Folic Acid ... what dose???

Well I thought I'd post about folic acid as there are such variations in the doses we all take it might be helpful to some, following an experience at my GPs today!! That and Tilda told me too, ha ha not really but she did think it was a good question.

So having been started on mtx I was prescribed the obligatory folic acid. Mtx Monday, 1 x 5mg folic acid on a Friday. Now as I knew that some people take it a couple of days a week and some every day but mtx day to help with nausea etc, when I stared suffering from nausea I asked my Gp if I could do this too. This was about 10 days ago and he said that would be fine, he would prescribe 5mg of folic acid to take daily except mtx day and that's what I have been taking.

However, when I say my Gp again to ask for a steroid injection today, I happily informed him that the increase in folic acid had helped my nausea. He asked me if I was now taking 2 tablets so I said that no I was taking 6 which he had prescribed for me. He looked shocked and baffled that he had done this and had to double check, he then told me that this was way too much and I should reduce to 2 a week.

Unimpressed as my mtx dose was increased so now expecting bad nausea again, I came home and spoke to the wonderful nras helpline to ask their advice. They read information out from their mtx info sheet which said that folic acid can be taken daily but mtx day if its taken at 400mcg or a maximum of 2 x 5mg per week. They went on to say that an excess of folic can stop or reduce the effectiveness of mtx.

So I know that some of you take folic acid 6 x a week but at what dose. How much folic acid do we all take and what helps. I'm dreading next week when I increase my mtx and decrease the folic acid!!

Take care all, Rosie xx

16 Replies

  • I think we all have been given conflicting advice regarding folic Acid. I was originally prescribed 15mg of MTX & one 5mg four days after mtx, but when they increased my mtx straight up to 20mg I began to be so nauseaous, I rang & spoke to my Rheumy nurse who told me to go back down to 15mg MTX then gradually increase by one tablet & to take folic acidtabs 3 days a week. I only managed to go up to 17,5 MTX on a sunday night & take one folic acid on a Wednesday,thursday & Friday. My monthly blood test seem to be ok, Ive not been told otherwise, & Im keeping my fingers crossed as my RA seems to be in remission. I finally got diagnosed Jan this year.

    I don't know if this helps Rosie, it will be interesting to hear from the others, Rie x

  • Hi.... When I was on MTX my Rheumy advised me to take it every day, he said that I would probably hear not to take it on MTX day but that it really didn't matter if I did...I think I was on 5 mg. it seems we all get told different things? X

  • Hi Rosie

    Not sure if this helps or confuses matters further but I started five weeks ago on methotrexate and was advised to take 5/mg of folic acid 24 hours after. As I have suffered vomiting and nausea since starting methotrxate I have been prescribed omeprazole and meto something to help with that as they want to increase the methotrexate as ra hasn't responded as much as they would have liked.

    So know exactly how you are feeling xx

  • Hi Rosie

    I have been on Methotrexate for 6 years I also take Folic acid one every day omitting methotrexate day the dosage is 5mg this works for me with no nausea

  • Well I have to say I had hoped to hear everyone who was taking it every day but mtx day was on a lower dose but that certainly doesn't seem to be the case and like you say, confusing!!!

    My mtx dose is increasing from 10 to 15mg so I'm thinking I need a better plan than ginger tea!!

    Friday fever, like you I'm also on Omeprasole and my GP also prescribed the met thing you've got for sickness. I've been a little reluctant to take this as I had a very severe reaction to an anti sickness drug before and it's making me nervous.

    Be interested to hear other folic acid and mtx experiences tho

  • Hi Rosie, i have been on Mtx for just over a year, i take 20mg on a Monday and take 5mg of Folic acid on a Friday. My Rheumy once said it can be increased to 2x5mg on Friday. Fortunately i don't really suffer with Nausea. Apart from this site, i don't know anyone else that has RA so not aware of the variations. I missed a couple of doses once and my white blood count went right down, unsure whether any correlation there??

