Folic Acid for Sickle Cell Disease

Reviewed by: HU Medical Review Board | Last reviewed: February 2023

People with sickle cell disease (SCD) often take folic acid supplements to treat anemia. In the body, folic acid gets converted to folate, which the body uses to make new red blood cells. Since people with SCD have increased red blood cell production to make up for anemia, they may need more folate.

It is still unclear if folic acid improves symptoms of anemia for people with SCD. But many doctors still recommend daily supplements because there are minimal risks. Ask your doctor about folic acid supplements and how to incorporate folate into your normal diet.

How does folic acid work?

Folate is a vitamin that our bodies use in the process of cell division. This includes making new red blood cells in the bone marrow (soft tissue inside our bones). Our bodies cannot make folate, but it naturally occurs in many foods. Vegetables, fruits, nuts, and beans have high levels of folate.1

Low levels of folate (folate deficiency) cause anemia (low red blood cell count). This can happen if:2

  • You do not eat enough foods that have folic acid
  • Your body absorbs too little folate because of inflammatory bowel diseases or medications
  • You are pregnant
  • You drink too much alcohol

People with SCD may need more folate because they produce more red blood cells to compensate for anemia. Folic acid gets converted to folate in the body and may treat anemia in SCD by helping to produce enough new red blood cells.3,4

What are the possible side effects?

Folic acid is very safe for most people. Most people do not experience side effects when taking the normal dosage. This is because folate is easily removed from the body in urine.1

Folic acid can be unsafe in large doses over a long time. Always follow your doctor’s instructions about dosage. Large daily doses of folic acid can cause:1

  • Abdominal cramps
  • Diarrhea
  • Rash
  • Sleep disorders
  • Irritability or depression
  • Confusion
  • Nausea
  • Bloating and gas

Allergic reactions to folic acid are rare, but possible. Get emergency help if you have any signs of an allergic reaction, such as:1

  • Hives
  • Difficulty breathing
  • Swelling of the face, lips, tongue, or throat

These are not all the possible side effects of folic acid. Talk to your doctor about what to expect when taking folic acid. You also should call your doctor if you have any changes that concern you when taking folic acid.

Additional things to know

Take folic acid exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended.1

Before taking folic acid, talk to your doctor if you:1

  • Have any other medical conditions, especially kidney disease, infections, or alcoholism
  • Are pregnant or breastfeeding
  • Are taking any other prescription or over-the-counter medicines or vitamins

These factors may change your recommended folic acid dosage. The dosage of other medications may also need to be changed while you are taking folic acid.

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