Folic Acid

Ok so I had my RA diagnosis from the rheumatologist today and she has started me off on a course of steroids and methotrexate. As many of you know, it was all a bit of information overload and I can't remember what she said the folic acid was for and what is the significance of taking it on a different day to the methotrexate. Anyone refresh my memory?

16 Replies

  • Ok, I'll try to keep info to minimum! No-one quite knows how methotrexate works, but one of the things it does whilst controlling your RA is to knock out some of the folate (folic acid) in your body. Folate is essential, so you need to replace it. But if still you replace it at the same time as the methotrexate then it stops the methotrexate working as well as it could.

    So generally people are advised to top it back up again 24 to 48 hours after taking the methotrexate. My rheumy likes to keep the extra folic acid to a minimum so I only take it once or twice a week as I have no side effects from the methotrexate. Others find they need to take more to help damp down side effects so you can take it up to 6 days a week. LIke veeything with this disease, it is variable!

    But sorry you've been diagnosed and I hope like me you have a great reaction to MTX and it controls the disease well.

  • Hi Robdoe

    I like helixhelix hope the Medes assist you. However listening to people over the years there is no set pattern for folic acid it depends on your specialist. I can tell you it should not be taken on the same day as the methotrexate, I was told to take mine 3 days later. However you should phone your Rehumy line and ask for a call back to find out exactly when you should take it.



  • Bummer re the RA diagnosis but welcome to our merry band of strong willed, polite RA/autoimmune jivers!😎

    MTX is metabolized via the same route as folic acid is and thus depletes the folic acid availible in the body. If you take the folic acid on the same day as the MTX it interferes with the MTX metabolism. I take mine 3 days after my MTX but others take it the day after and for six days a week (mine is only one dose a week).

    All the best


  • Hi- I take mine 3 days after and then for 4 days: up until the day before I'm due to take mtx again.

    Sorry that you have the diagnosis of RA but you'll find a friend in NRAS 😆

  • Sorry you've got the confirmation Rob but as you have welcome to the club! It is a lot to take in when you receive your diagnosis, easy to forget things. MTX is a folate antagonist, it depletes the little folate we store so it needs to be replaced. Folate depletion upsets healthy cells, those which unless we don't replenish enough cause the side effects common when taking MTX, mouth ulcers, gastro upset, hair follicles (which can lead to some hair loss in some) & liver problems.

    There's no hard & fast rule of how many folic acid tablets to take & to make it even more awkward Rheumy's each have their own thoughts on it but one seems to be pretty much agreed & that's not to take it the same day you take MTX as it's thought it can reduce it's efficacy. I started off taking just 1 5mg tablet the day after, that was increased to the day before as well when I had some nausea. Since seeing my current Rheumy she prefers her patients to take 6 a week. It will say on your directions label on the box or bottle how often your Rheumy wants you to take yours.

    Any other questions just ask. I hope you do as well on MTX as I do, it's been a very good med for me for 7 years.

  • I often get a little confused when reading how others are prescribed Folic Acid as I'm never certain if they are taking 1mg tablets or 5 mg as it's not often indicated. I was given 5 mg tablets 1x per week (the day after MTX).

    I image if your doctor gave it to you 6 days a week except on MTX day then it's 1 mg. Doctors often have such different personal preferences I just thought it would be good to realize that the tablet dose may be different so if you read how often someone is taking it and it's considerably more often then you then this may be the reason.

  • It can be confusing Lucy. Here in the UK we're prescribed 5mg per day & but in the US (& I think some other countries) only 1mg is prescribed. So, if a UK member doesn't mention it the dose it'll be 5mg per day. The frequency isn't as easy as there's no recommended amount of days. I see you're taking 5mg once a week whereas I take 5mg 6 days a week (so that's every day except MTX day), it's whichever your Rheumy prefers I'm afraid, though I would think if necessary yours could be increased being the lowest possible. Hope this makes sense.

  • Thanks for this NMH. Makes total sense. I am on a low dose of MTX (10mg) as I am also on a biologic but still have issues with hair loss. Its strange as my doctor said hair loss or other side effects don't usually occur in that low of a dose. Sad thing is that he said I could take another 5 mg the day of MTX as well as the day after. I say sad because everywhere I've read says its a no no to take the day of MTX for the reasons you and others mentioned. I don't like having doubts of my doctors recommendations, but ok, I've learned that sometimes that comes with the package. I'm still not going to take the day of and will tell him so. Thanks for the reply ;)

  • If you're not happy taking it on the same day you could always ask for the dose to be increased & take it the day before, particularly as you've some hair loss. I say ask for the dose to increased, if you've said no to taking it on the day you'll only be prescribed 4 a month not the 8 you'd need. Hair loss unfortunately can happen on any dose though it is more common the higher the dose, it's a case of how you respond & what folic acid you're retaining naturally. If I was you I'd increase the dose to 2 a week & see if your hair loss eases.

  • Thanks for the recommendation NMH--We are given a box of Folic Acid and have a prescription for a year refill at our pharmacy when and as often as we would like to fill it so I did indeed plan on taking 2x 5 mg/ per week just not on the day of MTX. thanks again.

  • I hope the extra one helps Lucy. I've not heard of that way of prescribing folic acid before, it's a good one & saves you quite a bit on prescription charges over the year.

  • There is no set rule for taking folic acid. The UK says no folic acid on mtx day. Health Canada says folic acid can be taken on mtx day or not. The FDA (USA) says the same as Canada.

    My advice is follow your doctors advice.

  • Hey thanks suzannedale. Much appreciated. I gave a call to the RheumaClinic. My doctor wasn't in so the nurse asked another who recommended I take 5 mg the day before and 5 mg the day after MTX so no hard rules even in the same clinic. One thing I learned on this discussion is that some people take 5mg 6 days a week like you! Granted I'm only on 10 mg of MTX but my doctor doesn't want me taking folic acid more than twice a week. He believes it would mess with the efficacy of MTX. Never mind that--you're going into remission! Yippie!

  • I was prescribed 5mg once a week, but when I started getting bad side effects they upped it to 5mg every day except MTX day.

    I'm not on mtx anymore due to feeling very ill on it. Shame, because it did work for my PSA.

  • Sorry to hear you've joined the club that nobody wanted to join. It's not that bad though and you're on the right track with medication. Wishing you luck!

  • I've come to realize that taking folic acid on mtx day or not is equivelent to what side of the toat do you butter?

    If you live in the UK, the guidelines say no folic acid on on mtx day. If you live in North America, the guidelines say take folic acid on mtx day or don't take it.

    I take 5mg daily 7 days a week and I am going into remission.

    I think you should follow your countries guidelines.

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