Too much folic acid taken

Hello. I've just done something stupid and it's not surprising as my Methotrexate and Folic Acid tablets have both been dispensed in identical little brown bottles. So Friday night is Methotrexate night and I tipped out 6 tablets to take 15mgs MTX, swallowed 3 of them, then something made me look at the bottle - I'd taken 3 folic acid tablets instead! I know that MTX and Folic acid shouldn't be taken the same day, and as I've just had a triple dose of FA I've decided to skip my MTX this week. Has anyone else taken too much folic acid and could it be harmful? I'm going to put different stickers on the bottles so it never happens again. Angela.

20 Replies

  • No problem with folic acid bug ask a pharmacy if you want to double check hope this helps

  • Many thanks.

  • Ask pharmacist but I doubt you need to skip the MTX. Sometimes I forget to take MTX on scheduled day. My Dr said take it even if a day or 2 late and take it on time the next week. Also my RA dr told me to take Folic Acid everyday, that it doesn't matter to skip on MTX day. So I take FA every day but not at same time as MTX.

  • Thank you. Yes, I think I will do that.

  • Yes, I'm always worried I'll do that as the tablets look so similar! Don't think too much folic acid is dangerous, as pregnant women take it, but I reckon you should definitely still take your dose of MTX.

    PS When you're getting your prescriptions at the chemist, ask them to put them in different bottles. :)

  • Thank you. That's a good idea.

  • Yes I did the same but took 8 - no ill effects I glad to say.

  • 8! Well it's so easily done isn't it. Good to know you had no problems.

  • At least it was the right way round Angella and you didn't accidentally OD on MTX. Have words with your pharmacy about these brown bottles I would advise! X

  • Thank you. Yes, I was thinking the same thing about if it was the other way round. Will definitely be more careful in future. Stupid bottles, the packets are much better unless you have trouble squeezing the tablets out of course.

  • As I understand it, the only reason one doesn't take folic Acid on the same day as Methotrexatre is that the FA can compromise on the efficacy of the MTX. I don't think it is actually harmful. But I would check with your pharmacist or specialist nurse.

    At least you didn't do what one patient did in the clinic I attend. 6 days of 25 mg methotrexate and 1 day of prednisilone at 25mg. As you can imagine, she suffered severe toxicity, but she survived.

    It's to avoid any confusion

  • Oh that's scary. I'm glad she survived. I'm feeling less of a panic today and will take my MTX this evening.

  • ... As I was saying, before I was rudely interrupted...

    I use a pill dispenser ( a large one) so that I can count out a week's supply of pills.


  • Hi there, I believe that we can't store B vitamins in our bodies and that they just flush through so taking too many Folic acid. Shouldn't do you any harm. I think you're doing the right thing by taking your Methotrexate though. Take care, Mary

  • I did the same thing - don't worry about it.

  • I take 5mg folic acid daily and mtx. Same day. I would call pharmacist to check or Google. Probably fine !

  • Thanks for the reminder.. I have no folic acid left in the house.. they

    add that to our breads and pastas etc.. so I am not taking it but was

    told to for MTX and I am dosing today. I have to take 1mg per dosing.

    Do you take that everyday? I dose MTX once a week.

  • From what our US members have told us Karen it seems guidelines there are to be prescribed 1mg, however often you Rheumy directs it. Here in the UK & also in Spain where I was first diagnosed (who oddly follow the US guidelines for everything else) we're prescribed 5mg. The amount is really up to the individual Rheumy. I started off on 15mg in tablet form with one 5mg tablet the day after which was increased to the day before & the day after to ease side effects (some hair loss, nausea & diarrhoea). My Rheumy in the UK, even taking subcut prefers I take 5mg every day except the day I inject, now on 17.5mg working up to 20mg as I have a history of abnormal LFTs going straight from 15mg to 20mg.

  • Thank you so kindly for the above information. I just read the prescription of folic acid and it does say 1mg every day.

    I did read the manufacturers directions and it says can be taken up to 20mg per week.

    Says do not take within 8 hours before or after MTX.

    Your information is very helpful too. xx

  • Hi

    I have been looking for definitive answer to your questions but, as with all things medical, evidence can be conflicting. The following is taken from an NHS paper on this topic and quotes from the British Society for Rheumatology guidance and states the following

    "There is no definitive answer regarding the optimal dose of folic acid for patients with rheumatoid arthritis who are being treated with methotrexate. It is generally agreed that folic acid supplementation reduces the toxicity of methotrexate without significantly affecting efficacy; although there seems to be a consensus of opinion that folic acid supplementation should be avoided on the day of methotrexate in case it adversely affects absorption. Folic acid supplementation should be continued for the duration of methotrexate therapy because adverse effects can occur at any time.

    There have not been any dose determining trials but regimens used in some of the studies include:

    •5mg folic acid taken the day after the methotrexate dose

    •1mg folic acid daily except on the day of methotrexate

    •5mg folic acid daily except on the day of methotrexate

    It is considered that the folic acid dose should be high enough to prevent folate deficiency. Many reviewers have extrapolated the data from the studies and recommend using 5mg folic acid weekly. Some administer this dose the day after the methotrexate dose and others suggest that a dose taken 48 hours prior to the methotrexate dose may give added protection against the gastrointestinal adverse effects. The dose can be increased to 10mg if the patient experiences any adverse effects to the methotrexate.

    The British Society for Rheumatology guidelines for disease modifying anti-rheumatic drug therapy recommends a typical folic acid dose of 5mg once weekly, preferably the day after the methotrexate. They state that folic acid can be given any day as long as it is not on the same day as methotrexate. Folic acid reduces toxic effects and improves continuation of therapy and compliance."

    Hope that helps.

    Best wishes


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