Methotrexate Folic Acid — SCE Rheumatology MCQ
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Correct answer: C — Folic acid 5 mg once weekly not on the day of Methotrexate
BSR 2025 csDMARD guidelines recommend that all patients on Methotrexate should be co-prescribed folic acid supplementation at a minimum dose of 5 mg once weekly, NOT on the day of Methotrexate. Higher doses (5 mg on days other than Methotrexate day, i.e. up to 30 mg/week) may be prescribed if clinically indicated to reduce side effects. Folic acid reduces the risk of GI side effects, hepatotoxicity, and myelosuppression without compromising Methotrexate efficacy. Folinic acid (Calcium folinate) is reserved for Methotrexate toxicity.
Reference: BSR 2025 - Guideline for prescription and monitoring of conventional synthetic DMARDs