Methotrexate-related adverse event prevention

Concurrent folic acid in patients on low-dose methotrexate (5–25 mg weekly for rheumatoid arthritis, psoriatic arthritis, psoriasis) reduces hepatotoxicity, haematological side effects, and gastrointestinal intolerance without compromising efficacy. Included in international rheumatology guidelines.

1 drug

Also known as: Folate rescue therapy

Drugs used for this condition

AFolic acidFirst line · Vitamins. Haemopoietic stimulantsConcurrent folic acid 5 mg once weekly (day after methotrexate) is a required component of low-dose methotrexate therapy in rheumatoid arthritis, psoriatic arthritis, and psoriasis. EULAR 2023 includes folic acid in the standard protocol. Reduces hepatotoxicity, nausea, stomatitis, and cytopenias without compromising methotrexate's anti-inflammatory effect.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit