• Welcome to Crohn's Forum, a support group for people with all forms of IBD. While this community is not a substitute for doctor's advice and we cannot treat or diagnose, we find being able to communicate with others who have IBD is invaluable as we navigate our struggles and celebrate our successes. We invite you to join us.

No Folic Acid with Methotrexate?

So, I'm starting MTX and after doing a little searching, I learned that it can deplete folate. I'll be taking a low oral dose every week. I called my GI's nurse and she said that he doesn't recommend taking folic acid with MTX. Anyone else's GI? So, I pushed further and asked, "Well, if I wanted to take folic acid, how much should I take...?" I'm waiting to hear back....

P.S. My previous GI never told me to take Calcium/Vit D with Prednisone, either! I had to find that out on my own, too.
I am currently on methotrexate and I take 10m of folic acid every Friday and methotrexate on a Monday. I have never heard of a dr saying not to take folic acid the only time you shouldn't is on the day of your methotrexate or immediatley after as it can stop it working. I upped my dose of 5mg to 10 when I was having bad sickness and feeling really run down from the methotrexate and it really helped.
Deffinatley keep on at them this doesn't sound right to me. Hope you get some answers soon x
My GE told me that it was fine to take folic acid on injection day, it would just be a waste since absorption would be low. I think I'm supposed to be taking 1mg a day, but will check when I get home...I would remember better if I also remembered to take it every day!


Humm... this is really odd and I do hope it was just a misinformation because, unless my infos are wrong, the folic or folinic acid really are recommended especially with the low dose methotrexate. It does reduce the adverse effects and it helps preventing the need of discontinuation of the treatment. It helps regulating the liver enzymes level, nausea, tiredness, ulcers,etc.. It also reduces the artherosclerotic effect of the MTX.

I was advised not to take it on the day of the injection but the remaining of the week, I was told to take some folic acid. The dosage seems to change from doctor to doctor. Some will suggest a daily basis and other will suggest a big dose once a week.

So yeah, I don't want to tell you not to listen to your doctor, but if the response is again that you should not take folic acid... I would at the least have a discussion about it with your pharmacist or GP as it seems a little weird...

Sometimes people don't know... I went to the ER once and the nurse asked me if I was pregnant right after I told her I was on MTX. She asked because of the folic acid... I told that anecdote to my friends (well my nurses friend, I have a few) to see if I was supposed to be scandalized or not by this, and well their eyes told me they knew it was highly teratogenic...
Yeah, I just got off the phone with his nurse and she told me I don't need to take the folic acid. But if I wanted to I could take 1mg per day.

Yeahhhh, I don't know if I like this GI. At my very first appointment he made me feel like crap for being in pain management and he told me that I was going to die early because of it. But I'll stick with him for awhile and see how the methotrexate works.


Yeah... well, I'd go for the 1mg a day, but the day of the injection. That was the regimen I was on. Does he check your blood levels often?
yes you 100% should be taking folic acid with methotrexate. I would say if you don't then you will almost certainly cause a whole host of other problems in the future because folic acid is a very important molecule in a huge number of bodily functions.

The only time folic acid shouldn't be taken with methotrexate is if you are using it to slow down cell replication in certain diseases (e.g cancer). One of the things methotrexate does is inhibit folic acid synthesis in the body, by doing this it slows down the division of certain cells. If you were then to take folic acid supplements, you would be defeating the whole purpose of taking the methotrexate. However for treating crohn's disease the mechanism of action is different, methoxtrexate basically inhibits t cells (white blood cells) which are involved in the inflammation response. Taking folic supplements will not make any difference to its effectiveness for treating crohn's and is definitely needed because otherwise your body will be short of what it requires for vital functions, which could cause a number of problems such as anaemia.
I also take MTX, mine is for inflammatory arthritis. I take 2 mg of folic acid every day. When I was taking MTX pills I was getting sick to my stomach so my dr upped the dose of folic acid from 1 mg to 2 mg. It has helped a lot. I take Humira for the crohns and am hoping that by taking MTX will also help with the crohns.
They never seem to tell you anything that seems important to recovery. Just like they say diet has nothing to do with it. Just keep one thing in mind. Dr's would make no money if they have all their patients cured, now would they? They take baby steps in the way they treat us. Trying all these new meds to me is scary unless you absolutely know the possible side risks involved. Make sure you read up on them before you take them.Whenever possible, try natural methods first. That's my opinion.


My doctor said to take 1mg of Folic acid daily including on the day of the injection.

I have 100% Folic acid in my multi but they still wanted me on it. Not sure why since I'm obviously getting it.
From the forum wiki

Drugs shown to interfere with Folic Acid Utilization include methotrexate and sulfasalazine. If sulfasalazine is prescribed, folic acid supplements are normally given. The purpose of methotrexate is to inhibit dihydrofolate reductase and thereby reduce the rate de novo purine and pyrimidine synthesis and cell division. Low dose methotrexate is used to treat inflammatory bowel disease. Low doses of methotrexate can deplete folate stores and cause side effects that are similar to folate deficiency. Both high folate diets and supplemental folic acid may help reduce the toxic side effects of low dose methotrexate without decreasing its effectiveness
My son just took his first dose of 25mg of Methotrexate this weekend. Dr. told him to take 1mg of Folic Acid every day even day he takes Methotrexate. He has Crohn's colitis and dr. said methotrexate is better than 6MP for teen boys due to slightly increased lymphoma risk. Did anyone hear about that? Clash I would love to talk to you about your experience on Methotrexate. My son is 16 yrs. old too. Diagnosed in March this year. So much to take in.
I think in later studies there was a case of HSCTL with methotrexate as well, Rose.

