MTX and folic acid

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Rider Fan
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Date Joined May 2008
Total Posts : 1445
   Posted 11/13/2008 3:47 PM (GMT -7)   
Gosh, I'm so confused. My doctor told me to take 1mg of folic acid every day, but from reading the internet I've come across so many different dosages! Myself I've been taking 1-3mg a day to help my liver out.

Some say to NOT take any on the day of the injection. Some say take only the day AFTER the injection. Some say to take 1mg a day, some say 5mg a day, some say 5mg a week, some even say 10mg a day! Some say it doesn't reduce the effect of the MTX, some say it does but not very much.

GAH!!!!

I think navy takes 5 a day, sjkly takes 3 I think. I just did my 4th week injection yesterday, I hope I haven't canceled out the effects of the MTX, I need this drug to start working!

Thoughts needed please!
Dx'ed in 1999. No surgeries.

Current meds: 25mg Methotrexate. Udo's Choice Probiotics (30 billion).


Betaine, digestive enzymes, Candicin (oil of oregano capsules), Beta Sitosterol.

Tried SCD, didn't work, now avoiding gluten and dairy.


MMMNAVY
Veteran Member


Date Joined Jul 2006
Total Posts : 6927
   Posted 11/13/2008 4:03 PM (GMT -7)   
Yes, I take 5 MG a day and it has stablized my hair loss along with other vitamens. No you did not cancel the effect, but I would stick with 1 MG doc's orders if you are not feeling the side effects of MTX. I also take the injectable folic acid on days I can't keep the pills down.


Forum Co-moderator - Crohn's Disease
...I will find a way, or make one. -Philip Sidney 1554-1586
Make sure your suffering has meaning...
All suggestions/options/opinions are caveated with please consult with your local health care provider...

Post Edited (MMMNAVY) : 11/14/2008 6:01:51 AM (GMT-7)


camjames
Regular Member


Date Joined May 2006
Total Posts : 229
   Posted 11/13/2008 4:12 PM (GMT -7)   
Hi, I'm a university student who has crohn's, and I'm actually doing a presentation on Crohn's in a few more days. I came across some literature that mentioned taking 1-2mg of folic acid daily can prevent side effects such as stomatitis and nausea. While methotrexate is a folate antimetabolite, it is known to possess a variety of other immune modulating and anti-inflammatory mechanisms. These include inhibiting interleukins (IL-1, IL-2, IL-6, IL-8), which are key signalling molecules in immune molecular pathways. Also, methotrexate causes induction of adenosine, which alters even more biological processes. Moreover, methotrexate in Crohn's seems to still work when folic acid is administered, which indicates these other mechanisms play a role.
 
In my personal experience reading these forums, I have noticed that most people start with just 1mg of folic acid daily, then slowly bump up their dose, one milligram at a time until side effects are minimal. I haven't heard of many people taking more than 5mg of folic acid daily so I would check with your doctor about such higher doses.
 
Overall, from what I read about the efficacy of this drug, it appears methotrexate is good for inducing remission and maintaining remission.

Rider Fan
Veteran Member


Date Joined May 2008
Total Posts : 1445
   Posted 11/13/2008 4:41 PM (GMT -7)   
Thanks for the replies so far! Navy I'm taking the injections, 25mg and I do notice fatigue and headache for about a day. But I'm going to go down from 2 to 1 a day and see how it goes. Thanks for being my mentor on my mtx journey so far.

Very interesting Cam, good to know it that works in different ways, thanks for your input.

Any other thoughts comments are welcome!
Dx'ed in 1999. No surgeries.

Current meds: 25mg Methotrexate. Udo's Choice Probiotics (30 billion).


Betaine, digestive enzymes, Candicin (oil of oregano capsules), Beta Sitosterol.

Tried SCD, didn't work, now avoiding gluten and dairy.


sjkly
Veteran Member


Date Joined Dec 2007
Total Posts : 2113
   Posted 11/13/2008 7:36 PM (GMT -7)   
I take 3 but when I was researching how much I could take I found an article on mtx and folic acid that studied dosages up to 5mg and concluded that it does not reduce efficacy in RA patients-it does effect efficacy in cancer patients. 5 mgs is the upper limit only because high levels of folic acid can mask B-12 deficeincy. Folic Acid is a water soluable vitamin and is not toxic so you do not need to worry about over dosing.
I increased my dose from one to three miligrams on my own and told my doc at my next appointment she immediately wrote a script for the higher amount.
I had horrible fatique after taking mtx until the day I started the higher dose of folic acid and then had no side effects.
Sj

Bammer
Regular Member


Date Joined Mar 2008
Total Posts : 381
   Posted 11/13/2008 11:18 PM (GMT -7)   
Get weekly mtx injections and have had eight so far. My GI gave me a prescription for 5 mg. folic acid tablets to be taken once per day as well as an anti-nausea drug (Odansetron). I took the Ondasetron before the first two injections but none since. I have not had any nausea, fatique or any other side effects so far and bloodwork comes back OK.
55 yr. old F dx. CD 07/07
Was on prednisone for three months but no medication for next 11 months.
 Started weekly methotrexate injections 09/22/08.


