Hi, I take my 15mg Mtx each Monday evening, then folic acid in the evening of every other day of the week. Had a routine 4 weekly blood test yesterday morning, ie before weekly Mtx. My rheumatology nurse called to say my B12 was low. She's going to check again in 4 weeks. Any suggestions meanwhile how I can improve things, as it seems to me it will be even lower through the rest of the week.
Low levels of B12: Hi, I take my 15mg Mtx each... - PMRGCAuk
Are you on omeprazole? How much folic acid are you on?
B12 and folate are different and mtx doesn't reduce the B12 as far as I know, just the folic acid. I don't think that folic acid makes a major difference with the mtx nausea, just the other things like hair falling out etc. The usual way of avoiding the nausea is giving mtx by injection.
You should have good stores of B12 in your liver - so it isn't until the blood level is very low that there is any real problem. But since you have one a/i disorder - you could also have developed pernicious anaemia although older people commonly have low B12 because of the reduced amount of acid in their stomach (and the reason I asked about omeprazole).
Hi PMRpro, yes, I'm taking Lanzaprozole, and I take 5mg Folic acid on the 6 days a week that I don't take Methotrexate. I just had another blood test taken at my family doctor's this morning, and the nurse has included the B12 test. She says the doctor will phone me if any results are abnormal. My family doctor is now managing all of my prescriptions, and he has said he will monitor my blood in addition to the rheumatology clinic because the clinic don't inform him of the results of their tests ! So hopefully if the B12 comes back as low again my family doctor will be able to sort it. He has been very good so far. Regarding the nausea, I can cope with that, I think it's probably better than sticking needles in myself !
Foods are ok as long as you are able to absorb B12. Chances are you can’t if your diet already rich in B12 . If you have to wait 4 weeks before retesting, I’d would really try to eat lots of B12 rich foods so if it is low again, I can say that it is in spite of an excellent diet, so give me an injection now please. Folate won’t influence B12.