My son started methotrexate last November and since he is also on Remicade GI was only hoping to have him on it for 6 months, 9 months at the most at the 25mg level.

So May of this year C, my son, took it upon himself to quit taking his MTX. He eventually told me and I conveyed it to the GI. The GI was fine with it since C wasn't having any symptoms and his Fecal Calprotectin test was normal.

Two months later symptoms started to return so the GI put C back on MTX but at a much lower dose. He now takes 7.5mg a week. And, of course, 1mg folic acid every day.

C has never really had side effects from the methotrexate or the Remicade. He started taking the MTX on Fridays since he might need the weekend to recuperate but now he takes his dose on Sunday evening.

My son is now 17, so he has been on MTX for the better part of a year and on Remicade at every 6 weeks since May of last year.

Things are going really well right now. I always hate to say that out loud because that is when CD rears its ugly head just to prove me wrong!
Just looked at
"The use of methotrexate for treatment of inflammatory bowel disease in clinical practice
S Saibeni, S Bollani, A Losco, A Michielan… - Digestive and Liver …, 2012 - Elsevier"

It is a retrospective study. It found 83% of 112 patients receiving methotrexate got folate supplementation, median dose was 5 mg per week. Side effects were more frequent (74%)in patient without folate supplementation than those who got folate (38%). It remarked that physicians have no shared rules regarding methotrexate use (dose, route (oral vs injection)) or folic acid supplementation. It concludes that "folic acid supplementation appears to be able to reduce MTX toxicity and its use should therefore be strongly recommended."


http://onlinelibrary.wiley.com/doi/10.1002/ibd.21166/full this article describes the long term single center experience with mtx in Crohn's.
They wrote "All patients were prescribed concomitant folic acid (5 mg weekly) to be taken orally the day after MTX application."

I was so nervous when my son took his first dose. So many people have nausea/vomitting on it. My son got moderate headaches that improve with Tylenol and some fatigue. Did your son ever take the 6MP. I know that it's a little late but seems as if my son should have started with 6MP before methotrexate. Does your son take folic acid on same day he gets his methotrexate dose. My doctor said yes but alot of studies say not on dose day. I am assuming he will decrease my son's methotrexate dose after he is successfully weaned off budesonide (Uceris). Your replys mean the world to this new chronie mom.
I was nervous about the nausea/vomiting too! C went straight to remicade shortly after his diagnosis so the only meds he has been on so far are it and MTX. C does take folic acid the day of the MTX.

You need to check out our Parents Forum(<---click here). There are tons of parents with great support and experience. There are several who have kids on MTX as well as other medications. Please stop by and post your son's story.

As far as 6MP, I don't think there is any regimen to which med a child should be on first. Since, 6MP and methotrexate are both immunosuppressant and have similar side effects and similar risks, I think it is just the discretion of your son's GI.
I was told to take Folic acid with my Methotrexate. I have only been on it a few months.

Have good days and bad days, very tired of the bad days. i really really want to turn this around!!

Good luck to all on this medication we are talking.

I've been on Mtx for many years now. I found the side effects to be much worse when I took the folic acid weekly. Currently taking 1 mg daily except for needle day. Best of luck.

Lynda Lynda

60 hours off of my Budesonide and reading old posts 😳

How long does a person with Crohn's stay on the methotrexate ? I have been on it for almost 2 years.
I take Stelara, Methotrexate, Folic Acid and quit taking Budesonide per doctors order this week. Will my doctor also be taking me off of my methotrexate and folic acid now ?
Getting my Stelara levels checked next week. My BM's are good and I am afraid of being taken off everuthing, except Stelara, is going to make me sick again, I emotionally cannot handle pooping in my pants again like I used to.

From my 32 years experience having crohn’s is once the doctor finds a drug or drug combo that works for you they keep you on it until it no longer works. Then switch you to something else. Except the bridge drugs like prednisone you take to bridge the gap until the other drugs such as methotrexate and stelara start working then taper you off the bridge drugs. In your case the doctor may try getting you off methotrexate and see if the stelara will work alone. But I truly doubt the doctor would unless you were to push the issue of wanting to be off methotrexate or stelara. I would ask the doctor what he thinks would be the best course of action going forward now that he is tapering you off the budesonide. I am 100% sure the doctor will not take you off everything.

my little penguin

Staff member
My kiddo has been on Stelara and methotrexate for almost 6 years and was on humira and methotrexate for 4 years prior to that .
His combo though is for his juvenile arthritis as well as crohns .

Most docs don’t pull multiple meds at once

Lynda Lynda

Well, now the NP at my Gastroenterologist office makes it sound like she didn't tell me to stop the Budesonide. There's times I don't remember everything, so the next appointment I will take a note pad. But I know she said that I had been on the Budesonide a long time ( 2 years ) ....but I went from 9mg to 6mg then 3mg.