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Methotrexate and Folic Acid Dose

Hello, I start using 15 mg MTX injections and the day after injection I take 10 mg folic acid. Do you think 10 mg folic acid too much? Isn't recomended folic acid dose 5 mg/week or 1 mg/daily? And does folate supplementation reduce MTX efficacy?
Thank you.
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No, folate supplementation does not reduce efficacy. I'ts highly recommended, in fact.

But I believe you are taking too much. From what I heard, you want to stay around 1mg. Personally, I take a dedicated folic acid supp, 800 mcg, and then there is 400mcg included in my multivitamin - so 1.2 mg total.
I used to take 10mg folic acid whilst on methotrexate because if I dropped any lower I would suffer with horrible sickness caused by the methotrexate.


There does not seem to be a concensus on which acid folic dosage someone taking methotrexate should take. Daily dosage will generally be someone between 1-3mg 6 days a week (skipping the day of the injection/pill). 10 mg is a bit higher that what I generally saw being mentionned but for medical condition 10 mg is still an acceptable dosage.

I'm not familiar enough with the pharmacokinetic of that product to suggest if the daily versus weekly dosage is best though.


Was it your specialist that suggested you to take it even on the day of methotrexate?
As far as I know, taking it on that day will lessen the efficiency of methotrexate because it competes for the reductase of the same enzyme... Now... is 1mg a big deal? That I don't know and I can't find a publication that specifically adresses this. I only found some regarding 5mg where they advise to take it 6days/week. All I know is that my GI and Rheumy had both advised me to skip on the injection day and I was on 1mg as well.


It's possible in my case he doesn't care so much about the efficacy because he sees it as mainly a tool for preventing antibodies to Remicade.
When I was on MTX previously & I was taking 10mg of folic acid per week, 3 days before my shot. I still had side effects but they weren't too crazy.

I was then in remission for a year or so until around Feb last year and tried to deal with it without meds up until October last year when I was put back on it. I was given a new GI and this particular GI didn't believe in prescribing folic acid with MTX due to indications that it may promote polyp growth in the intestines. I tried it without the folic acid for 3 months and had terrible side effects - nausea and fatigue to the point where I couldn't even leave bed on some days. It got so bad that I actually stopped taking my shots for a few weeks because I was sick of feeling so horrible.

Only a few weeks ago, my GP decided that it's better off me taking folic acid and having my MTX shots rather than being on nothing at all so I'm back to taking both. I haven't noticed any major side effects yet so I'm feeling more hopeful.

I'm actually looking to see a new GI and talk to them about changing meds to something less intense - maybe azathioprine - and see how I go.

Best of luck!
I just looked at my new prescriptions my GP is starting me on. 2 1mg tablets per day. She gave me oral MTX, starting at 7.5mg per week. The poor lady is trying to act as my rheumatologist AND GI, because I am broke. This just doesn't seem right though.

I hope that you do well with it!