My husband was recently disanosed with RA and is due to start Methoxtrexate this evening (15mg) and has been given a 5mg Folic Acid Tablet to take the Day after.
When we attended the hospital appointment they had asked us to bring a list with all medications and supplements he took but the consultand never asked for it and we forgot about it with everything else we were being told. We then expected he would see his GP prior to starting Methotrexate but we were sent his medication yesterday and told to start today.
He takes the Seven Seas JointCare + Turmeric, with Omega-3, Glucosamine, Chondroitin, Vitamins C and D, Manganese and Zinc as well as Vitamin D3 and Vitamin K2 he was also taking a Vitamin B Complex supplement which also contains folic acid 50 μg (micrograms).
Having searched online the other supplements seem ok although he will not take them on the day he takes his Methotrexate but I am worried about the B complex supplement. Do any of you take a B complex while on Methotrexate? I was thinking that if we omited the B Complex on the day of his Methoxtrexate and the day after when he takes the 5mg Folic acid that he could take the B complex the remaining 5 days of the week seeing as the Folic acid amount in the tablet is very low.
I have been looking for B complex supplements without Folic Acid available in the UK but haven't found any. I would just stop them but my husband feels they help with his fatigue and wants to keep taking them if possible.
Any experiences or thoughts you could share on this would be great, also if you know of a folate free B Complex that would also be good.
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jencar7
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Your husband should to speak to his Rheumatology nurse before he carries on taking all those supplements. Unless he is prescribed them or is living on bread and water….he probably doesn’t need half of them.
. If you are on any sort of prescription drug, you should never take any supplements until you have run them past your clinical team.
The most innocuous sounding Vitamin pill can cause problems with your prescribed medication …..so take hubby off to contact his rheumy team,
AgedCrone Thank you for that info, we have a number for the Rheumatology Nurses but it is currently unmanned but you can leave a message and hopefully someone will get back to us. I will stop his supplements until we talk to his doctors.
Did the consultant and GP do blood tests as if he needed B12 it'd be prescribed and in a far greater dose than that purchased in the UK classed as a foodstuff. Fatigue is a symptom of RA so may improve when he begins medications so might it be a good idea to stop until the medications start to work and see what happens. That would give him time to talk to his GP or RA nurse. I'm sorry I don't know anything about the supplements you're looking at but do take B12 and AdCal D3 both prescribed. I don't take MTX. To purchase OTC it would cost a lot as the therapeutic dose is much higher.
medway-lady He did have some blood tests but I am not sure what ones, we were given a booklet with space to record blood test results but we haven't yet ever been given any blood test results. I assume as you say if he had needed B12 he would have got it.
As others have mentioned supplements can interact with medications. Many use the same enzyme to metabolise, and it can result in either inhibiting or enhancing the effect of the meds, if it inhibits, the drug never reaches therapeutic level, if it enhances then the drug can reach toxic levels, I have personal experience when a sales rep assured me that a turmeric supplement was safe with my clopidogrel, it wasn’t, and ended up with toxic levels, and extensive bruising. Turmeric can also cause damage to the liver, which MTX can also do, so should be used with caution when taken together. Your husband really needs to get the gp to check his levels to advise what’s needed, as I suspect many aren’t needed, if he’s eating a balanced diet. You also went to avoid any that can boost the immune system l, as that counteracts the medication that’s given to suppress the immune system. High levels of some of these supplements can cause issues too, so anyone taking meds should speak with their team and pharmacist before starting. It actually advises this on the information on the bottles, for the reasons I’ve mentioned.
Thanks for this insight, I did see quite a few studies which suggested that Turmeric can help alievate some of the problems that methotrexate causes in fact many seemed to suggest that Turmeric actually reduced the risk of hepatotoxicity but I did also see warnings that it could also increase the risk. I suppose the mechanisim by which certain supplements reduce possible damage is by literally making the methotrexate less effective which would perhaps negate the value of taking it at all.
I suppose ideally we would have been able to discuss all this with his consultant but the whole process of his diagnosis and treatment has felt very rushed and we were told he would be seen by a physio for example to work with him on improving his wrist mobility but all he got was a quick call and a pdf of exercises emailed to him. The only info on my husbands medication is not to take the folic acid tablet on the same day as his methotrexate nothing else. We have really recieved very little guidence on his treatment at all we didn't even know he had to avoid certain foods, only alcohol was mentioned to him. We are in the UK.
It’s worth mentioning that if he struggles with side efects, it would be worth contacting his rheumatologist. Many of us take folic acid 5mg 6 days a week, omitting the day we take MTX.
You could always phone his secretary and ask if they could ask about which supplements they’re happy for him to take. They get these kind of calls regularly, so they’ll be happy to help
Hi, I take a B-complex alongside RA medications and my rheumatologist is fine with me doing that, but your husband will need to check it out with his team just to make sure that's ok for him - we're all different.
If his rheumatologist gives him the all-clear I wouldn't worry about finding a folate-free preparation - the folic acid content in the B-complex is likely to be much lower than what's prescribed to help with methotrexate side effects anyway.
Vitamin B complex, particularly folic acid, can interact with methotrexate, a medication used to treat rheumatoid arthritis, psoriasis, and other autoimmune diseases. Here are some key points to consider:
Folic acid supplementation: Large doses of folic acid (more than 1 mg) taken on the same day as methotrexate can reduce the effectiveness of the medication. However, small doses (less than 1 mg) of folic acid in multivitamins or as prescribed by a doctor are unlikely to interfere with methotrexate.
Vitamin B12 supplementation: Vitamin B12 is important for preventing anemia and nerve damage caused by methotrexate. If you’re taking folic acid supplements, it’s recommended to also take vitamin B12 supplements (1,000 mcg per day) to minimize the risk of pernicious anemia.
Timing of supplementation: Take folic acid and vitamin B12 supplements at least 24 hours before or after taking methotrexate to minimize potential interactions.
Monitor liver enzymes: Methotrexate can cause liver damage, and folic acid supplementation may help reduce this risk. However, it’s essential to monitor liver enzymes (SGPT and SGOT) regularly while taking methotrexate.
Consult your doctor: Before starting any supplements, including vitamin B complex, consult your doctor or pharmacist to ensure they won’t interact with your methotrexate treatment.
I used to take a lot of vitamins before my diagnosis- because I was diagnosed with long covid before they found the RA. I used the vitamins as one of many ways to try and feel better. I tried everything under the sun. Some made some difference for a little while.
But I privately saw a physio who said to stop everything, especially when starting new meds. Because they could mask effectiveness. I’ve found that the meds are somewhat fixing the issues I had anyway. The only vitamins I take now are perimenopausal ones, because I can’t have hrt.
I understand his need to do everything he can to make this better for himself. But I have learnt that there are other ways
Thank you so much for raising this. I'm on the max dose of methotrexate plus 5mg Folic Acid every day, except the day I take the MXT. However, I also take supplements including a B vitamin which I hadn't realised contained more folic acid! I've been taking it some years but will now stop it. Thank you again.
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