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Folic acid should never be given alone or in conjunction with inadequate amounts of vitamin B12 for the treatment of undiagnosed megaloblastic anemia. Although folic acid may produce a hematopoietic response in patients with a megaloblastic anemia due to vitamin B12 deficiency, it should not be given alone in Vitamin B12 deficiency states as it may precipitate the onset of subacute combine degeneration of the cord. Therefore, the inclusion of folic acid in multivitamin preparations may be dangerous as an improvement in vitamin B12 dependent megaloblastic anemia may mask the true deficiency state.
Caution is advised in patients who may have folate-dependent tumors.
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