Methotrexate + Folic Acid

Methotrexate + folic acid is a combination therapy commonly used in the treatment of rheumatoid arthritis. This combination consists of methotrexate, a disease-modifying antirheumatic drug (DMARD), and folic acid, a vitamin B9 supplement that helps reduce methotrexate's side effects. ## Mechanism and Purpose Methotrexate works as an immunosuppressive medication by reducing the activity of the immune system and preventing it from attacking the body's own tissues[6]. It decreases inflammation by: 1. Blocking folic acid metabolism, which reduces the replication of harmful cells[5] 2. Increasing adenosine release in inflamed joints, which has anti-inflammatory effects[8] Folic acid is added to this combination specifically to prevent folate deficiency caused by methotrexate[6]. When methotrexate reduces folate levels in the body, it can lead to various side effects. Taking folic acid supplements helps replenish these stores and significantly reduces the occurrence of side effects without compromising methotrexate's therapeutic efficacy[3][7]. ## Dosage and Administration The typical dosage of folic acid prescribed with methotrexate is: - 1 mg by mouth daily, or - 5 mg once weekly[2] Most healthcare providers recommend avoiding folic acid on the day of methotrexate administration, though some studies suggest there's no decrease in efficacy if taken on the same day[8]. Some protocols suggest taking folic acid 48 hours prior to the methotrexate dose may provide additional protection against gastrointestinal side effects[1]. ## Benefits of Combination Therapy Research has demonstrated that folic acid supplementation during methotrexate therapy: - Reduces the incidence of side effects such as nausea, vomiting, mouth ulcers, and abdominal pain[1][2] - Decreases the likelihood of abnormal liver function tests[7] - Improves patient adherence to methotrexate therapy[1] - Helps prevent discontinuation of methotrexate due to adverse effects[1] - Does not interfere with methotrexate's efficacy in treating rheumatoid arthritis[3][8] ## Side Effects Despite folic acid supplementation, some patients may still experience side effects from methotrexate, including: - Mouth sores - Nausea and vomiting - Upset stomach - Weakness and tiredness - Fever and dizziness - Decreased white blood cell count - Increased risk of infection[6] Without folic acid supplementation, patients taking methotrexate are at higher risk for folate deficiency symptoms such as: - Extreme fatigue - Muscle weakness - Headache and dizziness - Shortness of breath - Low blood cell counts - Neurological problems - Mental health issues including depression and confusion - Gastrointestinal symptoms[4] This combination therapy represents an important approach to maintaining the therapeutic benefits of methotrexate while minimizing its adverse effects, allowing patients with rheumatoid arthritis to continue their treatment with improved quality of life.

Brand names

RheumatrexTrexallOtrexupRasuvoRediTrex

Other names

methotrexate + folic acid