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Rank: Advanced Member
Groups: Registered
Joined: 12/5/2009
Posts: 103
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Hi,I took my first does of 15mg of MTX yeasterday at 7.30 in the evening and I was wondering how long it takes before any side effects kick in.I know not everyone suffers with side effects but if you do,do the side effects happen each time you take MTX. Also,I will be taking 15mg Folic Acid,do I take that today at 7.30pm like I did with the MTX yesterday and do you take it with food?There was no instruction leafleat with the Folic Acid tablets. Many thanks, Brenda. 
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Rank: Advanced Member
Groups: Registered
Joined: 3/24/2010
Posts: 102
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Hi Brenda
I think I have been told NOT to take folic acid on the same day as mtx. I take mine 2 days after the mtx (mtx - Sunday - folic acid - Wednesday)
It took months before I got the sickness side effect of the mtx and after getting good advice on here - I now take mine at night - I feel a bit sick on Monday - instead of taking it Sunday morning and feeling sick all day Sunday and Monday - even being sick!
Hope that helps
Love Beth
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Rank: Advanced Member
Groups: Registered
Joined: 2/26/2010
Posts: 271
Location: hampshire
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Hi Brenda, I was told not to take folic acid on the day I took mx, so I take mx on a Thursday night and folic acid sun.mon and tues. Also, I take mx Thursday night (25mg) so usually feel sick on a Friday but ok on a Saturday. Its not too bad really because I work Tues, Weds and Thurs so it forces me to rest on a Friday which always helps! I have heard of some people who split their dose of mx to avoid the nausea.
Take care, hope all goes well for you!
love Heatherxx
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 1,740
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Hi folic acid ive always taken after breakfast with all meds unless told otherwise, just dont take in same day as mtx dosage day. regarding mtx im not on it now stopped march was on it 2 years,i got some side effects mild nasuea same day took it,make sure have it after food and with lots water. good luck hope helps you tons. melly cuddly cats make my world seem so much more fun
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Rank: Advanced Member
Groups: Registered
Joined: 12/5/2009
Posts: 51
Location: Blackburn, Lancashire
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I have been on mtx since diagnosed 9 years ago and personally have not had any side effects. I was told, by my RA nurse, to take mtx with just a glass of water before food in the morning and to take the folic acid the next day
Hope this helps
Lisa
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Rank: Advanced Member
Groups: Registered
Joined: 12/3/2009
Posts: 585
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Hi
I have taken MTX for the past 14 years and I have never had any side affects (except feeling very tired)
I always take mine on a Sunday night so I can just fall into bed I then take the folic on a Wednesday
it can take 12 to 16 weeks for the MTX to get into your system
by the way welcome to the forum
but sorry you have RA
looking forward to getting to know you better
take care
Mary L
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 3,157 Location: Huddersfield
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Hi Brenda,
Regarding the folic acid 15mg which I presume is 3 tablets, are you sure you were told to take all 3 on the same day?
Most of us take only 5mg at a time, so 15mg is spread over 3 days (but like everyone says, not the same day as the mtx).
Doreen xx
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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 336
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Hello Brenda, are you sure that you need to take 3 folic acid tabs together. I once took 2 of mine together by mistake and it gave me the runs. You do sound as if you haven't been given very clear instuctions, I hope that you are OK. Try not to be too concerned about side effects, most of us get away with very few. Glenys.
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Rank: Advanced Member
Groups: Registered
Joined: 12/5/2009
Posts: 103
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Hi,Thank you all for your comments. Regarding the dose of Folic Acid,on the box it says 'Take Three Tablets Each Week on the Day After Taking Methotrexate' so I assumed I took the Folic Acid all in one go.Took the first MTX on Sat and so far so good,do feel very tired though.I guess side effects can occur at any time when first starting the MTX.I'm still on Omeprazole,Hydroxy and one Prednisolone although I come off the Pred in a weeks time.After 6 weeks being pain free I've just strted to notice slight stiffness returning in the hands probably due to the low dose of Pred(one a day now).I see my GP a week today so will mention to him about the Folic Acid.I thought it strange I had no instruction leaflet with the MTX.Dosen't give me much faith in the rheumy consultant. Brenda.x
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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 2,127
Location: Thornton Cleveleys
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Hi Brenda Way too much folic acid in one go! Overload!!! Just checked my BNF and the correct dosage is "5mg every 1-7 days depending on underlying disease". The usual maximum dose in combination with Methotrexate is "5mg daily taken on days when Mtx is not taken". I am on 15mg of Mtx, taken Wednesday, and 5mg Folic Acid taken Thursday to Tuesday, 1 tablet a day. Some people do get away with less Folic Acid and it varies between practitioners. Lyn x
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Rank: Advanced Member
Groups: Registered
Joined: 12/5/2009
Posts: 103
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Hi Lyn,I was concerned about the amount of Folic Acid I am taking so have rung the Rheumy nurse and she said that amount was correct.She said as I have started on 15mg MTX then 15mg of Folic Acid is what they usually prescribe.Also had a word with the NRAS helpline and the lady I spoke to said that consultants do prescribe in different ways and that can be confusing.I will still ask my own GP when I see him a week today.Apparently there is no standard dosage,each consultant has their own way of prescribing drugs and that in itself can be worrying for patients. Brenda.x
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Rank: Advanced Member Groups: Registered
Joined: 12/3/2009 Posts: 1,740
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Hi good idea to check seems to vary for me i only was given 5 mg to take at start day before mtx my rheumy ordered,then when i had lot mouth ulcers swollen gums they upped to max of 5mg 6 days week not mtx day. im now off mtx due tt wantign family. good to check around to be sure,no info leaflet with mtx thats occured with me to though not first time of taking it. you could ask chemist locally for a leaflet. the main guide howver is to follow the blood monitoring booklet for mtx. take care melly cuddly cats make my world seem so much more fun
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 3,006 Location: Timperley
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The problem is that too much folic acid reduces quite considerably the efficacy of the mtx.