MMMNAVY
Veteran Member


Date Joined Jul 2006
Total Posts : 6927
   Posted 11/14/2008 1:29 AM (GMT -7)   
I have been on 25 mg of MTX injections since OCT '06 and so the side effects such as hair loss and such took about 6-9 months for me to feel. I would suggest hyper hydrating the day before, of, and the day after you are injected to minimize the side effects, especially the headache (I no longer get them if I drink 10-12 (8 oz each) cups of water a day around the injection day). Plus 3 cups of milk, and some sort of real juice (3 cups) just space them out.

I also take folic acid and b-12 by injection if I cannot take them orally (which is more often then not). Folic acid is a daily injection or pills, and B-12 is a weekly injection for me.
Forum Co-moderator - Crohn's Disease
...I will find a way, or make one. -Philip Sidney 1554-1586
Make sure your suffering has meaning...
All suggestions/options/opinions are caveated with please consult with your local health care provider...


Rider Fan
Veteran Member


Date Joined May 2008
Total Posts : 1445
   Posted 11/14/2008 9:17 PM (GMT -7)   
Navy, is folic acid known to be hard on the stomach, or are you just sensitive to it? I haven't read about any GI issues with taking it.

Bammer have you noticed any improvement yet?
Dx'ed in 1999. No surgeries.

Current meds: 25mg Methotrexate. Udo's Choice Probiotics (30 billion).


Betaine, digestive enzymes, Candicin (oil of oregano capsules), Beta Sitosterol.

Tried SCD, didn't work, now avoiding gluten and dairy.


MMMNAVY
Veteran Member


Date Joined Jul 2006
Total Posts : 6927
   Posted 11/15/2008 5:55 AM (GMT -7)   
I am just a vomit comet...LOL
Plus sometimes my transition time is so fast that I have pills coming out in whole form.
Forum Co-moderator - Crohn's Disease
...I will find a way, or make one. -Philip Sidney 1554-1586
Make sure your suffering has meaning...
All suggestions/options/opinions are caveated with please consult with your local health care provider...


Rider Fan
Veteran Member


Date Joined May 2008
Total Posts : 1445
   Posted 11/15/2008 10:23 AM (GMT -7)   
Oh wow! Thanks navy, take care.
Dx'ed in 1999. No surgeries.

Current meds: 25mg Methotrexate. Udo's Choice Probiotics (30 billion).


Betaine, digestive enzymes, Candicin (oil of oregano capsules), Beta Sitosterol.

Tried SCD, didn't work, now avoiding gluten and dairy.


Howlyncat
Elite Member


Date Joined Jan 2005
Total Posts : 24909
   Posted 11/15/2008 5:11 PM (GMT -7)   
I am also on 5 mgs of folic acid daily
With 20 mgs of MTX weekly

I use to have alot of fatigue but luckily that has changed
and I also use to have to take anti nausea meds but
am now getting along alot better

I dont have too much hair anymore due to other reasons so I just use a super duper
mousse and fluff it and hairspray ..own shares in hairspay I believe lol
 DX: Crohns,Pyoderma Gangrenosum,Anxiety/Panic,
Fibro & Other DD

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sjkly
Veteran Member


Date Joined Dec 2007
Total Posts : 2113
   Posted 11/15/2008 5:49 PM (GMT -7)   
Folic acid and other b vitamins can also be taken sublingually-(under the tongue) they are also much better absorbed by that method then when swallowed.
Folic acid protects from GI and liver toxitity from folic acid and prevents the mouth ulcers some people get with MTX.

Rider Fan
Veteran Member


Date Joined May 2008
Total Posts : 1445
   Posted 11/15/2008 7:56 PM (GMT -7)   
Hcat, how long have you been onmtx and how long did it take to start working?
Dx'ed in 1999. No surgeries.

Current meds: 25mg Methotrexate. Udo's Choice Probiotics (30 billion).


Betaine, digestive enzymes, Candicin (oil of oregano capsules), Beta Sitosterol.

Tried SCD, didn't work, now avoiding gluten and dairy.


Bammer
Regular Member


Date Joined Mar 2008
Total Posts : 381
   Posted 11/16/2008 7:00 PM (GMT -7)   

Rider Fan

I have a significant stricture in my sigmoid colon which some doctors think should be surgically removed. Scopes have showed constant inflammation in that area for the last year-and-a half since it was found but I do not suffer with usual symptoms of Crohn's. Even going on mtx was a hard decision but we are going to try reduce the inflammation and then scope again in January. Seeing a great GI who understands my situation.

Until then, the only thing I nocticed was that the number of bowel movements has gone from 6-7 to 1-2 per day after a month of taking mtx. I used to feel what I called a kink or pressure on the left side of my abdomen but haven't felt that the last month either.

I previously thought I would just have the surgery but am beginning to think that I feel way too good to do that yet. I watch what and how much I eat at one time and will see what happens.


55 yr. old F dx. CD 07/07
Was on prednisone for three months but no medication for next 11 months.
 Started weekly methotrexate injections 09/22/08.


Rider Fan
Veteran Member


Date Joined May 2008
Total Posts : 1445
   Posted 11/16/2008 8:00 PM (GMT -7)   
Sounds like you made the right decision Bammer. Good luck and keep us updated!
Dx'ed in 1999. No surgeries.

Current meds: 25mg Methotrexate. Udo's Choice Probiotics (30 billion).


Betaine, digestive enzymes, Candicin (oil of oregano capsules), Beta Sitosterol.

Tried SCD, didn't work, now avoiding gluten and dairy.

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