How do you approach folate supplementation for methotrexate-related side effects?

All MTX users should be taking some form of folate supplement. Either daily folic acid or weekly folinic acid are used and generally are effective. Tracking the RBC MCV is one way to ensure that patients are receiving adequate folate supplementation.

The question has been raised whether folate supple...

We use folic acid at least 1 mg daily in all patients on methotrexate. Immunosuppressive effects of methotrexate for rheumatic disease treatment are dependent on the adenosine pathway. Inhibition of the folic acid pathway is important for the anti-cancer effects of methotrexate and is also responsib...

I use folic acid 1 mg PO daily. There have been suggestions that it may be best to skip the folic acid on the MTX day but the evidence is scarce. Some physicians use weekly dosages.