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Methotrexate-folic acid co-prescription — GPhC CRA MCQ

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EasyPatient CounsellingMethotrexate-folic acid co-prescriptionGPhC CRA

A 45-year-old woman presents with a new prescription for methotrexate 10 mg once weekly for rheumatoid arthritis. She is also given folic acid 5 mg once weekly (not on the same day as methotrexate). She asks why folic acid has been prescribed alongside methotrexate. What is the most appropriate explanation?

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Correct answer: D — Folic acid helps reduce the side effects of methotrexate, particularly nausea, mouth ulcers, and liver toxicity, without reducing its effectiveness

Folic acid supplementation is given alongside methotrexate to reduce the incidence and severity of side effects, particularly mucositis (mouth ulcers), nausea, and hepatotoxicity. Methotrexate inhibits dihydrofolate reductase, depleting folate stores. Folic acid is typically given on a different day to methotrexate. It does not reduce the therapeutic efficacy of methotrexate in rheumatoid arthritis.

Reference: BNF; NICE NG100 Rheumatoid Arthritis