Love Jeanxxx
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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 2,127
Location: Thornton Cleveleys
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 Confusing or what?? I have quoted from the British National Formulary, 'the book' used by GP's for prescribing. There is huge diversity in prescribing practice which only serves to confuse people further. I don't doubt the amount of 15mg is correctly prescribed but the ambiguity in the instructions for use is open to ones own interpretation. Folic acid is a water soluble vitamin (B9) which is absorbed from the small intestine, carried by the bloodstream and stored in the body, but not in significant amounts. 7 mg maximum is stored in the liver and other tissues; the body uses what it needs and the rest is excreted in urine. Hence the reason folic acid is topped up over several days. 15mg in one go is more than the body can use! Excess folic acid causes a number of problems of its own, diarrhoea, cramps etc., and as Jean says affects the uptake of Mtx. As well to check with your GP before taking any more! Lyn x
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Rank: Advanced Member Groups: Registered
Joined: 12/3/2009 Posts: 3,157 Location: Huddersfield
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Hi Brenda,
The doseage of Folic acid 15mg weekly is fine, it's taking the whole 15mg on one day that doesn't sound right.
As Lyn says, the recommended dose is no more than 5mg per day so you would take the 15mg dose over 3 days.
Doreen xx
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Rank: Advanced Member Groups: Registered
Joined: 12/3/2009 Posts: 3,006 Location: Timperley
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This info is on the NRAS main site:
MTX inhibits the activity of an enzyme called dihydrofolate reductase which is involved in the production of folic acid. Folic acid is required for the efficient activity of various other important enzymes involved in the production of proteins, and these enzymes too are inhibited by MTX and its breakdown products. The production of DNA and RNA (the genetic material of cells) is reduced whereas there is increased production of adenosine which has anti-inflammatory properties. Overall there is reduced growth and development of cells and reduced protein synthesis. Rapidly dividing cells including those of the immune system are particularly susceptible to these effects of MTX, which is believed to explain its efficacy in RA. There are also effects on the production of cytokines (proteins which have pro- or anti-inflammatory effects in RA); on the breakdown of bone; on the activities of neutrophils and macrophages (cells involved in inflammation) and the production of rheumatoid factor. MTX increases the production of the cytokine IL-10 and reduces that of nitric oxide which is associated with a favourable change in the ratio of TH1/TH2 lymphocytes and in apoptosis.
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Rank: Advanced Member Groups: Registered
Joined: 12/3/2009 Posts: 1,740
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yeah so right jean,thats why i was doing worse having to keep on the max dose folic acid. i was supposed be on it only 1 month for max dose but ew rheumy told me keep on max dose due to reoccuring ulcers,swollen gums. hope you get on very very well with mtx Brenda,most dont have much if any side effects. take care melly cuddly cats make my world seem so much more fun
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Rank: Advanced Member  Groups: Registered
Joined: 12/19/2009 Posts: 182 Location: kilwinning north ayrshire
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i take my mtx on monday night then take my 1 a week folic acid on the wed night thats what my gp told me but everybody diffrent i would check with gp sylvia x
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Rank: Advanced Member
Groups: Registered
Joined: 12/3/2009
Posts: 351
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In my hospital Blood Test Book, it says, "Folic Acid A vitamin supplement called folic acid has been shown to help your body cope with the methotrexate and also reduces some of the side effects you may experience. Your doctor or nurse will advise you when you should take these tablets. Folic acide should NOT be taken on the same day as your Methotrexate tablets." Addenbrookes advise taking Methotrexate on a Monday (M&M) and Folic Acid on a Friday (F&F), for those that take Folic Acid once a week, to avoid confusion. Carol
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