How Do I Take It
Methotrexate is taken ONCE A WEEK. You will choose a day of the week, for example Saturday. You will then take your methotrexate every Saturday. The pills are 2.5mg each and the usual dose is 3 to 10 pills. Follow your rheumatologists directions. Do not take more or less medicine than ordered. This medicine can be taken with or without food. You should also take 1mg of folate each day. Your rheumatologist will prescribe the folic acid. This will help prevent side effects.
Overall Completeness And Applicability Of Evidence
Sample size could potentially be a confounding variable because only 1 folinic acid study entered more than 40 patients per group. Interestingly, it appears that the benefit shown was greater for trials with higher numbers of patients and overall higher quality. Several authors, have reported that the inverse is usually true with lower-quality studies showing greater benefits, suggesting biases from poor design. The finding of a trend in the opposite direction in this metaanalysis is reassuring and indicates the likely validity of the reduction of side effects from folate co-administration.
A concern with metaanalysis is the potential existence of publication bias. It is possible that some trials have been completed that found no benefit of folic or folinic acid supplementation. It is difficult to be more definitive about publication bias in this review but we feel it is unlikely that we would be unaware of negative studies of sufficient size to eliminate the benefit seen in this metaanalysis.
Supplementation with folic or folinic acid in patients with RA who are taking MTX provides a reduction in the incidence of abnormal liver function tests and a reduction in overall withdrawal from treatment. There is also a trend toward a reduction in the incidence of GI side effects and stomatitis. The results of our review do not suggest any clear clinical advantage of one form of folate over the other.
Methotrexate And Folic Acid
Methotrexate is a cornerstone of disease-modifying antirheumatic drug therapy for rheumatoid arthritis. It is an analogue of folic acid and thus classed as an antimetabolite. Methotrexate inhibits dihydrofolate reductase , but the mechanism of action in rheumatoid arthritis is unclear.
On average, 30% of patients cease methotrexate within one year due to adverse effects and 60% experience mild adverse effects.20 Gastrointestinal intolerance and transaminase elevation are the main reasons for dose reduction or cessation. The risk factors for methotrexate toxicity include alcohol use, obesity , older age and folate deficient status.
Concurrent folic acid supplementation reduces elevations of hepatic transaminases, gastrointestinal intolerance and stomatitis, and may increase the maximum tolerated dose of methotrexate.21 Supplementation does not appear to have a protective effect on the development of cytopenia or liver disease, such as cirrhosis.
Studies have shown no reduced efficacy of methotrexate with a folate:methotrexate dose ratio of 3:1, that is, the dose of folate can be at least three times that of methotrexate before there is any effect on efficacy. For a once-weekly dose of 15 mg methotrexate, up to 45 mg of folic acid could be prescribed concurrently if required. There is no difference in benefit between folic acid 1 mg/day or 5 mg/week during methotrexate therapy.23
Also Check: What Causes Arthritis Pain In The Knee
Folic Acid Supplementation For Rheumatoid Arthritis Patients On Methotrexate: The Good Gets Better
A recently updated Cochrane Review by Beverley Shea and colleagues looks at the evidence for lowdose folic acid or folinic acid supplementation for reducing side effects of methotrexate in patients with rheumatoid arthritis. The review highlights some key aspects of the use of folic acid that merit further discussion.
MTX is an effective and commonly used diseasemodifying antirheumatic drug for treating rheumatoid arthritis.2, 3, 4] It is used alone and in combination with other DMARDs or newer biologic therapies targeting various inflammatory cytokines and cells. Treatment guidelines from the American College of Rheumatology and the European League Against Rheumatism highlight MTX as the first line of treatment alone or in combination therapy.5, 6] Although its exact mechanism of action in rheumatoid arthritis is unclear, we know that polyglutamate metabolites of MTX interfere with folatedependent enzymes such as dihydrofolate reductase and 5aminoimidazole4carboxamide ribonucleotide transformylase. The resulting accumulation of AICAR leads to the extracellular release of adenosine, which interacts with receptors on neutrophils and mononuclear cells, and this is likely to contribute to MTX’s antiinflammatory effects.
