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Crohn's Disease Forum » Treatment » Methotrexate » How much folic acid with MTX?


07-16-2016, 09:14 AM   #1
FrozenGirl
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How much folic acid with MTX?

I recently increase my dosage of mtx to 15mg/ week. Along with the increase my GI told me to increase my folic acid to 5mg/day. Previous I was taking 1mg/day (on 12.5mg/week). This seems like a huge jump to me (esp since prenatal vitamins have less than 5mg) but I pressure you can't have too much folic acid.

So: how much mtx are you on and how much folic acid? Also when do you take folic acid? Mtx day included or skipped? (I feel like with a larger dose I should skip mtx day, or maybe just use the 1mg pills not to mess with effectiveness.)
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07-18-2016, 10:48 AM   #2
Clash
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My son is on mtx injections. His dose is equal to 20 mg oral dose. He takes 1 mg of Folic acid every day including mtx injection day.

He has been on oral and injectable mtx. He has never experienced any side effects with mtx.
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PAST MEDS: remicade, oral mtx, humira
07-18-2016, 11:21 AM   #3
FrozenGirl
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Interesting. Thanks for the info. The folic acid amount seems like a big jump but since I have had issues with MTX previously I'm guessing my GI is trying to ward those liver problems off with a higher folic acid dose.
07-18-2016, 03:14 PM   #4
Maya142
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My younger daughter was on 2 mg per day. We increased it from 1 mg per day when she started getting very nauseous with MTX. She was on anywhere from 7.5 mg to 25 mg of MTX (by injection).

My older daughter takes 1 mg per day with 15 mg of MTX.
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07-20-2016, 06:03 PM   #5
FrozenGirl
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Hmm this far with my googling and the responses here this seems to be a really high dose of folic acid I would be at 35mg/ week or 30mg/week if I skip injection day.
07-20-2016, 06:44 PM   #6
my little penguin
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Ds takes 17.5 mg of oral Mtx a week
He started 1 mg of folate X 2 day every day after too many mouth ulcers at once a day on 7.5 mg of Mtx

He is still on 1 mg X 2 day of folate
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07-20-2016, 06:49 PM   #7
Maya142
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I once asked my daughter's rheumatologist if increasing folic acid (more than 2mg daily) would help and she said that all the extra would just be excreted out and there is only so much you absorb, so it wouldn't really make much of a difference.
07-20-2016, 06:52 PM   #8
FrozenGirl
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Thanks for the input. While I'm sure the high amount won't be "bad" per say I am concerned it will negate the fm effectiveness of the MTX.

Might be worth mentioning: I have had prior issues with MTX. On a 15mg injected dose I had elavated liver enzymes (primarily ALT) until it got to the point where I was forced to stop because they kept going up and it was getting to the point of damage. I restarted a month later after normalized liver enzymes at 10mg/ oral. I bumped up to 12.5 and started folic acid 1mg/ day. Now on 15mg/injection. Since restarting my liver has been good.
07-20-2016, 07:02 PM   #9
FrozenGirl
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I once asked my daughter's rheumatologist if increasing folic acid (more than 2mg daily) would help and she said that all the extra would just be excreted out and there is only so much you absorb, so it wouldn't really make much of a difference.
That is somewhat reassuring. Thanks.
07-20-2016, 07:05 PM   #10
Maya142
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If you are very uncomfortable with 5 mg of Folic acid, you should ask your GI if you could try 2 mg or something like that. We get 1 mg pills of Folic acid so it's easy. You could also ask if you cut your 5 mg pills in half.

We don't skip folic acid on the MTX day, but I have heard of parents who do that for their kids.
07-20-2016, 07:27 PM   #11
FrozenGirl
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We have 1mg pills over the counter but 5mg is a prescription. I would probably prefer to cut the 5mg because I have full precaution coverage so I don't have to pay for the 5mg pills. Hmm... I think I am going to try the 30mg per week for 2 weeks and see if I feel like the MTX is less effective.
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