Folic acid

[Need2knowN]

Hi I was told to take folic acid a day after my MTX, but I’m reading about others taking it 6 times a week aside from MTX day? Will my once a week suffice?

[Philip]

Frolic acid eh, mmmm, I also only take it once a week, on Tuesday I eat my mtx and on Wednesday I dine on frolic, mmmmm lol yummy I’m only 7.5 mg, next day next it’s the little single frolic.

[Need2knowN in reply to Philip]

Thank you Philip! 😊

[Maggiemae58 in reply to Need2knowN]

I take folic acid 5 days a week. Stop day before and day of Methotrexate

[cpetry in reply to Philip]

I also take it only once a week, in my case the day before taking the mtx. Up to now, my blood tests are ok like this.

[MarshaM]

I take folic every day but my pills are only 1mg.

[Need2knowN]

I guess that makes sense my folic acid dose is higher. Thanks both

[Neverending63]

When I was on methotrexate I took one 5mg tablet on a Monday and methotrexate on a Friday. It seems to vary a lot depending on your rheumy preference.

[Ruth12345]

I have 20mg methx on Wednesday and untill a week ago had 5mg Folic on a Sunday but started to get very sore mouth so now taking 6 times a week. Mouth much better.

[popsmith1874]

Hi I'm on 20mgs Methetrexate and take it 6 days a week except mtx day , but as others on here have said I think every other rheumys got there own way off working xxx

[helixhelix]

My rheumy explained to me that she likes to keep you on as low dose of folic acid as possible, as there is a (unproven) theory that it can hamper the effectiveness of MTX. So she starts with one a week and increases it if the patient is having side effects like hair thinning, nausea and mouth ulcers. I've ended up on 3 a week.

[Need2knowN in reply to helixhelix]

This explains it! Thanks!

[Evaflo10s]

I’m on 25mgs methoxetrate and 5mg folic 6 days a week .

[vonniesims in reply to Evaflo10s]

So am I

[Bandido]

Yes I take 25mg MTX Monday and 5mg Folic acid on Friday. Your blood test would show normal levels of folic and perhaps if we are low they say take it more than once

[AgedCrone]

If you are feeling OK with no nasty side effects taking 1 X 5mg Folic Acid that is probably right for you. If side effects creep in - ask your rheumy nurse for advise.

[Gigi71]

I have a b12 and folic acid deficiency and was on folic acid 5mg 7 days a week, long before taking mtx. I dropped down to 6 days when I started mtx. I also suffered hair loss for the first four months on mtx and an upset stomach for a few days after taking for approx 11 weeks. Goodness knows how I would have been without the folic acid. Only started on 10mg mtx and went down to 7 and half because of eye problems. We are all different, I'm sure your rheumy has prescribed a suitable dose for you, it can be adjusted if needed. All the best. X

[Hidden]

I also take it once a week mtx on Wednesday and Folic Acid on Saturday’s

[Maeve31]

My first rheumy had me on 5mg once a week but my second put me on it 6 days a week. When I queried the change, he said it minimised the side effects of methotrexate.

He also said different hospitals and countries varied between the once versus six times. So it often depends on where your rheumy trained.

[Marhar52]

I am on 25mg MTX by injection, on Sunday evening, I take 5 mg folic acid 6 days but not on Sunday. X

[Pulfs]

I do 10mg injection of methotrexate on a Thursday and 20mg of folic acid tabs the next day x

[Hidden]

I asked my doc about skipping the one day. She said do not skip. One a day always. So seven times a week. What was the reasoning behind not taking it the day of meds? I have not understood that.

[helixhelix in reply to Hidden]

Some doctors believe that folic acid can inhibit Methotrexate and make it less efficient, so recommend skipping folic acid on MTX day. There's not a lot of evidence either way, so I really don't think it makes a huge difference if you do or not - especially if you are only on 1mg.

[Hidden]

My folic acid is also 1 mg. I’ve been told to add Biotin to my regime. It seems to have helped with the hair loss.

[Need2knowN in reply to Hidden]

Interestingly, my friend who has epilepsy and takes quite a lot of meds mentioned this to me today!

[Hidden]

Regiment

[Hidden]

My understanding is it’s all about side effects. I originally took it once a week but now every day except the MTX day - the change was because my hair was thinning. It’s improved that and it’s grown back curly - my hair is straight so the mix is interesting to deal with!

[nomoreheels]

It's very much your rheumy's preference because folic acid is unlicensed for use with MTX, therefore there are no guidelines for prescribing. This means that your Rheumy has chosen to prescribe you 1 x 5mg weekly, the day after you take your MTX. Mine did the same when I first started tablets but I had some nausea & hair loss so he increased it to the day before as well. I'm on 20 mg MTX & my current Rheumy chooses to have all her MTX patients on 5mg x 6 days, I guess so if there are any side effects (anaemia, nausea, hair loss etc) she's not as concerned her patients are presenting with them. Generally though Rheumys prefer to keep you on as low a dose as possible as it is thought that folic acid can interfere with how much we take in of our MTX dose, so be less effective & why we're usually asked not to take it on MTX day.

If you're doing ok on MTX & not having any side effects then you can just continue of 5mg a week. If do have or start having side effects, you're finding it difficult to cope with them & feel you need an increase would help you'll need to contact your Rheumy, nurse or GP (if your Practice prescribes your meds). If you're only prescribed 4 tablets a month & you choose to increase it yourself you'll need your repeat script increasing otherwise you'll run out of tablets.

Just for clarification patients in the US, & I think Canada too, are only prescribed folic acid in 1mg tablets but are, if indicated, sometimes prescribed folinic acid whereas we're generally not except when used as recovery (antidote) in chemotherapy.

[helenlw7]

I take one folic acid 24 hours after my mtx an have been doing so for over ten years, with no side effects from the mtx.

[Mall]

I read on here a while ago that it is commonly prescribed daily in the USA as there research showed little incompatibility with methotrexate. In the uk it is generally not prescribed on the day you take methotrexate . It does reduce the unpleasant side effects of methotrexate like hair loss, mouth ulcers etc. I took it once per week for a good few years and then my Rhuemy decided I should take it six days a week.

I think there is still some debate and leeway, but it is helpful. I leave it down to my consultant.

[Need2knowN]

Thank you all for the replies. It’s interesting to note the differences! As I’m only at the beginning of my MTX journey, I’ll let time dictate! For now though no issues! 🙏🏿

[Peachbby]

Yes, you're supposed to take it daily. I have switched however to 5-methyl-folate because it bypasses the need for folic acid to go through the process of changing it to folate, just in case you are missing some enzymes needed for the conversion. I've heard many diseases could be attributed to low folate. I do seem to feel better (less swelling) when I do take folate.

[HappykindaGal]

I take it 6 days a week now to reduce any nausea. Who knows if it works. Ginger tea does the trick generally