MTX and Folic Acid

Let me start by saying I would never advise anyone else to take more of any thing then they are prescribed-now let me tell my story.

I started 1mg/day of folic acid according to my doctors order just about 1 week before my first dose of MTX-at that time 10mgs-we built up from there. I had a horrible reaction to it-not typical, fever, chills, exhaution, headache. My rheumy didn't want me to stop taking it she cut it down to 5mgs for one week adding another pill each week. After that first reaction I went searching for information on line and found a lot of studies on folic acid and mtx. I decided to raise my dose to 3mgs per day and see what happened.

I immediately felt better, did not have reactions after taking MTX and was not fatigued. I was on an every two week schedule with my rheumy at that time so when I saw her I told her that I had upped my folic acid dose and what the results were-she immediately wrote a script for the higher dose and I still take 3 mgs/day and when I skip doses I can tell.

I didn't mention any other meds but basically this is the history:
When I first saw my rhuemy I was on sulindac and 30 mgs of prednisone
She started me on plaquenil and She cut the pred pretty quickly to 10 and tried to get me to 5 but it failed repeatedly. So, she suggested MTX.
She scripted 1mg of folic acid and told me to start it right away while waiting for the results of a TB and hepatitis tests-she then mailed the MTX script and had me start on that.
I increased the folic acid after two or so doses of MTX. After a few months I was off prednisone completely.

That was it for years-eventually I let her change the Sulindac for relafin. And my Primary Care scripted Tramadol for pain-not related to the RA usually.

It is actually totally fine to take MTX and folic acid at the same time-I swallow them together in the same handful.
Methotrexate is an anti folate-it prevents folic acid from being reduced into folinic acid which is neccessary for every cell in the body. In cancer treatment that reaction is the active part of the methotrexate so if you are using methotrexate to treat cancer they tell you not to take folic acid and they use folinic acid (leovocorin) as a rescue to prevent the mtx from overly damaging your cells.
In RA the mechanism of action of methotrexate is not well understood but, folic acid does not reduce the efficacy of the methotrexate.