MTX & Folic | Arthritis Information

Hi all

I'm puzzled by the amount of folic some of you take with mtx. I'm on 7.5mg mtx once a week and 5mg folic once a week, taken 48 hours after the mtx. I was told not to take the folic sooner than that because then the mtx would not have enough time to work properly. I'm not doubting anyones word, it's just such a stark contrast and I don't know anyone in the UK to compare notes with.

I have heard all kinds of different things about folic acid regarding dosing (how much and how often). My RD has been in practice for 35+ years and so he has been around for the entire time that MTX has been used for RA, so I trust him implicitly. He told me a minimum of 1mg/day (meaning taking 1 mg each day, not 7mg once a week). When I mentioned I still have a little queasiness around the day I take it (not a big deal) he said to double my folic acid the day before, the day of and the day after...and it has helped considerably. I have heard others say that they were told not to take it the day you take the MTX, but I always have and the drug has worked fine for me.

Jeanne
There are so many variables. There's your MTX dosage. There's how you do on it (nausea, hair loss, mouth sores, etc.). There's how you take it. I take folic acid in the morning and night each day. We're changing that to Leukovorin, taken 24 hrs. after the MTX, and then one folic acid pill a day. Folic acid dilutes the power of the MTX - but it's also necessary. The less you can take without complications, the better. I take 15 mg. MTX - that's a fairly high dose. People who take 25 mg. of MTX are sometimes on 4 mg. of folic acid.

Like everything else with RA, every response is slightly different.
I take 25 mg of mtx....and I take 4 mg folic acid everyday....including the day I take my mtx.I'm taking 20 mg of MTX and 2.5 of Folic Acid. I was told by my RD not to take FA on the same day that I took MXT. FA weakens the MXT effectivness. I trust my RD explicitly but I also do my homework and have found out that many RDs recommend not to take FA on the same day as MXT. Since it seems that 1/2 do and 1/2 don't I'll err on the side of not taking the FA on the same day. I want to get the full, maximum effect of the MXT.

Hi,

I am in the UK too! I take a low dose of MTX to complement the Infliximab (remicade). When I went on it they told me that MTX depletes your body's folic acid so you need a massive supplement dose to make sure your body gets enough for what it needs. I take MTX on one day (7.5mg) and every other day I take 5mg folic acid. I was told that taking both on same day might affect the MTX working (but might not) but the main reason was that the MTX will mean you lose all the folic acid you're taking that day so it's not worth it! All of the pharmacists I've been to to get prescriptions filled have given the same advice too!

Interesting posts...my RD told me to take FA daily, 1 mg. I take 10 mg of Mtx once weekly. I took my FA in the am and took my Mtx last night.

Phatgirl2

I take 17.5 mgs. of methotrexate a week; 2 mgs. of folic acid daily, with no instructions about skippping it the day I take the methotrexate.

However, I'll be looking into that for myself. It does make sense to skip the folic acid that one day, if it is indeed known to nullify the efficacy of methotrexate.

It's interesting how many variations there are between RD's and MTX/folic acid "theories".

My RD has me take Leocovorin (folinic acid) instead of folic acid. I take 15mg MTX a week, and at the same time I take 10mg Leocovorin. He did tell me that a lot of doctors want you to wait a day to take the Leocovorin, but he hasn't seen any difference, so he has his patients take it at the same time for simplicity.

I've been doing this for about a year now, and the MTX does really help me alot. Also, I don't notice any side effects from the MTX so I'm sticking with his method.

I also do get 433mcg of Folic Acid daily in the multi-vitamin I take.

dordale I've started taking the leucovorin, too, and what a difference. The mouth sores cleared up almost overnight. Hair loss seems to have dropped dramatically, too. But I take folic acid in addition to the leucovorin - just not as much. I take 17.5 mg MTX once a week and 1 mg folic acid once a day everyday including the day I take my MTX injection. My Rheumy says that replacing the folic acid the MTX destroys is important for RA patients since the destruction of folic acid is only important to those patients who take MTX as a chemotherapy drug. She says that for RA patients the destruction of folic acid is considered a bad side effect that is counteracted by taking folic acid on a daily basis. For cancer patients it is a necessary evil that they must endure. I don't know if she knows what she is talking about or not but my pharmacist agrees with her. Maybe this will help.I am just going to be starting MTX - my RD is having me take 1mg of folic everyday (including the day of MTX).I start my mtx tonight. I have been on rx pre-natal vits for many years now, that have 1mg folic acid in them. The rheumy said to continue to take those everyday and gave me a script for another 1mg folic acid and to take those everyday except the day I do my injection. So, I guess I'll be doing 2mg a day for 6 days and 1mg the day of the injection. I do 12.5mg of mtx and 1mg of folic acid daily. I have read that it is to prevent the mouth sores that the mtx can cause. I have only taken 1mg. of folic acid every day... I'm on 20 mg. of methotrexate and the doctor didn't say not to take it on the day I take MTX. Guess all docs are different?

Hi Tinker,

My hubby has RA (was diagnosed in January this year)...and...we are from the UK. I can very well understand your confusion

Anyways, answer to your question....Hubby is prescribed as follows:

15mg MTX tab weekly...48 hours later 5mg Folic Acid tab

4mg Prednisolone daily & 4 tabs of Diclofenac daily (can't remember dose...He's got them upstairs, and sleeping right now) & 8 paracetamol daily!

He's tired the entire time, still in immense pain, has severe muscle wastage on legs, bum, and arms. Lost loads of his face and can barely walk! He's been told that if he feels the need for extra iron, to eat more Liver! OH PLEASE!

Please keep in touch....Lets swap notes!

Best wishes....sandie xx