Starting Methotrexate. Any advice on when to have blo... - NRAS


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Starting Methotrexate. Any advice on when to have blood tests and take folic acid please?

devette profile image

Hi everyone,

I'm about to start taking Methotrexate, initially 15mg with 5mg folic acid once a week, and wondered if you'd any tips on which day to take the folic acid and when to have the fortnightly blood tests.

I'm planning to take MTX on Tuesday evening after my evening meal as my little girl is in nursery all day Wednesday.

I think the nurse said to have blood test 2 weeks after 1st dose which I think means just before I take MTX. Does that sound sensible?

She also suggested taking the folic acid either the day before or day after. What would you recommend?

Many thanks in advance for your help.


25 Replies

Devette, welcome to the world of mtx. When i was on mtx i took my folic acid the day after my mtx. Blood tests are done to see how the mtx is working so any time in the two weeks after you have taken mtx will be fine. There is no set time to have your bloods done as long as they are regular.

Best of luck with the mtx.


Hi and welcome to the site, you'll find lots of support and advice. Remember to bare in mind Rheumatologist's are different and prefer different methods and medications.

I was advised to take MTX on a Monday evening and Folic 3 days later. Blood tests were done weekly initially then 4 wkly, 8wkly eventually every 3mth, sadly I never got to 3mthly, even now I'm on Leflunomide my bloods are every 6wks.

Good luck hope the meds work for you.

Beth xx

Hi, I agree exactly with Beth re taking of metho & colic that's how I take mine, but it did take a while before I got it right. Same for bloods, I am n it 3 years and still get bloods done monthly or there a bouts.

Best of luck, and don't forget to ask your rheumatologist or GP as many questions as u want no matter how simple or complicated, there job is to care for you.


I have just started methotrexate, last night. Am feeling fine so far to my relief! Advised to take folic 3 days later. Have booked to have bloods done next Tuesday. Good luck and let me know how you get on. Its pretty scary taking these meds isnt it??

We had a debate recently on thgis site about the best day to have blood tests, and I recall that the concensus was that any day's ok except for the just after you actually take the MTX. And I take my folic acid 24hours after, but there's quite a range for this. Some people do need more and others don't, but you'll work out what's best for you. I'm a bit surprised that you're starting on 15mg, as lots of people have a couple of weeks at lower dose just to get used to it. But try not to worry - the first time I took them it took ages to force myself to actually take the pills. And now I just chuck them down my throat like smarties without even thinking about it. Polly


my experence was the same as Sylvies. But mainly the Rheumies told me when to come and when to take the tablets at the beginning. So didn't have much choice!! Good luck and hope your treatment works. Axx

Hi, I started MTX about 10 weeks ago now and was prescribed Folic Acid to be taken two days after. I started on 15mgs MTX so was flung in at the deep end, so to speak, with no run up time to get used to the drug. I found the side effects very troublesome so took the Folic acid daily except MTX day and this has made things better.

Some people have no problems whatsoever so hope you're one of them.


Hi i was started on 15mg and then it was upped to 20mg a fortnight ago. I take folic acid Monday to Friday and Mtx on a saturday. Bloods monthly at the moment during the week. Everyone is different so keep in touch with your rheumy nurse. Good luck xxx

Hi devette

I was on the same dosage initially (after a year on Ferrous Fumarate to get my red blood cells up!) and was advised to take the Folic Acid the day after, which I chose the weekend so it didn't interfere with work.

I didn't have much success on the MTX though and decided myself to stop taking as it was making me ill. I'm now 3 year's into Humira and doing great.

One bit of advice about the blood tests, try to alternate your arms at least for the fortnightly tests. This avoids any scarring of the tissue.

Good luck with the meds!


HI ... welcome devette ..

i take 10mg MTX on a monday morning with me brekkie and folic acid the other 6 days a lot of people say we are all different .. some have mild side affects some moderate and some cannot tolerate it ... so until your body gets used to it or rejects its a waiting game ... just one thing that is a must NEVER miss is your blood test as thats the thing that they can tell how your doing ...

debs xx

I have been on Methrotrexate for 2 years now and it has been very succesful. I was doubtful about starting to take it and spent a long time in pain because of all the horrid side effects I had read about. I had none of these and am now almost pain has certainly enhanced my day to day living. I take 20mg once a week, and take the Folic Acid every day except the day I take the Mtx.I hope you are as lucky as I have been.

Hi everyone,

Thanks for all the great tips. It's so helpful to be able to speak to people who have gone through the same thing.

I think I've got a plan now so I've left a message to speak to the Rheumy Nurse again to make sure they're happy too.

Thanks for all your help and good luck to you all too.


in reply to devette

Welcomem I take my methrotrexaten12.5m every Tues My Dr has me on one Folic acid daily.


I saw the rheumy for the first time in March.

She diagnosed ra and wanted to start me on drugs that day, but as I had swollen glands this didn't happen.

As I posted here before, I have been really struggling with the diagnosis, and at times have managed to convince myself that it was all a mistake.

I had to go to the doc this week because I have a chest infection, and there was a letter there from my rheumy dated over a week ago.....if I hadn't been about my chest, it would have just got lost I think!

