Question about Folic Acid: Hello all. I haven’t asked... - NRAS


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Question about Folic Acid

Bubblyb profile image

Hello all. I haven’t asked my rheumy for clarification yet but I think your collective experience is much more valuable anyway. My question is regarding when to skip my folic acid on the day I take my injection of methotrexate. I take my injection on Monday night around 10pm so do I skip my folic acid on Monday or Tuesday? I do experience slight nausea, headache and fatigue with the MTX but I also don’t need a cane anymore so it’s worth it to me. Thank you in advance for any thoughts. (I’ve been skipping it on Mondays.)

12 Replies

In the UK you would be advised to skip it on Monday. In the US you could be told to take it every day including Monday. Not sure about other countries. So I reckon this means that it makes no difference either way!

I take MTX at 6 PM on Monday, and don't take folic acid then. I take it every evening otherwise.

My rheumy said to skip on the day u take MTX so in your case the Monday.

The advice is not to take the folic acid on the day you take your mtx,xxxxx

I inject Monday night and skip my folic acid on the Tuesday morning. I think of the day you take the mtx as the 24 hour period following the dose. The mtx stops your body from absorbing folate so the folic acid replaces what you have lost. I usually take my folic acid in the morning so there isn’t any point taking it less than 12 hours after my mtx as my body won’t absorb it. I hope this is helpful as it goes against what the others have said. 🙂

Bubblyb profile image
Bubblyb in reply to ruth_p

Yes, I was thinking and wondering along the same line of thought that you explained. If I were to skip it on the “day” I take it, and since I take it very near my bedtime on Monday night, I was thinking maybe I should not take it Tuesday morning. I take my folic acid in the mornings along with my other usual daily meds. ( omeprazole, prednisone) It had me so confused but I think I will go with my gut and follow your schedule. I do so appreciate you and everyone else and the advice, I just think it’s kind of a confusing case because of how late on Monday I take it. 🌷

Gnarli profile image
Gnarli in reply to ruth_p

I do the same so there's 24 hours between MTX and folic. It works for me

When you think about how we are told methotrexate works, it doesn't seem logical to skip things at all. If it is long acting and working all the time, being topped up each week by the injection (or tablets) then why should stopping the folic acid on the day of the injection make any difference? Unless the folic acid is reducing the amount of methotrexate that is absorbed by the body? Has anyone come across any work suggesting that? There are quite a few articles demonstrating that folic acid competes with methotrexate and would therefore make it less effective - but this would be the case whenever you took it?

Perhaps that is why the advice varies?

nomoreheels profile image
nomoreheels in reply to oldtimer

Sort of the second one. My Consultant explained when I started MTX something like this. The day we take MTX it rids the body of some of the folate store we have (it being a folate antagonist). We need folate for DNA, for healthy cells including those needed for hair, tum etc & to stop red blood cell count reduction/anaemia so whilst we generally know we're taking it to help ease any side effects these side effects are caused by the reduction caused by MTX of folate. This is why we take folic acid (the synthetic or man made version of folate). We top it up through the week by however many days we're prescribed it & why it's increased if we have side effects but because it's off-licence there are no exact guidelines as to how many days.

Hope I explained ok.

Bubblyb profile image
Bubblyb in reply to nomoreheels

I really appreciate your explanation! Thank you! 🌷

Hi Bubbly

I was informed not to take folic acid on the day I took MTX.


You really need to check with your Rheumy because answers from us will vary but it makes sense to me if you're injecting your MTX at 10pm you'd not take your folic acid until 10pm the next eveningas that would be a full 24 hrs. If it helps as an example I inject my MTX on Wednesday morning with my morning meds & don't take my folic acid until Thursday morning. But, as your MTX dose is 20mg & you only take 1mg I would think it won't make as much difference taking it the same day/evening until you can ask your Rheumy as say us in the UK who take 5mg folic acid. If it helps

I'm pleased it's helping so much you're not using your cane. I'm on the same dose MTX the mo but 9 years in total. I do need my stick when my feet aren't so good though.

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