Folic Acid: This is just to satisfy my own curiosity..I... - NRAS

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Folic Acid


This is just to satisfy my own curiosity..I’ve been on methotrexate for 10yrs now and at the start of treatment I was told to take 1 folic acid tab the day after I take the methotrexate...I know that some folk take the folic acid every day except the day they take the methotrexate..does anyone know why some of us are told to take it once a week and others every day ?

57 Replies

Hi i take mine 6 days a week now after getting mouth ulcers before that it was one a week

Hi A234, I have not heard of taking folic acid only one day a week. All that I have read on it also says daily except on MTX day as it is believed to help reduce effects of MTX.

Maybe you should check with your GP and Rheumatologist.

I took MTX orally then Metoject pen injections along with daily folic acid except on MTX day but now on Leflunomide. :-)

It was my consultant that recommended it because it was always suffering mouth ulsers

Hi, when I was on methotrexate I took my folic acid once a week the same as you, don’t know why it’s taken daily? mabey controls some side effects off the methotrexate for some people. 🤗 X

I take folic acid once a week also 48 hrs after methotrexate, I'm not sure why we're all given different information, I've recently moved up to 20mgs and I did ask do I need extra folic acid and my rheumatologist said no, thankfully I've no major side effects so I didn't pursue the matter any further.

Im the same 48hr after as directed by my rhuemy nurse.



I started on once a week 3 days after methotrexate day and then upped to twice a week - day 3 & 5 after MTX day. The last time my folic levels were tested I was at the top end of ‘normal’ so don’t need any more at present. Presumably if my folic/iron levels were to be low next time I’d go to 3X a week!


Thank you all for your replies, I guess whatever works for each of us is all good, as long as we are taking it regularly as directed x

My first rheumatologist explained to me that MTX knocks out folate, so you need to top it up. However, at the same time there is a theory that too much folate stops MTX working effectively. Therefore she liked to start people on a small amount of folic acid, and only increase if side effects or blood tests warranted it. So I started at 1 x 5mg a week, and ended up on 3 x 5mg a week.

Each rheumy has their own theories...

And our US friends take it 7 days a week....

in reply to helixhelix

Thank you helixhelix that makes perfect sense 🙂

in reply to helixhelix

That does make sense but from the start I was told daily... and I am in the UK! However my diagnosis is of a severe aggressive type of RA.

in reply to charisma

I also have pretty severe and aggressive RA, and am in the UK. I think there’s very little to prove what works best so each Rheumy has their personal approach. It’s also the one thing that I do forget to take, which again seems to make no difference. I once completely forgot for about 6 weeks!

Hi helix I have been having alot of constapation since on mtx 15mg shot. Taking laxado and prune juice daily and still just once a week bowel movement. Would an increase in my once a week 5mg folic help me as I have just read it can help digestion.

You’d have to ask your doctors if you can try this....I don't know.

Hi I am on 20mg Methotrexate and initially was taking 5mg folic acid 4 days after. Due to chronic fatigue I was advised to up my dose I now take 5mg four times a week and so far so good. The meth is not working as well as they thought so I am now wondering if I am taking too much folic acid 🤔 the joys

Hi my folic acid is taken only for 3 days. I have noticed this does vary. Xxc

Hi, I take mine once a week 24 hours after taking MTX.

I have been taking folic acid in the last sixteen years on!ybonce a week.

I’m surprised that there’s so many variations, I think I’ll as my Rheumatologist why this is when I see him next month...just out of interest .

Yes, I'm confused 😕 now!!

I take fa 6 days out of 7?? ,I'll ask my rheumy at my next appointment.

I take 1x5mg folic acid a week. Seems to do the job

Me too. Might ask for folate levels doing when I next have my bloods done. I have been on 6 days a week for 10 years!


I started off once a week but it was increased because of nausea. I was told it helps with that side effect. I now take it 6 days a week and have no nausea.

Hi I also take mine 6 days a week but not on mtx day. I’ve always being on that does since day one. I started mine 18 months ago. I’m in uk if that helps 🙂

I too started on one per week but because of fatigue and mouth ulcers I was put on one every day apart from the day I take MTX Been on it for a long time but I still have fatigue and still get mouth ulcers

When I was on tablet form and dose increased I suffered terrible nausea. I was then told to up the folic acid. Once I moved to injections it was back down to 1

Judging by everyone’s reply’s it seems that if your tolerating your meds with no side effects then 1 tab a week is enough.

Thanks everyone 🙂

I'm in the US and my rheumy has me taking 1 mg. of folic acid every day. I think that's the norm here. I believe most people who take it only once or twice a week are probably taking a higher dosage (like a 5 mg. tablet)? So over the course of a week the dosage might work out to be about the same, or (for example) someone taking a 5 mg. tablet twice a week would be getting more than someone like me who takes 1 mg. daily.

in reply to Pawz4me

Yes, 5mg is the most common dose in UK.

I was originally told to take just one a week. And to take it a couple of days after taking the MTX to allow the MTX do really do it's job. Yep it's to replace folate.

However I am one of the 6 days a week folk otherwise boy oh boy do I pay the price with the nausea.

