When I met my first rheumatologist, I left with a handful of prescriptions. One for folic acid. Really? Did I need a prescription for a vitamin? Doc said “to make sure it’s enough, yes, it’s a lot more than a daily allowance.”
I already knew why over the counter supplements (OTC) are not considered as reliably dosed as prescriptions – because OTC products aren’t subject to the same quality control for measurement of ingredients as prescription products. Folic acid was just one more part of a whole program that started that day. No questions asked.
Doubling down on folic acid with higher methotrexate doses
When the methotrexate dose climbed to 25 mg and the Humira shot became a weekly occurrence, I constantly got small skin infections. Every little scratch became inflamed. When I plucked my eyebrows, they got sore and angry.
So, I told Dr. KBC and we doubled the folic acid dose to 2 mg per day. It worked like magic. I asked whether I might ever take more and doc was not sure. Two milligrams was okay, but no more.
My folic acid prescription journey
A couple of years later, Dr. Smart wrote the same scripts, no questions asked. I read more about folic acid for the blog or to answer other patients’ questions, but my own dose was unquestioned and unchanged for years. I learned that patients take different doses. And that some patients weren’t given any at all. Of course, they usually felt pretty sick and sought out my blog as a result…
When I lost Dr. Smart, I kept my refillable 90 day prescriptions. Until they expired…
Dr. Good GP came to the rescue, submitting an identical folic acid prescription…
Mail order maintenance pharmacy dropped the ball, losing the prescription…
Kelly bought OTC folic acid at Walmart to tide herself over…
Worse than useless: OTC folic acid
For over two months, I took handfuls of OTC folic acid – and was more sick to my stomach from methotrexate than I’d ever been. I entertained all kinds of possibilities about what was turning my digestive system black and white and red all over – like an elephant joke – –
An ant and an elephant were going on a motorbike. They had an accident. The elephant was seriously hurt on the head, but the ant was not. Why?
Because the ant was wearing a helmet!
Finally, the prescription folic acid arrived! Within a few days, it worked like magic. I proved that the advice I’d given to patients a hundred times was positively right: ask your doctor about a folic acid prescription, just in case. Folic acid is the bike helmet for my stomach with methotrexate!
If your methotrexate dose makes you feel sick, talk to your doctor.
“A consensus for folic acid or folinic acid dosing or administration does not exist, and the decision to initiate supplementation is physician-dependent.”
Some bonus jokes to start your week with a smile!
What’s gray and comes in a red and white can?
Campbell’s cream of elephant soup.
What’s gray and comes in a bottle?
What’s gray, black, and white?
Sister Mary Elephant.
What is beautiful, gray and wears glass slippers?
- Rheumatoid Arthritis and Hair Loss
- Folic Acid with Methotrexate: the Debate
- The 1st Dose of Methotrexate for Rheumatoid Arthritis: 15 Questions
- Part 6: Checklist for Moderating Methotrexate Side Effects in RA