Can I take Folic acid and Methotrexate together?

Why this happens

Methotrexate works by blocking the body's use of folate (a B vitamin) to stop certain cells from growing too quickly. Folic acid is a man-made version of folate. While it helps protect healthy cells from methotrexate's side effects, too much of it can "compete" with the medicine, potentially stopping it from working properly against the disease.

What you should do

You must follow your doctor's specific schedule for these medicines. Usually, you will be told NOT to take folic acid on the same day as your methotrexate dose. Do not start taking over-the-counter folic acid supplements or multivitamins containing folic acid without checking with your specialist first.

Important precautions

Pregnancy and contraception

Methotrexate can cause severe birth defects or miscarriage. You must use effective contraception during treatment and for at least 6 months after stopping (applies to both men and women).

Dosing schedule and folic acid use

Methotrexate is usually taken only ONCE A WEEK on the same day. Taking it daily can be fatal. Folic acid must be taken on a different day to methotrexate to help reduce serious side effects.

Infection and blood disorders

Methotrexate can lower your white blood cell count, making you more likely to get serious infections. Seek urgent medical help if you develop a fever, sore throat, or unexplained bruising/bleeding.

Vitamin B12 deficiency (Pernicious Anaemia)

Folic acid can mask the symptoms of vitamin B12 deficiency. If you have B12 deficiency, taking folic acid alone can allow serious nerve damage to progress even though your blood count appears normal. Your doctor must ensure your B12 levels are checked before or during treatment.

Food and drink warnings

Alcohol

You should strictly limit or avoid alcohol while taking methotrexate. Both alcohol and methotrexate can cause liver damage, and taking them together significantly increases the risk of serious liver problems. Your doctor will advise you on whether a very small amount is safe for you based on your blood tests.

It is best to avoid or strictly limit alcohol while taking folic acid. Alcohol interferes with the way your body absorbs and uses folic acid, which can make the treatment less effective. Chronic alcohol consumption is a common cause of folate deficiency.

Caffeine (Coffee, Tea, Cola)

Large amounts of caffeine may reduce how well methotrexate works for some conditions like rheumatoid arthritis. If you notice your symptoms worsening, try to limit your intake of coffee, strong tea, and caffeinated soft drinks.

Dairy products

Avoid consuming large amounts of milk or dairy products at the exact same time you take your methotrexate dose. Dairy contains an enzyme that may slightly interfere with how the medicine is absorbed. It is fine to eat dairy at other times of the day.

Folic acid supplements (outside of prescribed dose)

While you have been prescribed folic acid to reduce side effects, do not take extra 'over-the-counter' multivitamins or fortified foods containing high levels of folic acid unless your doctor agrees. Taking too much folic acid on the same day as methotrexate can make the treatment less effective.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.