Folic acid and Methotrexate - advice please

tillytop

Hello helpful peeps

I am just wondering how many of you who take mtx also take folic acid alongside - and if so how much and when - and if you think it makes a difference.

I am just about to start methotrexate again at a low-ish dose (7.5mg/ week) but the doc has made no mention of folic acid. As far as I remember I didn't have folic acid the last time I took mtx (about 10 years ago). The pharmacist tells me that folic acid is usualy prescribed alongside because it can help to reduce the toxicity of the mtx so I think it's probably quite important. Also, the vitamins I take contain quite a lot of folic acid and the pharmacist says I shouldn't therefore take them along with mtx without checking with the GP first. I really don't want to stop taking the vitamins so I am hoping that, if I need more folic acid, the doc can just prescribe a smaller dose to go with that already in the vits.

I have read previous posts and it seems to be that different consultants suggest different doses/timings so I would just like some information about what others are doing which I can take with me when I go to the GP next week.


Many thanks!

Tilly x

joon51

Morning Tilly

Hope this might help. I take mtx when I first started I use to take 1 folic acid 5mg once a week, when they upped my mtx they upped my folic acid to 3, 5mg pills a week, have been feeling quite sicky recently the Rheumy nurse then upped my folic acid to every day apart from the day I take mtx, saying that I was at the docs yesterday and she said don't know how folic would stop you feeling queasy, CONFUSED I am, seeing rhuemy on Tuesday will find out more then.

love


Junex

robertls

This was asked about a couple of weeks ago......

I've bumped up thread...

Rob x

annie_mial

Tillytop, you are quite right when you say that we are all different.

I had a really bad problem with mouth ulcers due to the MTX and the Rheumy then told me to take a week off it and then start again using a split dose. I am on the max 25mg, so take 12.5 Mondays and Thursdays.

At the same time she advised me to take the folic acid for the other 5 days a week - previously I had been on 1 tab x 3 days each week.

I'm inclined to think that generally they start you off with a lowish dose of FA and then see how it goes.

I have had no problems with mouth ulcers since starting this regime, but I'm sure it is individual to me.

Annie

dreamdaisy

I've never taken folic acid, but then I rarely have side effects from meth. I am on 17.5 injected weekly. DD

chicara

Hi Tilly

As others have said I think it comes down to the individual and the views of individual consultants. I take 15mg methotrexate a week, my old consultant told me to take 5mg folic acid everyday except the day I took methotrexate, my new consultant told me to take 5mg 2 days after. The only time they increase it is when my folic acids levels are low.

I think it's like most things we take, what suits one doesn't necessarily suit another so it's a case of finding what works for you.

Hope all goes well and you get some relief with the methotrexate.

Take care

Chicara

joyful164

I normally take my folic acid every day except the day before, day of, and day after MTX. You are on a fairly low dose of MTX, so you may not need as much as this. I think you need to take folic acid because over a time you could get uncomfortable side affects
Do you see a rheumatologist and do you have a rheumy nurse?
You could always ask them#
joy

julie47

Hi tilly

Funny enough I never understood and still don't about taking folic acid.

Yesterday I went to a new Rheummy doc and she wanted to know all meds. When folic acid was mentioned she asked how much and how often. I am on 10mg mtx weekly. I told her I used to take folic acic 5mg each day then was told that it wasn't necessary to do that and once a week would be ok. She replied Once a week is fine . I was told it is supposed to eliminate any side effects of mtx.
( I shrg my shoulders here but you cant see me) :?

hope that was of some help.

Anyway isnt there folic acid in rice crispies

love juliepf x

cthornley

Everybody who takes MTX should take folic acid as a supplement as it is a foliate depleater
How much will depend on you, your dosage and your side effects?
Generally it should be 5mg. taken following mtx as it makes up for the depleted foliate.

Folic acid is important in terms of healthy growth and cell renewal, it is an essential nutrient that cannot be produced by the body by itself. Lack of it can also cause anaemia.

All doctors should prescribe it except in exceptional circumstances however many doctors (GP's especially) don't really understand mtx so get it wrong. The level of folic acid in your vitamins is likely to be so low that it won't make any difference to add some more....to put it in perspective "The recommended daily intake of folic acid is four hundred micrograms and if you are pregnant you should take between six hundred and eight hundred micrograms daily." , when on MTX you usually take between 5 and 10 mg which is over 10times as much. You should however check the interaction of any drugs and supplements with your doctor or pharmacist for safety.

Hope that makes sense
Chrissie

julie47

cthornley wrote:

Everybody who takes MTX should take folic acid as a supplement as it is a foliate depleater
How much will depend on you, your dosage and your side effects?
Generally it should be 5mg. taken following mtx as it makes up for the depleted foliate.

