Last updated: October 17, 2014
Trade Names: Generics
Synonyms: Folate, pteroylglutamic acid
Drug Class: Vitamin
Tablets: 0.4 mg, 0.8 mg, 1 mg
Injection: 5 mg/mL
Dose: For prophylaxis of methotrexate adverse effects 1 mg/day
Indications: Used to prevent adverse effects caused by methotrexate (oral ulcers, GI intolerance, hematologic, hepatic)
Mechanism of Action: May inhibit effects of methotrexate in some cells; does not affect methotrexate control of RA
Contraindications: Vitamin B12 deficiency. Folate may obscure the diagnosis of pernicious anemia. Neurologic deficit may progress while anemia improves.
Precautions: If patient is macrocytic, check vitamin B12 level before folate supplementation.
Pregnancy Risk: A
Adverse Effects: Uncommon: flushing, rash
Comments: Patients treated with methotrexate should usually receive folic acid.
Shea B, Swinden MV, Tanjong Ghogomu E, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database Syst Rev. 2013 May 31;5:CD000951.PMID:23728635