Should We Routinely Use Folic Acid Supplementation with Methotrexate?

Folic acid reduces methotrexate-related nausea, but it might lower efficacy against psoriasis — what’s the right balance?

Patients often experience nausea while on methotrexate (MTX) treatment. In the early 1990s, researchers reported that folic acid supplementation reduced MTX-associated gastrointestinal toxicity without reducing efficacy in patients with rheumatoid arthritis (Ann Intern Med 1994; 121:833) and psoriasis (J Am Acad Dermatol 1993; 28:466). Last year, investigators reviewed the literature and advised folate supplementation for all patients receiving MTX (J Am Acad Dermatol 2005; 53:652). However, a recent report indicated lower efficacy in patients with rheumatoid arthritis (Arthritis Rheum 2005; 52:3030). Thus, the wisdom of folic-acid supplementation remains unresolved, especially in psoriasis, which has been less frequently studied.

To measure…

Reviewing Author

Jeffrey P. Callen, MD