Lower Methotrexate rheumatoid arthritis side effects with folic acid

It is possible that incidence of side effects may be less with lower dosage or with parenteral route as reported in some studies. We chose fixed 15mg oral methotrexate schedule to treat our patients. One should also be aware of these side effects while using methotrexate. A few of the side effects such as flu-like syndrome and tremors however, have not yet been reported. Majority of side effects seen in this study find mention in standard text books of dermatology. Addition of folic acid also did not interfere with therapeutic efficacy of methotrexate. Once folic acid was supplemented, the side effects reported with methotrexate pulse were reduced to minimum and patients were able to accept therapy much better. Majority of these patients had taken conventional antiemetics and H2 blockers for methotrexate related G I symptoms in past with little or no benefit. Onset of symptoms was reported within 12 hours of taking methotrexate and continued for upto 1-3 days. Majority of these symptoms appeared with the first or at most second pulse of methotrexate.

Dose of 10 mg Folic Acid for methotrexate for rheumatoid arthritis

A dose of l0mg folic acid daily did not compromise therapeutic efficacy of methotrexate. How folic acid supplementation could take care of non-gastrointestinal side effects as well is difficult to explain. They were able to use methotrexate in even higher dosage without associated gastrointestinal symptoms. Similar results were experienced by Duhra et al. In this study it was possible to abolish or reduce severity of gastrointestinal symptoms induced by methotrexate by supplementation with folic acid. Thus, it should be possible to abolish these adverse effects by reducing intracellular methotrexate to folate ratio by folic acid supplementation. Therefore, the centrally mediated gastrointestinal effects of methotrexate may be produced via intracellular folate depletion. Reduced folate is involved in normal synthesis and metabolism of neurotransmitters in central nervous system. Intracellular accumulation of methotrexate and its metabolites result in depletion of folate store. However dosage lower than 15mg/week may not achieve the desired control of psoriasis.