Folic acid is important in terms of healthy growth and cell renewal, it is an essential nutrient that cannot be produced by the body by itself. Lack of it can also cause anaemia.

All doctors should prescribe it except in exceptional circumstances however many doctors (GP's especially) don't really understand mtx so get it wrong. The level of folic acid in your vitamins is likely to be so low that it won't make any difference to add some more....to put it in perspective "The recommended daily intake of folic acid is four hundred micrograms and if you are pregnant you should take between six hundred and eight hundred micrograms daily." , when on MTX you usually take between 5 and 10 mg which is over 10times as much. You should however check the interaction of any drugs and supplements with your doctor or pharmacist for safety.

Hope that makes sense
Chrissie

Thanks chrissie yes it does.
Julie pf x

breane

Hi Tilly, I have been on MTX for around 14 weeks at 7.5mg doseage.At first I was told to take 2 Folic Acid tabs 24 hours after the MTX.However,due to some hair loss caused by the MTX my rheumy nurse told me to double the dose of Folic Acid and take it 24 hours before the MTX. It appears we are all told differently how to take Folic Acid and it does get very confusing.I am going to bring up the subject again when I see the nurse next week. Breane.x

skezier

Hi Tilly,

Its down to individual rumo's and what they think.... we are all on different but fa makes me feel sick so I did ask if I could stop taking it and they were infatic you need it so now I have liquid and anti-emetics I got the hair thinning so was originally put on 10ml the day after the mtx but now take 10 ml for the 2 days before and the 2 days after.... still got hair thinning though

Good luck and hope it will help you. Did it last time you were on it? ((( ))) Cris xx

nanasue

Hi Tilly,
Just to let you know my experience. When I started MTX Iwas told to take it once a week but not on the same day as MTX, but I had a lot of problems with sore mouth and tongue (but not ulcers) so I now take it every day except on day of MTX and that seems to suit me. I also have difflam mouthwash for when my mouth is sore, I know some people use corsodyl but I find that too strong. As others have said I think it's just about finding what level is right for you, but you should be taking it a t least once a week.
Hope this helps in some way

Love Suex

tillytop

Thanks to Joon, Rob, Annie, DD, Chicara, Joyful, Julie47, Chrissie, Breane, Cris and Sue for your replies (hope I haven't missed anyone). And thanks Rob for bumping up the other thread for me.

As I suspected, there is obviously no standard approach to the issue of folic acid.

When I took mtx before, I took it at a higher dose and had to stop it after a year and a half because I couldn’t deal with the relentless nausea. It was the only thing which really helped the RA though until the anti-tnfs came along. This time I will be taking only a low dose, probably alongside Rituximab but I am still obviously keen to minimise any nasty side effects as far as possible.

As some of you have indicated, the GPs don’t really understand about the folic acid, so think I will leave a message for rheumatologist for advice. Can you believe that my GP has prescribed the mtx purely on my say so (!!!!) without waiting for the consultant’s letter, so it may be that the letter, when it arrives, will clarify matters. We have a week off next week so I’m not going to start the mtx until the following week, so hopefully will have clarity by then.

Thanks again for your advice.

Love Tilly x

Wonkylegs

HI Tilly

it is amazing how many times this subject comes up, and each time a gaze with puzzlement at how there can be so many different interpretations of what is 'good practice' :shock:

I have always been told to take 5mg folic acid daily except for the day I take MTX.

good luck with getting a straight answer!

WOnky

carola

I take 20mg of Methotrexate every Tuesday and then 5mg of Folic Acid on the Wednesday.

I have read several studies asking the question if too much Folic Acid interferes with the usefulness of the Methotrexate.

I built up my intake of Methotrexate and had asked my Rheumy should I be building up my dose of Folic Acid accordingly however she said no, just stay on 5mg of Folic Acid.

We have to bear in mind that everyone's bodies react differently to all these pills and things.

Minor side effects of Methotrexate are things like mouth ulcers (which I get alot) and major ones are things like cardio problems. I may be stupid however I try to welcome my mouth ulcers as I think to myself "Hey ho, at least my Methotrexate must be toxic enough to do me some good" !!!!
Carol

tillytop

Thanks Wonky and Carol for your replies.

As you say, there doesn't see to be any standard answer to this!

I spoke to a rheumy nurse today who told me that I should take one 5mg dose of folic acid two or three days after I take the mtx. And she says I can continue to take my multi-vits which contain folic acid which is good cos I don't want to stop those. I need all the help I can get!!!!

Thanks to all for your replies.

Love Tilly x