Oops took my Folic Acid on same day as Methotrexate 😬 Is it a big deal?

I foolishly tool my folic acid tab and just realised it's the day I take my mtx... Does anyone know if it's okay to still take mtx ? I am going to all my Rheumo but I know he won't call back until later on in the week - hence I am reaching out to the team here ... Any advice greatly appreciated :-)

Hessie x

40 Replies

  • Generally, it's OK to take your methotrexate, but it will make it less effective. The other alternative is to postpone your methotrexate to tomorrow if that's convenient to do and not take your folic acid tomorrow.

  • I think that is a good call! Thank you so much for swift reply too.

  • Thanks for the advice. I am going to delay taking, just waiting for a call from the Rheumo - fingers crossed they get back today!

  • Hi Hessie5,

    No need to panic. The safest thing to do is to wait until your rheumatology team get back to you. People are not allowed to give direct medical advice on this forum but they can share their own experiences with you and hopefully what they tell you will put your mind at rest.


    Beverley (NRAS Helpline)

  • Thank you Beverley - I have contacted the Rheumo team and hopefully they will get back to me. Just thought I would reach out in case anyone else did the same !

  • I have done this a couple of times, so now move my folic acid away from my meds the day before, I 'm sure we aren't the only ones. All the best X

  • Definitively going to do this Gigi. I was just too hasty - only grateful I didn't take the mtx. Appreciate your feedback!

  • Yes same here go on automatic pilot and down all my meds without thinking. X

  • Were you ok though?

  • No problem whatsoever x

  • From what was said to me last week by a Rhuematology doctor there is no research for taking Folic acid on MXT day and suggested that I start taking it to help with side effects. Apparently in USA they advise every day.

  • Interesting how it's different stateside - even the amount of mtx prescribred here is less than the there my Rheumo told me. Thanks for your advice.

  • Excuse my spelling - typing too fast ! PRESCRIBED - lol

  • Oh wow. How much mtx does the UK prescribe? In Canada/US they don't prescribe more than 25 mg of mtx

  • According to the Royal National Hospital for Rheumatic Diseases the maximum licensed dose is 25mg Sue. Rarely, the maximum dose can be 30mg.

  • My Rheumy said it's up to 30 I recall in the States - higher dosage and we are lower in the UK.

  • Yeah - 25 is the max here (in the US) too (at least to my knowledge), and my rheumy wouldn't go over 20 because she said she "didn't like what it did" to patients. No more explanation than that though..

  • Yes, all three of my rheumies said they only prescribe 25mg of mtx on extreme cases.

  • Hi Matilda - That is true - My rheumy had me taking it every day, and when I saw the advice on here to go one off to the shot day I remember asking her about it. She said it was not an issue and to take it every day (the Folic)..

  • Don't worry. I take folic acid 7 days a week. Yes even on mtx day. In Canada, the medical profession is still debating whether to take it 6 days a week or 7. Also they debate 1mg folic acid or 5 mg folic acid a day.

    Everyone should follow the advice of their doctor

  • I was told never to take on same day - it's interesting how our cases all vary. Indeed the sensible route is to speak with the Rheumo team. Still waiting there call! Thank you for your feedback - much appreciated.

  • Well taking folic acid is pretty much the same as munching through a large basket full of parsley and spinach, and nobody tells you not to do that on MTX day!

  • Hi Helix - hmmm that's a great point. Another question to raise with my Rheumy as I eat so much Spinach :-)

  • Well I take MTX on Monday evening before bed but take my folic acid in the mornings. So I won't take on a Monday because MTX day and not Tuesday morning because I just had MTX 8 hours before. My Rheumy said it's for sickness and can take it once a week if I don't feel sick. I eat a bag of spinach and kale every morning in a smoothie as well.

  • Thanks GlenB - I have to take folic everyday except my mtx days. Love Spinach not so fond of the Kale - a smoothie sounds like a good call though, may be more palatable ...

  • Oh Hessie5 , you are missing an awesome healthy treat. You have to try kale this way

    Remove the kale stem, place on baking sheet and sprinkle a little cheddar & mozza cheese, bake and remove when cheese melted....Oh my God....heaven yum

  • Ohhh that sounds delicious - I shall give that a try over the weekend thanks Suzanne!

  • Sounds amazing, so miss cheese! 😢

  • Oh it is amazing. The kale turns into a delicate crispy chip and oh the cheese,,,what can I say? Yummy :)

  • Shhh!!!! You're being mean

  • 300ml orange juice plus 100g of spinach and 100g of kale. The kale I freeze and add a little ginger. Really good for you and your stomach. Enjoy

  • That's my breakfast sorted. Thanks for sharing Glen.

  • Update - My Rheumy's secretary came back to me today and I was told not to take my mtx - take it tomorrow instead. Huge thanks to you all for your invaluable replies. Have a super week, looks like we're in for some glorious weather 🌤 😊x

  • It can be a bit confusing - or at least I can get confused by it!

    I am meant to take it every day except for the day I take methotrexate. However, I'm taking my methotrexate on a Tuesday night which means I don't take it on the Tuesday - but then I don't take it on the Wednesday as it's the same 24 hour period ( after Mtx), if you see what I mean? So essentially , it works out that I'm only taking the folic acid 5 days a week, instead of 6 as prescribed.


  • Exactly what I do. Sleep off any ill effects of MTX. 5 days a week seems ok for me with folic acid. My Rheumy said there is no ill effects of having folic once a week and I. Ever took it for first couple of years which was wrong but on track now

  • I did read somewhere that 12 hours was a big enough gap between mtx and folic acid doses - but don't follow that. If I take mtx in the evening on Tuesdays I take the folic acid on Monday morning and Wednesday evening so as far away as possible from mtx while still taking every day. I do have one of those weekly pill containers to help!

  • Thanks Bookworm. The container is a good idea.

  • I take my mtx on Thursday eve, so miss folic acid Thursday morning, but take it Friday morning, checked with my Reumy yesterday and she agreed was correct. X

  • My doctor did not tell me not to take Folic Acid on MTX day. I asked my pharmacist and she said it was fine to take it together. I will ask my doctor. I have to say that I have been taking 10mg once a week for 6 weeks and have not seen any improvement. I hope all is well for you. Thanks, Penny

  • My rheum told me to take it every day twice a day. So that is what I have always done.. so each place and dr may be different. Maybe each body too?..

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