I take Folic Acid daily except for my MTX day to combat the nausea. I think that is the thinking behind the variance in the dose that people are prescribed.

Monday folic Thursday shot

Don’t take folic acid .. take folate . There is a big difference. Please look it up .

in reply to Boobalou

What is the difference Boobalou ?

I have been on MTX tablets since December 2015. From start told to take folic 5mg every day except the day I take the MTX. So 6 days a week. However I am taking 5mg tablets and I think some people are only prescribed 1mg. I don’t have any problems like mouth ulcers etc. And have tolerated MTX well. Strange the varied treatment. I also take Sulphasalazine twice a day, 2x 500mg each time. Plus Benepali injection 50mg once a week. No inflammation in bloods for 2 years.

in reply to Arthurthecat

I’ve been on I tab(5mg) once a week since 2009, I also take 12.5mg of methotrexate once a week and 200mg of hydroxychloroquine every day and I have been in long term remission for most of this time..I guess I’m one of the lucky ones 🙏

Hi i first started one day a week and because of the nausea increase to 3 days and then to 6 days. Taking 6 days a week has eased the nausea

The increase of folic acid seems to relate to level of issues with the methotrexate

Because some of us become very nauseous with MTX and need to take it more often

I'm on 25mg of methotrexate with 10 mg folic acid day after. I guess all rheumys follow different regime

Would how much variety there is in fa dosing! I was originally on 1mg fa every day except dose day. When my gut reacted badly to the mtx (I'll spare you the details 😲), my rheum doc increased me to 2mg fa every day but dose day, which seems to be helping

I take 15mg Methotrexate weekly and 5mg folic acid 6 days per week. I’ve been on Methotrexate for 15 years or so. When I looked up folic acid some time ago, it said that different specialists have different views on how much folic acid you should take...

Hi, I was on the once a week and the 15g MTX injection was still causing me to be sick the following day, rheumy nurse suggesting taking the 5mg folic acid the day before injection and the day afterwards, so far so good, I have often wondered why it is different for others but just do what I was told by the experts

Hi I take methotrexate injections at home once week - folic acid 4 times a week but not on the day I take my injection.

Hello , I take it for 6 days 5mg , and miss the day I have to take methotrexate on . Rheumy Told me it’s also good for your liver whilst on mtx. And works as an energy boost , I’m waiting patiently for the energy boost lol , it’s different for different people , my liver isn’t that keen on mtx either tried it before n just didn’t agree with my body , and I’ll be told again stop and try something else 🤭

I was told by my rheumy nurse "MTX Monday's, Folic acid Friday's" but I was very nauseous so folic was increased to 3 days a week (they didn't say which 3 days! and I forgot to ask 😂). Last time I saw rheumy I was advised to split my MTX dose over 2 days and increase folic to 5 days, still get nausea though 🙄

in reply to JFlay

That’s very interesting Narnia-J I’ve never heard of anyone taking their MTX over 2 days, I was always lead to believe it had to be taken all on the same day each week .

in reply to A234

That's what I thought too but she said it's fine! So I take 3 on Sunday's and 3 on Monday's she said hopefully I'll tolerate it better that way, so far it's been ok but will see how my guts get on with it 🙄

I was started off with 0.5 mg daily(except for the methotrexate day,of course).After some months I started to get nausea,so I was told to take 1x 5 mg on the days before and after I took the MTX. This has worked perfectly for me,though I do get the occasional lip ulcer.If I do,I take a break the next time I have to take MTX,then get back on it again asap.

I was diagnosed with PsA (Psoriatic Arthritis) in March and am on once a week Methotrexate and 7 days a week 1 mg of folic acid. Into my 3 rd month on this regime, and have noticed that I am not doing as well as I was when I first went on it. Have pain and incredible fatigue. I have nights that I sleep very little and other days when I sleep for 10 hours. Pretty messed up right now.

Well; I would double check with your doc, google it and do what you are doing by asking others. I’ve been on oral tabs of the MTX for approximately 25 years taking, initially 6 tabs a week. It was increased maybe two years ago to 8 tabs a week. However, in the past year I’ve been diagnosed (late diagnosis) with three types of arthritis. Initially the MTX was for severe plague psoriasis. Presently, I have an injection of MTX equivalent to the 8 tabs. I have religiously taken a daily dose of 2-800mcg (1600 mcg) of Folic Acid for liver support. I’ve had two liver biopsies with positive results in addition to the lab work (liver panel). Rarely drink any alcohol. I hope that helps you and is reassuring. Definitely take your Folic Acid everyday! Very best to you!

Hi I take methotrexate 15mg on Friday and 10 mg of folic acid on Sunday, for your information.

I think it depends how well you tolerate the Methotrexate. Mine was upped when the Methotrexate gave me diarrhoea as it was apparently sitting in my bowel! The higher dose of folic acid has cured it.

I take Folic acid only one day a week, a Monday after taking Methotrexate on a friday

because some doctors believe the folic acid hinders the absorption of the MTX and some do not believe in this theory.

I think it also depends on what dosage the Folic Acid is. I take 20 mg Mtx a week and 5 mg of Folic Acid 2 days later. I guess some people may need a higher dose

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