Folate supplementation in methotrexate-treated rheumatoid arthritis patients

Immunosuppressive and cytotoxic pharmacotherapy for pulmonary disorders.

“…Antiemetics confer little or no benefit (310). Supplemental folic acid (1 to 2 mg daily) may abrogate these adverse reactions (292,310,311).…”

“…Stomatitis, usually manifested as painful oral ulcers, occurs in 2% to 8% of patients with low-dose MTX (275,278,291,311). Severe stomatitis warrants cessation of therapy.…”

“…Increases in the MCV or decreases in hemoglobin, leukocyte, or platelet counts should prompt temporary cessation of MTX therapy. We advocate supplemental folic acid (1 mg/d) to reduce toxicity (293,311).…”

“…Megaloblastic anemia, leukopenia, or thrombocytopenia complicate low-dose MTX in 1% to 4% of patients, but severe bone marrow suppression is rare (7,24,295). Hematologic complications are more frequent in patients with renal dysfunction, advanced age, preexisting anemia, decreased serum albumin, dehydration, concomitant ingestion of nonsteroidal antiinflammatory agents (NSAIDs), or patient confusion regarding dosage (275,295,311). Increased mean corpuscular volume (MCV) and low serum folate levels (292) are risk factors for future toxicity (292,293,319).…”

Methotrexate and oral ulceration

“…14 Folic acid supplementation has also been shown to be effective in reducing the adverse effects of methotrexate, with decreased loss of therapeutic effect and less precision required for dose scheduling compared with folinic acid. 15 It is also cheaper than folinic acid. A recent meta-analysis of randomised controlled trials indicated a 79% reduction in mucosal and gastrointestinal side effects when folic acid supplementation was used in patients on low dose methotrexate.…”