Anyway, my ra assay was 69 and in their lab it should be less than 15, so I guess I can stop kidding myself now.

I have to start mtx 7.5mg, increasing by 2.5mg every 2 weeks to reach a dose of 20mg per day.

Then 5mg folic acid 6 days a week.

Hydroxy 400mg daily for 3 months then reducing to 200mg daily.

So, it seems that it's all down to personal preference from your rheumy.

Good luck with it all


megant profile image
megant in reply to elsa123

Hi Elsa

I saw my rheumy for the first time in Feb. I am 42 and like you am struggling with my diagnosis and just seem to cry all the time.

I have found a support group in my area, which I am going to for the first time next Thursday, I will let you know if this helps.

I've had to stop taking my metho as my neurophils were low, but went to the docs yesterday. The results have picked up a bit so back on them on Monday, and now going to take 6 folic acids instead of just the 1. So like you say, its personal to each individual.

Good luck to you too



I have my bloods done on a Monday, fortnightly, I take my methotrexate on the Monday evening approx 7 pm. then take 1 folic acid 24 hours later.

You can take additional folic acid to prevent side effects of the metho but DO NOT take 24 hours before OR after taking the metho.

Hope this helps


Hi My Names Angie,i am also finding it hard to adjust to the RA ,i was on hydroxychloroquine for 3 months the side affects where very painfull,i am now on methotrexate

I take two folic acids on wednesday and 6 x 2.5mg methotrexateon saturdays 3 at lunchtime and 3 with eveing meal .

Sunday last week was ok , this week i was feeling sick and very tired is this normal ?Today im still feeling queezy.perhaps i should take folic acid every day

should i speak to my RA nurse?.

I take paracetal and ibrufen daily to help ease the pain in my hands and feet.Never taken so much medication,cant be good for your insides.

I am so pleased i found this site,and to understand you are all out there supporting each other ,its great .

Thank you


devette profile image
devette in reply to minxy1960

Hi Angie,

Oh dear, what side effects did you get from Hydroxychloroquine?

I haven't started MTX yet but I'd try speaking to your nurse. I'm still waiting to hear from mine but luckily everyone on here has been really helpful.

Has your GP given you a stomach protector? I was getting tummy pain and indigestion from Ibuprofen so I take Lansoprazole. They might be able to prescribe something.

I also take Domperidone as I get a lot of migraines and sickness. The nurse suggested taking some an hour before MTX.

devette profile image
devette in reply to devette

I also meant to say, if you've just started MTX perhaps the side effects will improve as you get used to it?

If you post a new question it will show on the home screen and more people will see it.

Hope you feel better soon. Let me know how you get on.

Good luck,


Smel profile image
Smel in reply to minxy1960

Hi Minkxy1960,

I take MTX for my Psoriasis, a skin problem!! But I was always told not to use Asprin or Ibrufen, as it was like drinking and could effect your Liver! After a two year brake, I started back on MTX 4 weeks ago with 4x 2.5Mg, so 10Mg a week taking the 5Mg Folic acid on Friday night (tonight) and the MTX the following night (Sat). It is making me feel quite sickish! for about 3 days, never heard of taking FA every non-MTX day, might give it a try, can you take too much, I suppose you can, any ideas!!!



Hi: I take 20mg Thurs. night and 2.5mg folic every day starting Friday. BUT, when first on MTX my bloods were taken every 2 weeks with folic acid once a week, 3 days after the MTX. Then bloods taken once a month, then told to take folic acid every day except the day I take MTX and now that I've been on MTX 12years my bloods are done every 6 weeks. Still take folic acid every day but only after I found out I should have been doing that for years but no-one told me! When I asked consultant, she said, oh yes, didnt you know? Doh!!! but your RA cons. will let you know when to take the folic and how often for bloods. Just remember to take it same time every week so you don't forget.


I take MTX on a Monday morning after breakfast as it's easier to remember being the start of the week, Before BF its the daily Omeprazole to protect my stomach. My Rheumy advised Folic acid should be taken the following day. Blood tests just now are fortnighly on a Monday and the MTX date has no revevance according to my nurse, GP and specislist. After 9 weeks the MTX is working well and starting to ease off the Ibupro and aiming for 3 x 20 my rather than 3 a 400 mg as most swelling and joint problems now pushed nicely into the background so consider myself very very lucky I was diagnosed early.


hi i have been told to take folic acid on a friday cos they both start with F and methotrexate on a monday as that starts with an M

I can only relate my experience which is, I have been taking MTX (15MG) for the last 10mths once weekly, on the day that I take MTX I do not take the folic acid (5mg) but the folic acid is also taken with 4x750 mg Adcal-D3 Caplets. 6x5mg Prednisolone, regarding the blood tests I see the haematology consultant monthly 2 days prior to this I have a blood test, on my visit last week he stopped the MTX but continued with all other medication until next visit. In view of a previous post I will be interested to see if their is any change in my energy levels.


I have been taking 15 mg MTX once every Tuesday. And 5 mg of Folic acid on the rest of the 6 days of the week. This has worked fine for me so far. as far as the blood tests you can follow your Rheumotologist's requisition. Remember to drink lots of water the day you take MTX.

Hope this helps. Good luck.

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