Role of Folic Acid in the Management of Adjuvant Endocrine Therapy-Induced Hot Flashes in Breast Cancer Patients

Folic acid is one of the B vitamins that when absorbed into its active form is converted to tetrahydrofolate. Folate is an essential cofactor for the biosynthesis of norepinephrine and serotonin. Studies have also noted that folate, with a mechanism like hormone replacement therapy (HRT), can improve hot flashes by interfering with monoamine neurotransmitters called norepinephrine and serotonin .The purpose of the current study is to investigate the role of folic acid administration at two different doses (1 mg/day and 5 mg/day) in the management of hot flashes associated with adjuvant endocrine therapy in patients with breast cancer.

Inclusion criteria

• Females older than 18 years
• Diagnosed with confirmed breast cancer and currently treated with an adjuvant endocrine
• Experiencing bothersome hot flashes at least 14 times/week
• Taking the treatment within 6 months to two years.
• Able to read and write to complete the study questionnaires and hot-flash diary.

Exclusion criteria

• Known hypersensitivity to folic acid
• Patients who have been treated with selective serotonin reuptake inhibitors (SSRIs) within the past 30 days.
• Metastatic breast cancer
• Renal impairment (Serum creatinine > 2 mg/dl)
• Significant liver disease: liver enzymes 2 folds the upper normal limit
• Taking other medication for hot flashes
• Medications inducing hot flashes such as (Clomiphene, Opioids, Nifedipine, Prednisone)