Question about methotrexate and folic acid

[Trainnner]

I was diagnosed with rheumatoid arthritis a week ago and have been given weekly methotrexate (12.5g) and I am going to start tonight. I have also been given weekly folic acid (5mg) to start a few days later.

But I react badly to medication usually and I’ve read that taking daily folic acid can make the side effects of the methotrexate milder. (But skipping the methotrexate day.)

Does anyone do this? And how much folic acid daily (apart from medication day)?

Nervous!

I started on 5mg 1x per week (the day after methotrexate), but increased folic acid to 5, then 6x per week, but skipping the day of the methotrexate.

I started methotrexate tablets, I did have a few gastric side effects so called the rheumatology nurse phone-line. Iirc they increased the folic acid, then switched me to methotrexate injections, but it might have been the other way round!

Nb folic acid is cheap, so you'll very possibly be told to increase if you have side effects. And it's small and easy to swallow too. Yay.

Have you taken it yet?

I seem to be experiencing increased nausea with the methotrexate. I’ve been on it for around 2 years I think. It’s helped my joint issues hugely and have been flare free for a while. I tried to come off of it and had a big flare up.
I have good and bad weeks.

I take my folic acid once a week a couple of days before the methotrexate

DH takes his folic acid the day after his methotrexate. Once a week.

I take 10 mg mtx weekly. Changing from taking folic acid once a week to 6 times (every day except mtx day) made me feel so much better. Weirdly I also feel much better on the tablets than the injections whereas it’s usually the other way around.

Thank you everyone! If you take the folic acid six days a week, do you take the 5mg?

I took it last night and woke up with a few gastric issues and a foggy brain feeling and mild nausea.

I wonder if taking a folic acid might help?

I have the day off on Mondays, which is why I decided Sunday night would be a good day. But I feel a little disappointed that my day off will be spent each week feeling slightly unwell!

I've been on mtx for nearly 3 months (PsA not RA). I'm on 20mg and take my folic acid 24hrs after taking the mtx. The first week and then when I increased my dose I started feeling nauseous a few hours before I was due to take folic acid, and it did recede after taking it. I would suggest taking your folic acid the day after mtx, and if you're still struggling ask your rheum team to increase the days you take it.

The best advice I was given was to really up fluid intake (2-3L of water) the day before, day of, and day after taking mtx.

I started MTX last July and had to stop because of dreadful digestive problems. They switched me to injections which were better.
Started in September and it worked brilliantly very quickly for my RA but it's been a saga sorting out the side effects.
I was initially prescribed folic acid 5mg taken six days a week.
I mentioned nausea and they increased it to 8 tablets a week instead of six. Nausea got much worse so I concluded that the folic acid not the mtx was causing nausea.
Then they dropped the folic acid to two tablets a week.
Nausea cleared up but I got headaches.

Mtx has been four months of juggling doses and side effects. I didn't realise that folic acid prevented headaches, rheumatology nurses didn't seem to put two and two together. What I have found is that in order to keep the headaches at bay I need folic acid every day but mtx day but not necessarily at 5mg. I've been taking a smaller daily dose of OTC folic acid and it's doing the trick.
I second the extra fluid as well.. Another thing that made a big difference was taking magnesium.

I’ve been taking methotrexate and folic for about 20 years now. No side effects in all that time.

My daughter has been on Methotrexate for about 6 years now. She takes the folic acid each day she doesn't take the Meth. She has been fine,

Thank you everyone! I emailed rheumatology yesterday (as they told me to if I had any bad side effects) as I have been feeling unusually low mood all week - like something pushing me down. They told me to stop taking it and will discuss something else on my next appointment. I had asked them if the low feeling would eventually pass in the email, but they said just stop on the phone.

Did anyone else get low mood on it? Every day since I’ve been mildly nauseous and headachey as well as the low mood (I took it on Sunday night).

All week it’s sort of felt like I was getting ill (when I wasn’t) or hungover or like I did when I was in early pregnancy! (Sickish, headachey, foggy, a bit low.)

Ironically, this evening it feels like it’s lifting a bit!

Not had low mood, if anything the opposite because I was so delighted to feel better in spite of the headaches and nausea. My joint pain had been so bad and it cleared quickly, crushing fatigue which was the first thing to improve.
Definitely the nausea felt like pregnancy ( I had 9 months of nausea and vomiting) which is how I came to suspect the folic acid. The nausea went away when I reduced the folic acid.

I was on it for 18months, took the folic midweek as instructed by my rheumato and the meth on Sunday .

For about a month was pretty wiped out on Monday and had all the other side effects. Then I got used to it for quite a long time and it did really work.

However after about a year it really made me feel disconnected and stupid, no short term memory at all so I switched to biologics which are better for me but more expensive for the health service.