everyone seems to take a different amount of folic acid

I was wondering what the correct dose of folic acid should be when taking methotrexate. I was told when i was first diagnosed 12 years ago to take 5mg three days after the mtx. I was told last year if i had side effects with the mtx (which i don't) i could take it more often but i would be interested to know how much everyone else takes and what the recommended amount should be.

10 Replies

  • I dont think there Is a set recommended amount, as needs to be based on individual reactions. As I understand it the principle is to prescribe the lowest amount you need so generally people are started on 5mg. After that it's up to how you respond and whether you need more. What I've read is that the MTX does knock out folate in your body, but also taking more folic acid than you need can inhibit MTX from working as well as it could, so you don't want to overdo it. And also people do take quite a range of doses of MTX, and have different metabolisms and body weights so it is sort of logical that the dose of folic acid would vary too. But it's v cheering to hear that you're still on MTX 12 years later, so hope it's keeping your RA controlled. Polly

  • Thanks for your reply Polly, I started mtx about 8 years ago, i also take sulphasalazine, plaquenil and rituximab and to be honest i am not well controlled at all. I have never really thought the mtx has helped much but frightened to stop as i have been told i could be a lot worse without it. hope you are well. x

  • I'm on MTX, sulpha and hydroxy too, but not a biologic. And it's working in many ways, but I too would like it to be better than it is as am slowly accumulating more and more permanent damage. Stangely, after several years of 5mg folic acid I've recently started getting side effects so have had to move up to 20mg. So I guess we can never entirely relax that everything is under control whatever we're on. Polly

  • That is so true Polly, i keep hoping they will find something with no side effects that works well, oh we can only hope.

  • Hi, I am on Humira and 20mg/MTX and have 5mg of folic acid every day apart from Monday when I take the MTX. I can still feel quite queasy the day I take the MTX and the day after. And them some weeks I feel rough for longer! But generally ok.

    It seems that different Drs and hospitals have different prescribing regimes. I have been on MTX and folic acid for the best part of 10 years now.

  • Hi Pands, Yes, when i increased up to 25mg mtx i was told if i get side effects i could take it every day but i was never told that at the beginning. I guess as Polly says it probably lessons the side effects but i sometimes wonder if i should take it more than one even although i don't usually feel sick with it.

  • I am pretty sure that when I started on MTX I didn't take the folic acid every day but then I started to feel so grim that they upped it and it has just stayed the same over the past few years, I would say that generally it seems to help - though I am getting mouth ulcers again - something else to ask my rheumy when I see him next week!

  • heard back from my rheumy today about my mouth ulcers, and her proposal is to switch me onto injectable MTX from next week. She reckons that will help. Frightened of needles, but I'm going to try as the ulcers are becoming more of an issue. Interesting to see what yours says? Polly

  • Thanks Polly I will see what he says when I go (with a long list this time!).

  • When I started on low dose MTX I was on one folic acid tablet the day after, then the dose of MTX was increased every few weeks to find a therapeutic dose. When I got to 25mg I started getting a few symptoms so the folic acid was increased to 6 days and it did the trick. If I forget the odd day it doesn't seem to matter, but if I forget a few I get the symptoms back. I think the amount needed depends on the individual response.

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