Benefits Of The Combination
Taking folic acid alongside methotrexate does more than just prevent folate deficiency. Research shows it helps to reduce some side effects of the drug, including nausea, vomiting, and mouth sores.
Folic acid also appears to play a role in preventing liver failure, a potential adverse effect of methotrexate use.
A 2013 systematic review of published literature found folic acid significantly reduced the risk of elevated liver enzymes and gastrointestinal toxicity in people prescribed methotrexate.
A similar paper published in the Journal of Clinical Rheumatology in 2019 found that folate supplementation can lower the risk of liver toxicity in patients who take methotrexate and may prevent liver failure.
The study used data from six clinical trials for a combined total of 709 patients. Researchers found folic acid supplementation also improved medication compliance in patients taking methotrexate. In addition, investigators noted that folic acid appears to reduce methotrexate withdrawal symptoms.
Also Check: How To Ease Arthritis Pain In Lower Back
Why Is It Important For Me To Treat My Ra
RA is an autoimmune disorder. Autoimmune disorders occur when your immune system mistakes your bodys tissues for invaders and attacks them.
In RA, your immune system specifically attacks the synovium, which is the lining of the membranes that surround your joints. The inflammation from this attack causes the synovium to thicken.
If you dont treat your RA, this thickened synovium can lead to cartilage and bone destruction. The tissues that hold your joints together, called tendons and ligaments, can weaken and stretch.
This can cause your joints to lose their shape over time, which can affect how well you can move around.
The inflammation associated with RA can damage other parts of the body as well. These include your skin, eyes, lungs, heart, and blood vessels. Treating your RA can decrease these effects and improve your quality of life. Learn more about treatments for RA.
Eat Your Fruits And Veggies
Most of them are full of antioxidants, which boost your immune system and may fight inflammation. Try fruits like prunes, raisins, and berries. Go for veggies like kale, spinach, and Brussels sprouts. And don’t forget fresh, leafy greens. They’re a great source of fiber and folic acid. If you take methotrexate, folic acid can ease some of the drug’s side effects.
Read Also: Does Rheumatoid Arthritis Affect Your Toes
Methotrexate’s Effect On Folate
Methotrexate is the most commonly prescribed disease-modifying anti-rheumatic drug for rheumatoid arthritis and other rheumatic conditions. Available in oral and injectable formulations, methotrexate is usually administered once a week in doses ranging from 7.5 milligrams to 25 mg.
Initially developed to treat cancer, methotrexate is an antifolate drug. It works to stop cancer cells from multiplying by blocking their access to folate. As a result, folate is quickly depleted in people who take methotrexate. To replenish this important vitamin, healthcare providers commonly prescribe folic acid for their rheumatoid arthritis patients who are treated with methotrexate.
The complicated interplay of methotrexate and folate led to earlier speculation that taking folic acid alongside methotrexate may reduce the drug’s effectiveness. However, more recent research indicates that folic acid supplementation does not interfere with methotrexate’s ability to combat arthritis.
Nutrient Depletion With Ra Medications
Methotrexate depletes folic acid so much that doctors prescribe folic acid along with it. Plaquenil, one of the medicines I take, depletes calcium and Vitamin D, along with Vitamin K. And since I have osteoporosis, this is very important for me to know so that I can make sure to add those nutrients to my diet and supplement routine.
Unfortunately, Ive never had a doctor educate me about this but luckily, I found a book entitled, Drug-Induced Nutrient Depletion Handbook by Ross Pelton, James B. LaValle, and Ernest B. Hawkins, which has a very comprehensive list of medications and the nutrients that they deplete.
Read Also: How To Avoid Getting Arthritis
Do I Need A Prescription For That Amount Of Folic Acid
The daily doses of folic acid usually recommended by rheumatologists are available over the counter, but some doctors prescribe a 5 mg dose to use once a week. After folic acid is consumed, its converted to its active form in the body by the action of an enzyme.