  • I believe the idea is to take the minimum you need to deal with the side effects, which to my mind means that you start on a lowish dose once a week, then slowly add in more each week until it works well enough. So probably jumping from one tablet a week to six was a bit of a big jump - to the point where it may mean the MTX isn't as effective for you (which might be why you are needing the increased MTX dose). As far as whether you take it daily or weekly, if it were me, and I was only needing a fairly low dose, then once a week would be fine. If I was needing the equivalent of more than a couple of pills a week, at a higher total dose, then I would think it would absorb better to spread it either daily or every second day - though daily (except MTX day) makes it easier to remember. But, as you have realised, there is an incredible variation both in what is prescribed, and in what individual people seem to need.

  • Hi Rosie I have been on 25mg MTX for 18mths now and take folic acid 5mg 48 hrs after MTX I do feel sick I call it MTX hangover Drs gave me anti sickness tabs which I take if I feel to bad but I can remember back to when I was pregnant and they dished out folic acid and I found it made me sicker then so I dont think I will increase it unless it was needed but so far my blood work seems OK


  • I take 20mg of MTX a week and 5mg of Folic Acid 5 days a week (I split my MTX over two nights to deal with the bad fatigue it gives me). It was prescribed by my doctor and I haven't had any issues at all.

  • When I first started mtx I was on 5mg folic acid once a week but this was increased to 6 days a week as I was suffering hairloss. I don't take it on the same day as mtx and luckily I don't suffer nausea, just tiredness for 24/48hrs after taking mtx.

  • Hefllo Rosie,

    I have had RA for about 20years, I was on mtx and olic acid, I was ok when I was taking 5 mtx and one folic acid the following day, but once they increased my mtx dose I was very ill the day I took the folic acid for the whole day I couldn't leave the bathroom. No-one suggested increasing the folic acid and finally they took me off the drug and I am now having Enbrel injections once a week. I had to come off them for 6 weeks for another medical condtion but I have now passed the 6 I missed, and i don't seem to be pain free as I was back in March. I have to go to Rhumey next month and I was told they will have to access my medication again. Enbrel was working for me really well until I had to stop having the injections. Good luck with mtx it worked for me also, I just couldn't take the side effects and trying to work as well.

  • I've been taking 15mg MTX for about 18 months. Was first told to take 5mg folic acid once a week, but like paulywoo, when I noticed hairloss this was increased to 3 times per week. I've never really suffered sickness after taking MTX, but have often felt sick after taking folic acid. When I mentioned this to my rheumy nurse (and the hairloss had resolved) she suggested I reduce folic again to once a week, so am back to this. It's interesting how much variability there is and I also remember reading a medical article a while ago in which a specialist recommended the best times pre/post MTX for taking folic acid. Can't remember when exactly, but think it was around 48 hrs before/after MTX.

  • my rheum dept usually presribes 5mg folic acid the day before mtx and the day after.. though some consultants also give it only once a week at 5mg and some give it every day etc mtx day.. its presribed use varies wildly

  • Wow now I knew I'd get lots of people sharing their stories but crumbs the doses and experiences are sooo varied. It's really weird that the folic acid actually makes some feel sick whilst others it relieves their nausea. Earthwitch I think you're right my GP has possibly increased my folic acid so much that now the mtx isn't working and it'll completely confuse my system next week when I increase the mtx to 15 and reduce the folic acid!! I have to say paulywoo that I'd probably prefer to suffer the sickness rather than hair loss, but I might reconsider that after next week ha ha!! I bet I'll be back on here next week moaning and ranting like mad about how bad the nausea is!!

    I've decided I might ring my rheumy nurse and ask what my consultant would actually recommend. Although there certainly appears to he no right or wrongs on this!! Rx

  • I take 10mg Mtx weekly and 1mg frolic acid daily. I took 1mg frolic acid daily, even when I was taking more Mtx.

  • Well here's a funny one l have been on 20mg metho for 4 and1/2 years , l have 5 mg at breakfast lunch supper and the following breakfast then 4 and 12 hours latter l take calcium folinate . I have cimzia as well, joints are good but my yummy is very sore, going to start metho injections soon . Hopefully l will be able to get a bit stronger.

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