Methotrexate & Folic Acid - when to take them?

emmaholl
emmaholl Member Posts: 18
edited 3. Feb 2009, 15:31 in Living with Arthritis archive
I was advised by my new Rheumatologist that I should only take 5mg folic acid on the day after/before taking methotrexate. I have been takin it the other 6 days I do not take Methotrexate & he said I am overdosing on folic acid & it is counteracting the effects of methotrexate!
Has anyone else been given this advice?

Comments

  • jaspercat
    jaspercat Member Posts: 1,238
    edited 30. Nov -1, 00:00
    Hi, I have been on MXT for about 5 years now, the Rheumy told m to take Folic Acid 7 days a week, she has now changed her mind and I have to take it 5 days a week, but not on saturday and sunday, she gave the same reason about it affecting the effectiveness of the MXT, maybe they have just discovered this, I don't know love Jaspercatxx
  • livinglegend
    livinglegend Member Posts: 1,425
    edited 30. Nov -1, 00:00
    Folic Acid stops the Methotrexate working. I take Methotrexate once a week and on the following day I take a a dose of Folic Acid to kill it and stop long term usage side effects. This has been my dosage for seven years.n020.gif

    Some people need daily Folic Acid as Folate is a water-soluble vitamin, which means you need it in your diet every day because it can't be stored in the body. Obviously not on the day you take Methatrexate.

    If in doubt, query it with the rheumy.

    Joseph 8)
    Josephm0310.gif
  • Wonkylegs
    Wonkylegs Member Posts: 3,504
    edited 30. Nov -1, 00:00
    from starting my MTX tablets, right through to now with 25mg injections I have always taken 5mg folic acid every day except MTX day. They won't give me the injection if I have taken the folic acid that day.
  • ktl297
    ktl297 Member Posts: 50
    edited 30. Nov -1, 00:00
    Hi,
    I've been on MTX a couple of years and I take folic acid (5mg) on every day except the day I take the MTX. I was told that the MTX depletes the folic acid in your body so you take a super dose to compensate, apparently folic acid overdose is one of the ones that you naturally get rid of rather than some that can be toxic in large doses. I was also told that the large doses of folic acid taken on the day of MTX can interfere with it working. As I understand it the folic acid helps to avoid some of the side effects of the MTX such as hair loss, nausea, mouth ulcers. I think that the variety of advice everyone seems to have is due to the fact that Dr's don't have hard and set knowlege and facts, they all read opinions based on research and follow official (NICE) advice where it exists - I suppose it's worth changing the way you take meds to try to make it work better! KT
  • emmaholl
    emmaholl Member Posts: 18
    edited 30. Nov -1, 00:00
    Wow, such different advice. My husband found an NHS research article from 2006 which stated 5mg weekly is the best option so will stick with that. Guess it's individual to each person. thanks for your replies
  • doverliz
    doverliz Member Posts: 16
    edited 30. Nov -1, 00:00
    Hi. I have been on MTX and folic acid for four weeks and I was told to take them once a week but on different days. I also take steroids and arthrotec every day.

    Liz
  • honeykins59
    honeykins59 Member Posts: 20
    edited 30. Nov -1, 00:00
    hi i take metho20 mg on a sun and was told to take folic acid 4 days later i was not told to take it every day and now i read all your comment and it will be a question that i will ask at my next rhummy appointment next week as i have been on metho just over a year now at first it was not to bad but now im up to 20mg the day after and sometimeson the tues i feel really sick i take motillium for all the good it does it is supposed to help wiith the nausea i need to discuss this too thanx for the advice
  • plmb48
    plmb48 Member Posts: 125
    edited 30. Nov -1, 00:00
    hi
    i am so angry i have been taking metho 15mg for 5 years no one ever told me not to take folic acid on the same day.grrrrrrrrrrrrrrrrrrr so reading your posts it seems my metho has not been working as well as it could have been . :(:(:(:( pauline
  • emmaholl
    emmaholl Member Posts: 18
    edited 30. Nov -1, 00:00
    Hi Pauline

    How frustrating for you!
    I was not happy when told this since the hopsital pharmacy wrote on my MTX card to take every day except day MTX taken back in August! I also took MTX for several years before having a baby and am sure I was doing the same then!!
    All I can say is the same as the consuktant said to me is better finding out now than never or later!

