Arthritis Action

Taking Folic Acid following Methotrexate weekly injection: how much Folic Acid is safe to take 6 times per week?

Hello,

After much deliberating I have had my 1st Methotrexate injection yesterday, and will self inject every week. I have to take Folic Acid everyday except on the day of injection.

What concerns me is the strength of Folic Acid i must take: 5 mg. Is that not too much? I would really appreciate some feedback from people having Methotrexate injections and having to take 5 mg of Folic Acid.

Looking forward to hear from your experiences.

Many thanks.

24 Replies
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Hi I have injections every week and take 5mg folic acid 6 days a week you must take to reduce nausea I think most people take it, I hope the medication works for you x

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Tillie20 - thank you for replying. it is reassuring. Has it helped you as expected, and has the methotrexate really helped with reducing the pain?

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PMRPete,

Thank you for the link. Do you have methotrexate injections and do you take folic acid (5 mg) six times/week?

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No! but I have the information for my wife.

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Thanks for reply again. Does your wife take folic acid (5 mg) six days/week, following methotrexate injection? If so does she find the whole therapy really helpful?

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She just takes 5mg once a week (BSR guidelines), about half way between injections. She does find it arduous but generally worthwhile.

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Thanks again for replying. Am a little confused as how often I should take the folic Acid.The RA nurse said every day except for the day of Methotrexate injection. Will need to phone the RA department to ensure the nurse did not make a mistake...

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Yes the mtx injections have been a lifesaver for me and since I started I have felt great and the folic acid stops you feeling nauseous but I am one of the lucky ones I have only had 1 slight flare up in almost 2 years but again I must say I am one of the lucky ones wishing you good luck hope it works for you x

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Thank you so much for the information. Am quite anxious about mtx... Had my 1st injection on Thursday. Hope it will work... So pleased it has been so helpful to you. x

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So know how you feel I felt the same about taking medication but after being in so much pain not being able to wash or get dressed I thought it was better to try than suffer I just wanted a normal life again I feel good I try to walk for 1 hr aday I do Zumba twice a week and hula hoop I only do hula hoop wind I don't Zumba, I really hope it works for you good luck X

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Thanks. Very encouraging and it helps put my mind at rest. When I had mtx in the tablet form, 15 years or so ago, I felt like I was being poisoned and had to stop taking it. I started taking it when I first started biologic injection (Etanercept/Enbrel). I managed very well without it until both my knees needed to have total replacement and felt lots of pain. Now, 3 months post operation, and although injecting Etanercept again, my RA is still flaring up so rheumatoligist recommended I had mtx injections + 5 mg folic acid six days/week. Just hope it will stabilise my RA before I go for the second total knee replacement operation in next few months...

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Hi JGBH,

I've been on methotrexate for at least five years. It has made the difference between limping along with really stiff painful knee and hand joints and really having no symptoms. Give it a good try - be prepared for no noticeable change for two or three months.

I'm on 20 mg ONCE per week methotrexate as pills. I take one 5mg folic acid pill ONCE per week- usually the day after my methotrexate. No one ever said when to take it but that seems to work for me. Injections are usually prescribed to reduce the chance of nausea with high doses.

I think that the once per week folic acid is a normal dose for this purpose but if in doubt check with your doctor - maybe you need extra for some specific reason.

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Hi GordonEdin,

Thanks for the useful reply, especially the time factor wherby I can expect the Mtx to kick in to improve the treatment with my biologic injection, Etanercept/Enbrel.

My RA was fairly well controlled with the biologic therapy until my knees became very swollen and painful and I required total knee replacement operations. Had my 1st knee op in Decemnber 2017... getting better but it's a slow business. I had to stop injecting my biologic for 4 weeks during which my RA flared up rather a lot + my whole body chemistry being upset by major surgery. Unfortunately the RA has not stabilised totally yet therefore consultant decided to add methotrexate injection to speed up the process... However,I will have my 2nd total knee replacement in a few months.. so it is going to be pretty tough going. Not looking forward to that again.

Pleased it has made a big difference to you.

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Hi again JGBH,

Your medication is evidently more complex than mine. I have only every been on methotrexate except for an initial few months on sulfasalazine and I don't have any damaged joints. (Hopefully it stays that way!)

Nothing much changed in the first two months on methotrexate. The dose was then increased slightly from 17.5 to 20 mg and and shortly after that I noticed improvement which continued over a couple of years.

I haven't (so far) had significant side effects. I just noticed your other reply where you say that you had problems when you previously took methotrexate so I guess that might be the reason for the injections and the big dose of folic acid.

Best of luck!

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Hello GordonEdin,

Thanks for further information. It's good you don't have any damaged joints and I hope it will stay that way. Do hope you keep on improving. Best wishes.

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Hi JGBH,

I understand that you have RA. I have AS & PA and have been on Methotrexate in the past, didn't take folic acid with it. I found it was not for me. My Rheumatologist changed me to BENAPILI, which I self inject once a week, been on it for the last 8 months. I have a slight improvement with the AS, and a little more improvement with my PA. I am due to see the Rheumatologist in a couple of months time to see how I am progressing. Don't forget, as with any medication, what is good for one, is not necessarily good for another!!

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Thanks for reply. Am on Etanercept (Enbrel) and Methotrexate is supposed to help the biologics to work better.Pleased you are feeling an improvement.

Yes, I have RA, Sjogren's, etc. and am B12 deficient too.

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I was on 5mg of folic acid 7 days a week, long before I started on mtx, I was taking Azathioprine and on Humira. I had a folate and B12 deficiency plus my ferritin levels always on the low side. Folic acid was changed to 6 days a week when I went on mtx. I also have had much joint damage in the past. I would take what the rhuemy nurse has advised. Good luck x

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I've been taking Methotrexate for 7 years now, always with 5mg folic acid. There are no hard and fast guidelines for the amount you take, as it depends on whether or not you have side effects. My rheumy likes her patients to take as low a dose as possible, so starts with once a week, other prefer to give a full dose and start on 6 days a week. And in the States many patients take it 7 days a week.

For me taking it three times a week is now my dose.

If you have more folic acid than you need your body just excretes it, so don't worry too much.

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Thank you. After all, Folic acid is a B vitamin and is water soluble and can be excreted, as you say.

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I've been on methotrexate injections for a couple of years and take 5mg folic acid daily except injection day. It's taken about a year to get the methotrexate dose right and the final piece of the jigsaw for me is a cortisone injection. I'm now almost pain free and starting to walk for pleasure again, and have lost 4 stone.

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Thank you for reply. Are you on a biologic injection too? (Etanercept/Enbrel)?

Pleased you are getting some relief at last. Do hope mtx + folic will work for me too.

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No I'm not.

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