Table 2 Treatment of Hyperhomocysteinemia
From: Impaired Homocysteine Metabolism and Atherothrombotic Disease
Drug | Use |
|---|---|
Folates and cobalamin | |
Folic acid | In all patients with basal and postmethionine-load hyperhomocysteinemia. Nutritional folate deficiency, thermolabile MTHFR mutation, homozygotes for the CBS deficiency who do not respond to pyridoxine, heterozygotes for the CBS deficiency. 400 μg to 1 mg per day in acquired deficiency, 5 mg per day in congenital deficiency. |
Folinic acid or N5-methyltetrahydrofolate | Instead of folic acid in patients with altered folate metabolism or thermostable MTHFR mutations. |
Cyanocobalamin | Correction of acquired vitamin B12 deficiency before folate therapy. 400 μg to 2 mg per day according to the degree of deficiency. |
Pyridoxine | In patients with postmethionine-load hyperhomocysteinemia who do not respond to folate treatment. |
Nutritional deficiency of vitamin B6, dietary excess of methionine-rich animal proteins, 3 to 15 mg per day. | |
Homozygosity and heterozygosity for CBS deficiency, 30 to 100 mg per day. | |
Betaine and/or methionine | |
Betaine | Functional methionine synthase deficiency, thermostable MTHFR mutations. |
Methionine | Functional methionine synthase deficiency, thermostable MTHFR mutations. |