Another form of folate, called folinic acid, is already metabolically active and doesnt require the enzyme conversion. Folinic acid requires a prescription and is usually taken as a 5 mg dose once a week. The Cochrane Review found that folic acid and folinic acid have similar power to reduce MTX side effects. Rheumate, a medical food that contains folate, vitamin B12, and curcumin, also requires a prescription.
I rarely use folinic acid, as it is costly and, for most patients, provides no additional benefit, says Dr. Steiman.
Treatments For Rheumatoid Arthritis
- medicines such as methotrexate,biological medicines and steroids
Methotrexate is not recommended in pregnancy or while trying for a baby.
This medicine can stay in a woman’s body for 6 months after they stop taking it.
For men, there is a risk that methotrexate can damage sperm. This can affect the way a baby develops during pregnancy.
Women and men wanting to try for a baby need to stop taking methotrexate at least 6 months before trying to conceive.
Ask your doctor about changing to a different medicine before you stop using contraception.
Methotrexate may sometimes make you feel tired, or dizzy and light-headed.
If you are feeling tired or dizzy, do not drive, ride a bike or use tools or machinery until you feel better.
Also Check: What Are The Beginning Signs Of Rheumatoid Arthritis
Warning Disclaimer Use For Publication
WARNING: Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health.
DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. All information is observation-only. Our phase IV clinical studies alone cannot establish cause-effect relationship. Different individuals may respond to medication in different ways. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. The use of the eHealthMe site and its content is at your own risk.
If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date.
Folic Acid Supplementation Is Suboptimal In A National Cohort Of Older Veterans Receiving Low Dose Oral Methotrexate
-
* E-mail:
Affiliations Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America, Department of Medicine, Veterans Affairs Medical CenterSan Francisco, San Francisco, CA, United States of America
-
Affiliation Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
-
Affiliation Department of Medicine, Veterans Affairs Medical CenterSan Francisco, San Francisco, CA, United States of America
-
Affiliation Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
-
Affiliation School of Public Health, Yale University, New Haven, CT, United States of America
-
Affiliation Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
-
Affiliations Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America, Department of Medicine, Veterans Affairs Medical CenterSan Francisco, San Francisco, CA, United States of America
Also Check: Is Broccoli Good For Arthritis
Folic Acid Reduces The Gastric Side Effects Of Methotrexate
A study was conducted to study the efficacy of folic acid in reducing the gastrointestinal side effects caused by methotrexate in rheumatoid arthritis.
There was a 79% decrease in the gastrointestinal toxicity in patients who received folic acid supplementation along with methotrexate.
This showed that folic acid has a positive effect in reducing the gastrointestinal side effects caused by methotrexate.
A study was conducted in which it was observed that fewer people suffered from stomach problems when they started taking folate supplementation along with methotrexate.
35 out of 100 people suffered from stomach problems when they took methotrexate alone, however, only 25 out of 100 people suffered from stomach problems when they took folic acid along with methotrexate.
In the same study, people were tested for the occurrence of mouth ulcers as a result of methotrexate treatment.
It was observed that 6 fewer people suffered from mouth ulcers when they took folic acid supplementation along with methotrexate.
What does this mean? Patients with rheumatoid arthritis are mostly treated with methotrexate which leads to gastrointestinal toxicity. Folic acid supplementation is given along with methotrexate to reduce the side effects caused by methotrexate.
How To Cope With Side Effects Of Methotrexate
What to do about:
- loss of appetite, feeling or being sick, stomach ache or indigestion eat simple meals and do not eat rich or spicy food. It can help to eat and drink slowly and have smaller, more frequent meals. If you’re being sick, try taking small, frequent sips of water to avoid dehydration. For stomach ache, putting a heat pad or covered hot water bottle on your stomach may help.
- diarrhoea drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
- headaches, feeling tired or drowsy rest and drink plenty of water. Do not take non-steroidal anti-inflammatories, such as ibuprofen. You can try a painkiller such as paracetamol. Do not drink too much alcohol. Do not drive, cycle or use machinery if you feel tired or drowsy. Speak to your doctor if this does not get better.
