and hemoglobin recovering more gradually over several weeks. This medication is commonly used for Stomach Acid.
Koury MJ, Price JO, Hicks GG. Apoptosis in megaloblastic anemia occurs during DNA synthesis by a p53-independent, nucleoside-reversible mechanism. Blood. 2000 Nov 1;96(9):3249-55. Daniel S. Socha, MD, Sherwin I. DeSouza, MD, Aron Flagg, MD, Mikkael Sekeres, MD, MS and Heesun J. Rogers, MD, PhD. Severe megaloblastic anemia: Vitamin deficiency and other causes. Cleveland Clinic Journal of Medicine March 2020, 87 (3) 153-164. H.B. Castellanos-Sinco, et al. Megaloblastic anaemia: Folic acid and vitamin B12 metabolism. Revista Médica del Hospital General de México. Vol. 78. Issue 3. Pages 105-150 (July - September 2015). Anis Hariz, et al. Megaloblastic Anemia. StatPearls April 3, 2023.
Some side effects may be linked to nutrient depletion caused by this medication.
Research suggests that long-term use of H2 blockers and antacids might raise the risk of folic acid deficiency. These medications work by reducing stomach acid, which can also play a role in folic acid absorption. Folic acid is crucial for healthy cell growth and development, and a deficiency can lead to various health problems, especially during pregnancy. Some studies show a potential link between H2 blocker/antacid use and lower folic acid levels. Individuals who take H2 blockers or antacids for extended periods should consider supplementation with folic acid to protect against a deficiency.