What is the reason for not taking folic acid on MTX day? - NRAS


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What is the reason for not taking folic acid on MTX day?


Suffering a memory lapse and can't for the life of me remember why we don't take folic acid on the same day as MTX. I seem to think that it is because it renders the MTX ineffective. Can someone confirm this. Have tried looking on the tags but I can't find the reason

13 Replies

From memory, when I took it,

Yes it does effect the MTX.

That's why you generally take it 2 days after

.But ive heard some take the folic acid 12 hrs after to stop the hair loss and

sickness. Hope this helps a little,

Your better off waiting til a more experienced sufferer answers your question cos im still green on this illness. Take care x

Not sure if I class myself as more experienced, but I did read about it and I think you're right. It's a catch 22 - the MTX knocks out the folate in your body which is why you have to top it up. But at the same time adding in more folic acid does make the MTX less effective. So basically it's a balancing act.


I looked into this a few years ago, as my consultant didn't specify when to take folic 5mg, it seems most advise 4 days after, that is 3 days before mtx. I take my folic acid once a week on a Tues, and mtx on a Fri. I think this is correct. I was doing it differently but remembering that I changed when I queried from other sufferers. I have no side effects , well a little thinning around hair line, but nothing noticeable yet!

Hope this helps. I am sure others will have different opinions, and that's ok too....


Hi - yes, I was told it inteferes with MTX but you need it to counteract what MTX does to cells (as said above, a Catch 22 issue). At first I was told take it 3 days after MTX and just once a week, then after speaking with others and reading lots of stuff I asked about taking it every day (except MTX day) and both the chemist and my GP and then my rheumy cons. said oh yes,you should be taking it every day except MTX day! (Nice of the cons. to tell me, after 10 years had passed). Ask your rheumy cons. what to do as we all get different advice (which is rather perplexing).


Thanks for all the answers. I have only just seen the rheumatologist and I forgot to ask - cos I didn't write my questions down !!!!!!

My Dr has me on folic acid seven days a week. I take mtx in morning to try and lessen side effects and take the folic acid at night.

tiger in reply to salem974

Thamks Salem, it seems like it depends on the consultant


Hi All

Just to confirm, as Polly says, you take folic acid to top it back up because the MTX depletes your levels of folic acid, but it can make the MTX less effective, which is why it is not taken on the same day as MTX.

Although most rheumatologists seem to agree that it should not be taken on the day of the MTX, other than that their guidance seems to vary greatly. Some people will be on a low dose taken every day apart from their MTX day, some take it the day after (particularly if they had problems with side-effects such as nausea, as the folic acid can help to relieve this) etc.

Kind regards


tiger in reply to Victoria-NRAS

Many thanks Victoria


I take my MTX on a saturday and Folic on a Tuesday, this is what I was advised to do. I was worried when I read that people take it differently but as others have said I think it depends alot on your consultant.

It is worrying especially as i live in France and there is also the possibility of important things getting lost in translation! . Thanks for your reply.

My rheumy told me to take it every day and when I questioned her about that she said it was okay, that skipping a day was the "old way of thinking" when to take folic acid.

And if the USA, folic acid is taken everyday, including MTX day, so I guess it doesn't really matter when or how often you take it. The mechanisms of why folic acid can reduce side effects are not understood according to my rheumatologist.

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