- hair loss this is unlikely to be permanent. If hair loss bothers you, talk to your doctor. They may be able to lower your dose or recommend a different medicine.
Don’t Miss: How To Live With Arthritis In The Knee
How Does Folic Acid Help Rheumatoid Arthritis
//www.youtube.com/embed/Eddeozw1vJE
I havent heard that. I do water aerobics and warm water arthritis classes several times a week. They help me get things moving. I dont care for the pred I get.
A Complete Prenatal Multivitamin w/ Folic Acid for Nutritional Support
Methotrexate is the first choice disease modifying anti-rheumatic drugs for rheumatoid arthritis. Here, we refer to treatment consensus and systematic reviews.13,7 Traditionally, the recommended starting dose has been of 7.510 mg weekly for 4 weeks associated with folic acid in doses of 510mg the day after.
folic acid 400 mcg supplement tablet and pill
Folic Acid for Rheumatoid Arthritis. Food and drug Administration to treat rheumatoid arthritis. Folic acid does not replace any. Does Folic Acid Help.
Low dose methotrexate is a very common treatment for rheumatoid arthritis, psoriatic arthritis, and many other types of arthritis. Methotrexate is. Methotrexate is understood to work by altering how the body uses folic acid , a vitamin that is needed for cell growth. Patients can do them quickly at home. A small.
What makes her different from most other teenagers is that she is living with Juvenile Rheumatoid Arthritis. donations and walking to raise awareness for Arthritis! There are severeal ways you can help: JOIN OUR TEAM and.
Learn Symptoms, Treatments & Pain Relief Options For Arthritis Today!
Why Is Methotrexate Used For Ra Treatment
Methotrexate is often called a chemotherapy drug, as it is used to treat cancer, although generally it is prescribed in much higher dosages for cancer than for rheumatoid arthritis. Methotrexate inhibits the metabolism of folic acid, which is needed for the production of certain immune system cells.
Read Also: How Does Methotrexate Help Rheumatoid Arthritis
Data Extraction And Management
Data were independently extracted by 4 authors . Folate supplementation was considered as the administration of folic or folinic acid at any time with respect to MTX. The GI effects were combined . The incidence of stomatitis, as well as the incidence of abnormal serum liver enzymes, was analyzed independently. The following hematologic side effects were included, if reported: cytopenia, macrocytosis, or pancytopenia.
To assess changes in disease activity, the following measurements were considered a priori and ultimately included in the efficacy analysis: SJC, TJC, pain, disability score, grip strength, patient global assessment, and physician global assessment. A starting dose of 7 mg/wk folic or folinic acid was used as a cutoff value for studies to be included in the analysis. Worldwide guidelines currently support co-administration of folic acid with MTX, and where a dose value is suggested, it usually falls in the range of 0.5 to 2 mg daily,,,.
Folic Acid For Rheumatoid Arthritis Dosage
Having understood the importance of folic acid in rheumatoid arthritis, it is very important to know exactly how much folate supplementation should be taken along with methotrexate.
It is best to consult your doctor to find the dosage as some doctors prescribe 1mg of folic acid every day as soon as you take methotrexate whereas some prescribe 1mg folic acid only when the side effects of methotrexate occur.
Experts in rheumatoid arthritis suggest that the recommended dose of folic acid should be 5mg dose once a week but not a day before or after taking methotrexate.
It is essential to take the correct dose of folic acid as a higher amount are not good for health and can damage the nervous system.
Also Check: Does Collagen Help With Arthritis
Positive Effects Of Methotrexate On Ra Symptoms Do Not Disappear With Folic Acid
Taking a folic acid supplement can decrease or eliminate all of these side effects, and is therefore routinely prescribed for people taking methotrexate. 7 Interestingly, although methotrexate works by inhibiting the metabolism of folic acid, the positive benefits of methotrexate on rheumatoid arthritis symptoms do not disappear when taking a folic acid supplement.8
Personally, I continued to experience side effects while taking methotrexate in spite of taking folic acid. However, many people in our online community have shared that it did indeed help with their side effects.