METHOTREXATE (MTX) & FOLIC ACID Patient Handout – Print & Take to Your Doctor
Name: _________________________
MTX Dose: ______ mg weekly on ________ (day)
Folic Acid Plan: □ 5 mg once weekly on ________ (day)
□ 1 mg daily (except MTX day)
Why You Need Folic Acid
- MTX blocks folate → causes side effects like mouth sores, nausea, low blood counts, liver issues.
- Folic acid protects you without weakening MTX’s good effects (in arthritis/psoriasis).
Your Folic Acid Schedule
|
Day
|
MTX
|
Folic Acid
|
|---|---|---|
|
Mon
|
☐
|
☐
|
|
Tue
|
☐
|
☐
|
|
Wed
|
☐
|
☐
|
|
Thu
|
☐
|
☐
|
|
Fri
|
☐
|
☐
|
|
Sat
|
☐
|
☐
|
|
Sun
|
☐
|
☐
|
Best time: 24–48 hours after MTX
How to Take Folic Acid
- Tablet: 1 mg (white) or 5 mg (yellow) – swallow with water/food
- If 5 mg upsets stomach: Ask pharmacist to split into 2.5 mg × 2
- Missed dose? Take as soon as you remember unless it’s MTX day
Foods High in Natural Folate (Eat Daily)
- Spinach, kale, broccoli
- Lentils, chickpeas, black beans
- Avocado, oranges, fortified cereal
Warning Signs – Call the Doctor
- Mouth sores that won’t heal
- Severe nausea/diarrhea
- Unusual bruising or bleeding
- Yellow skin/eyes (liver)
- Extreme fatigue
Lab Monitoring Schedule
|
Test
|
When
|
|---|---|
|
Blood count (CBC)
|
Monthly × 3, then every 3 months
|
|
Liver tests (ALT/AST)
|
Same as above
|
|
Folate level
|
Only if symptoms
|
Important Notes
- Pregnant or planning? STOP MTX immediately – call the doctor.
- Cancer patients: Use leucovorin (IV) only – not folic acid.
- Alcohol: Limit or avoid – increases liver risk.
- Multivitamins: OK except on MTX day (most have <0.4 mg folic acid).
Pharmacy Tip:
Ask for generic folic acid 1 mg (affordable, approximately $4 for 100 tablets).
No prescription needed in most places.
Questions? Call:
Rheumatologist: _________________________
Pharmacist: ____________________________
Emergency: 911 or local ER
Print 2 copies: 1 for fridge, 1 for wallet.
Handout based on ACR/EULAR/BSR guidelines – last updated 2025