    Good luck & hope MTX works even more effectively when you change.

    I do think some NHS guidlines would be helpful here. I wonder if there's anyway we could all get a straight answer from somewhere regarding this situation?
    plmb48 wrote:
    hi
    i am so angry i have been taking metho 15mg for 5 years no one ever told me not to take folic acid on the same day.grrrrrrrrrrrrrrrrrrr so reading your posts it seems my metho has not been working as well as it could have been . :(:(:(:( pauline
  • rubyrude
    rubyrude Member Posts: 14
    edited 30. Nov -1, 00:00
    Folic Acid I take the day after my meth and thats all. Thats the instructions on the packet and the advice i was given. I bet you have felt bunged up folic acid had that effect on me when I had to take it every day for pregnancy!
  • colinone
    colinone Member Posts: 1,039
    edited 30. Nov -1, 00:00
    Hi Emma
    I think its one of the world’s great mysteries , some time ago whilst at the Rheumy clinic for my metotrexate a chat got going about the same subject. It seems that there is no straight forward answer because we had all been told different things and had different amounts to take. I suppose its all to do with what side effects you have. I was told not the day before not the day of and not the day after MTx but the woman sat next to me was told 7 days a week others just 2 or 3 a week.
    Colin
  • emmaholl
    emmaholl Member Posts: 18
    edited 30. Nov -1, 00:00
    Thanks for the responses guys
    I have e-mailed the British Society of Rheumatoloy and the National Rheumatoid Arthritis Society to see if they have any guidance too!
  • emmaholl
    emmaholl Member Posts: 18
    edited 30. Nov -1, 00:00
    emmaholl wrote:
    Thanks for the responses guys
    I have e-mailed the British Society of Rheumatoloy and the National Rheumatoid Arthritis Society to see if they have any guidance too!

    This is the response gained from the national Rheumatoid Arthritis Society on the matter:

    Thank you for contacting us regarding the differing guidance you have been given as to when you should take folic acid. You are certainly not alone in being confused about this, and this is something we asked one of our medical advisers about recently after a similar query.

    His response was that although consultants use different regimens, the most common involved taking the folic acid either 24 or 48 hours after the Methotrexate, and that the latest guidelines from the British Society for Rheumatology (BSR) recommends taking it the day after the Methotrexate. However, it is always recommended that you follow the guidance from your own medical team (such as your consultant or rheumatology nurse specialist) with regards to guidance for medications, as they will be more aware of your specific circumstances.

    I hope the above information helps to clarify things a little.

    National Rheumatoid Arthritis Society
  • emmaholl
    emmaholl Member Posts: 18
    edited 30. Nov -1, 00:00
    This is the response I received from the British Society of Rheumatology

    Further to your e mail below as a clinical rheumatologist who has published papers in this area I would have the following comments

    1. Taking a small dose of folic acid alongside Methotrexate will cut down the likelihood of any sickness and also of any abnormal blood tests arising

    2. The exact dosing schedule is a matter for debate – In a paper in (Whittle S, Hughes RA Methotrexate and folic acid Rheumatology 2004:43;267-271)

    Rheumatology in 2004 we suggested that evidence for a regime of folic acid of taking one day per week the day after the MTX at a dose of 5mg

    3. There is no convincing evidence that folic acid in these small doses )or indeed in any other doses counteracts MTX good effect

    4. There are no published NHS guidelines other than our paper to give guidance – no real clarification can be given as there is no convincing evidence of one dose versus another to base guidelines on

    5. If people are still sikc despite 5mg once per week I sometimes suggest they increase to 5mg every day before they abandon the MTX or decrease the dose – this sometimes works to reduce the sickness