Methotrexate/folic acid dose?: I’m on 20mg methotrexate... - NRAS


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Methotrexate/folic acid dose?


I’m on 20mg methotrexate once a week and 5mg of folic acid every day other than methotrexate day. Is this standard? (I’m in UK). I’m asking as I’ve just had my folate level checked and it’s come back as abnormal (slightly high)’ but gp note says it’s ok as I take folate as on methotrexate. I’m seeing a neurologist next week because of some very odd sensations (hence the blood tests). I’m now wondering if folate intake is too high

33 Replies

Talk to your rheumy team as there's no standard dose. I started on 1 a week, and am now on 3 - with 20mg of MTX. I have my B12 tested once a year to check all in balance.

I’m on 20mg methotrexate a week with 5mg of folic acid for the other 6 days. Like the OP said maybe speak to your rheumatology team.

BonnieT in reply to GemmaSt22

I originally replied that I was on the same doses but it’s only the same for the methotrexate. I take eight 2.5 methotrexate a week. Four on Tuesday and four on Wednesday. I take 1 mg of Folic Acid once a day everyday. My rheumy said not to skip the day I take the meds. Sorry I thought we were the same.

I'm also on 20mg MTX & 5mg folic acid every day except MTX day. There's no recommended dose, it's actually an off license supplement, it's dependent on what your Rheumy prefers his/her patients take on a case by case basis. I'm checked annually & all's been well in 9 years.

Folic acid can't be stored by the body, we wee it out. As your level is just a little over I wouldn't think it's of great concern. The other way is more serious, if we don't get enough folic acid (eg though diet) we can get folic acid anaemia, it helps create red blood cells.

What it can do is hide the fact you may have a B12 deficiency, this can cause nerve issues, hence the referral to Neurology I would think. What are your symptoms?

My B12 was also just checked and is fine, my symptoms are a numbness/tingling sensation on the left side, face, arm, leg. Stroke/tia etc have been ruled out as I had a break in symptoms before they returned this Friday. When ‘googling’ I’ve found reference to neuropathy being caused by excess folate. The query on my referral note is MS

I hope Neurology find just what the problem is. I've found them very helpful when I've had tests, informing me along the way. Keep us updated.

BonnieT in reply to girli1969

Just a side note, I’ve had peripheral neuropathy in both legs long before I started taking folate. My doses are same as yours. We can have other unrelated things happen even though we’re fighting the RA. (as I found out last week). Hope all turns out well for you. Glad stroke and tia were ruled out. Hugs!

girli1969 in reply to BonnieT

Thanks, and absolutely, could be completely unrelated, I’m just exploring all avenues.

I agree speak to your rheumy team I’ve only been on methotrexate 5 weeks 20mg but only take one 5mg a week of folic acid a week I have bloods every two weeks and so far they been ok. I hope you get sorted soon x

I too take 20mg metho once a week on Sunday evening but i take 5mg folic acid Sunday morning and 60mg on Monday .... i sm also on Humira injections every two weeks. All working well thankfully

girli1969 in reply to Ghugs

60mg?! Wow, that’s a huge dose!

Ghugs in reply to girli1969

yes ... I don't know where that came from …. its 15mg (3 tablets)

I take same amount of methotrexate weekly, however I take 1mg of folic acid daily

Hi I am on exactly the same dose of MXT and folic acid ad you. Seems standard.

I was on 20mg methotrexate a week with 5mg Folic Acid 6 days a week for the first 10 years, and 10mg methotrexate a week with 5mg Folic Acid 6 days a week for the last 10 years alongside a number of biological and trial drugs over the years, currently weekly injections of Abatacept.

I only take the folic acid once a week the day after my methotrexate injection never been told to take it more than once a week and I have seen 5 different specialists in three different countries


I inject 25mg mxt once a week and take 1mg folic once a day except for the day of mxt.

I too am on 20 mg Methotrexate and 5 mg Folic acid 5 days a week.

My rheumy told me to take folic acid once a week just not on MTX day and that is all u need.

Is MTX working for u and do u have any side effects? I have my injections in cupboard and still haven't taken first one I'm too scared. Any advice will be appreciated.

EDee in reply to Cheylann

Hi. I was diagnosed in March this year and like you I was absolutely petrified at the thought of taking such toxic drugs. I tried the tablets but the nausea was horrendous, so now use the injection once a week, my mind doesn’t like it but my body seems to be doing well. I always take mine when someone is at home with me (no idea why) and usually wait about 1/2 hour is and go to bed. The next day I feel sluggish and the world seems a bit “grey” like a hangover I’m normally back to normal after 48 hours. I hope this helps 🤗🤗🤗🤗

Cheylann in reply to EDee

It does thank u but don't like the idea of feeling sluggish for 48 hours but if it helps then a small price to pay.


I've always taken one every day except MTX day. Now I've decided to have a Vitami B tablet every day instead of Folic Acid as it contains every B vitamin including FA. don't know what my levels are.

girli1969 in reply to Hidden

Beware that over the counter folic acid is nothing like the strength you are likely to have been prescribed, I ran out once and asked chemist about supplements. When I’ve missed my folic acid for a couple of days the inside of my mouth has blistered

I work in a hospital and going by what I see in patients notes the max appears to be 5mg twice a week and it needs to be taken

To be taken two days after taking methotrexate. I would certainly get it checked out. Hope this helps.


I take 20 mg methotrexate once a week and 1mg of folic acid everyday and the same day I take methotrexate. My blood levels are fine.

I was prescribed 5 mg folic acid daily - is keeping my hair intact, very happy now. I was on a weekly dose of 5 mg, hair fell out in fistfuls.

There’s quite a variation, but also several taking same dose as me. I know I need the folate as when I’ve forgotten it my mouth has blistered. I will discuss with neurologist and with rheumy team next time I see them, thanks for replies


I'm not expert, just a patient.... But, I'm on exactly the same combo as you. 20mg Methotrexate weekly and 5mg of Folic Acid daily.

I take a 20 mg injection of methotrexate weekly and take 1 mg of folic acid every day except injection day

I am on 25 mg methotrexate but only take 5me folic acid day after

Yes I’m on same dosage but if I get flu symptoms or infection I have to stop both medications

I’m on 22.5mg methotrexate and 5g frolic acid which I take 6 days a week but not on MXT day.

My RA is gloriously under control at the moment - this may have a lot to do with having taken early retirement 😀(although I work a couple of days a week on a consultancy basis again). Having more time, less pressure and the ability to have an easy day if I need one has made a big difference.

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