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.