Methotrexate.. Splitting the dose to help with the si... - NRAS

27,590 members31,596 posts

Methotrexate.. Splitting the dose to help with the side effects?


Hi all, does anyone split the dose to help with the side effects? If so, how do you split it? Is it over 2 consecutive days or do you have a gap in the days? Thanks

20 Replies


You must not split this medication, take it on the same day the same time each week then the Folic Acid on the other six days. Do not take Folic Acid on days when you take MTX



I split over the same day, a few hrs apart. Usually take them after food & the last lot before I go to bed/sleep.

Sci x

HI JoMay, I was feeling absolutely awful taking the full whack ( I am on max dose as well as a cocktail of other drugs) so I made the decision to split. I take 5 tablets after lunch then 5 tablets after supper, this has helped. I now take folic every other day but not on meths day. Only by reading other fellow sufferers on this website did I find this info out. You Must Take All On The Same Day.

Thank you everyone for your replies. Much appreciated

I have to say the one time I split it over a few hours I felt better - good luck!

I haven't tried splitting mine, but I started taking mine just before bed and that helped - I suppose I was unconscious and didn't notice the nausea and horrible headaches that I was getting when I took them during the day!

Sort of in relation to this im only taking folic once a week I notice some of u take it more than once a week .. whats the general dose?

in reply to norfolkjo

Not sure, but for me, I take it three days/week (Monday, Wednesday, Friday)

in reply to norfolkjo

I was told to take folic acid every day except the day I take methotrexate. Perhaps you could ask your gp or hospital team x

in reply to selina

I checked basically folic can reduce how well meth works so low weekly dose is best only increasing if its needed . Makes sense now

I split the MTX dose approximately 60-40 with it taken pre bed on one day - sleep through worst of side effects and then the rest the next morning. My rheumatologist recommended splitting the mtx dose, and taking 5mg folic acid each day except methotrexate day - I take folic acid at night and so take it 6 days per week. Had bad side effects with MTX when taking all in one go, but on this regime very tolerable.

I take 7.5mg MTX every Monday morning and 5mg folic acid on Thursday. I was advised not to take folic acid too close to taking MTX as it wouldn't do its job. I have been on this combination for many years, along with 2.5mg prednisone and latterly Enbrel, after changing from Humira. I noticed some of you take a much higher dose of folic acid, and I'm wondering if I should increase it.

Thank you everyone. Re the folic acid. My understanding is it is to help with the side effects. And that whilst on MTX your body is stripped from the folic acid. So if your suffering bad side effects then might be worth asking if you can increase your folic acid. Your allowed to have 5mg daily except on the day you take the MTX.

I was on MTX for 10 years. TBH I hated the stuff. In the last few years I have been on Humira but then my body decided it didn't like it any more and I had drugged induced lupus. I am now on leflunimide, as I'm not allowed anymore biological. But the leflunomide is doing quite well with minimal daily side effects. It's worth speaking to your Rheumatologist about alternatives, don't always take what they say. I wish I had swapped from MTX to leflunomide years ago.

I was asking about MTX and dose splitting for a friend who has been recently diagnosed. I have "blanked" out all my memories of my MTX days. :-)

Thanks again everyone, and hope your all doing ok today



I have just checked my guidance notes on Methotrexate before posting this because I considered this as welland did not want to givemyoumthenwrong information.

This is a direct quote from the guidance notes not my opinion.


The FATAL bit kind of put me off!.


Hi - I'm not on MTX anymore but when side effects of oral dose was getting me down I asked my rheumy about splitting the dose (my GP wondered why this isn't encouraged more and asked me to ask him!). He explained that he would only advise me to split the dose on the same day. The reasons he gave were that splitting the dose could make it less effective. Someone here also told me that the body has to have 6 days to balance itself with the toxicity. If somebody splits the dose by a few days this could make the toxicity dangerous because the body's immune system would take too much of a battering to cope. I told a GP friend and she said this made sense to her as well. I did find that switching to injections helped for a while.

Once my dose was 8 tabs or more, my rheumy recommended I have half with breakfast and half with supper, on the same day, to reduce the chance of side effects. I never experienced any noticeable side effects with MTX, so maybe it worked. My current rheumy has me taking all 8 tabs at once.

I had been down to 4 tabs, and feeling great, but my RA is active again. I saw my new rheumy the day after taking my 4 pills, and she told me to take another 4 pills that day, and then the following week to take 8 at once.

From that I would take that there is a bit of leeway.

in reply to Karen77

This happened to me to... I was feeling great and then it came back full on! I wonder how you’re doing now- 5 years later

I take 7 all at once just before going to bed on a sunday nite, I drink plenty of water. I take folic acid on a wed, thurs & Friday morning. I use to take it on a Monday morning & at first had terrible nausea so asked for advice from everyone on here & suggested on an evening to sleep through the side effects. I have found it works well for me that way.

I have been taking them for over 12 months now. (also on Hydroxy, sulfa too). Rie

I was told a few years back when I took MTX full dose (25mgs) in tablet form, you CAN split the dose if advised by your rheumy to do so and exactly as Aurora said. Worked much better that way. As long as the rheumy has advised you that you can and said how to do it. x

My pharmacist told me not to split it and to take it in the evenings

You may also like...