MTX with Folic Acid

[Guest guest]

I wanted to respond to the questions some of you were having about Methotrexate (MTX) and having to take folic acid. I have had RA for 6 years now (since I was 18) and have taken a multitude of medications including MTX. I was on the pill form, but it didn’t work for me, so we switched over the MTX injections. So, I have had some experience with it… about 5 years worth. I have included some research from the net in my answer to help me along and to make sure that my experiences and what I have heard are correct and so I am not passing along false information. So, I hope this helps.

Methotrexate Users Need to Be on Folic Acid

“Methotrexate inhibits the body's absorption of folic acid (Vitamin B9), which is found in leafy green vegetables ('folic' is derived from the word 'foliage'). Side effects, such as nausea or mouth sores, can result from folic acid deficiency, so your rheumatologist may recommend you take a daily folic acid supplement.” The use of folinic acid has been shown to reduce toxicity, but in high dose may reduce efficacy.

I currently take .3cc (7.5mg) injection of MTX once weekly. I have been told by MANY health care professionals to NOT TAKE FOLIC ACID on the SAME DAY as my MTX as this causes the MTX to reduce its effectiveness. I usually take 3mg of folic acid per day, as I have a problem with my hair falling out and this helps to lessen the amount coming out. My rheumy is talking about putting me up to 4 or 5mg if my hair continues to fall out. But, as I just said, you must not take folic acid on the same day as your MTX or it just won’t work like it’s supposed to. Why take this poison (MTX) if you are planning to counteract the effects with taking folic acid on the day you take your MTX. Doesn’t make sense to me.

Common Methotrexate side effects, reversible once the medication is stopped, include nausea, hair loss (alopecia), skin rash, mild liver inflammation, and mouth sores. Folic acid supplements may help prevent some of these minor side effects. It was also found that taking folic acid made a huge reduction in digestion side effects of Methotrexate.

“Folic acid, an inexpensive vitamin, is safe in a broad range of doses and protects patients with rheumatoid arthritis who are taking methotrexate from toxicity while preserving the efficacy of methotrexate. It is important to continue folic acid supplementation over the long term in patients on methotrexate and folic acid in order to prevent them discontinuing treatment because of mouth ulcers or nausea and vomiting. Our data suggest that folic acid supplementation is also helpful in preventing neutropenia, with very little loss of efficacy of methotrexate.”

In one study I found taking a low dose of folic acid reduces Methotrexate side effects by 79% compared to a placebo (dummy supplement pill).

The substantial improvement in painful and swollen joints provided by methotrexate for RA was unaffected by low doses (5 mg per day) of folic acid, BUT high doses (10mg+) of folic acid reduced the ability of methotrexate to help RA.

Vitamin B9 (Folic Acid) Found in these vegetables

AsparagusAvocadosBananasBeansBeetsBrewer’s yeastBrussels sproutsCabbageCalf liverCantaloupeCitrus fruits/juicesEndiveFortified grain productsGarbanzo beans (chickpeas)Green, leafyvegetablesLentilsSproutsWheat germ

A link to one of the articles I found:

http://www.mercola.com/fcgi/pf/2001/aug/18/methotrexate.htm

I hope this helps.

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