Jen,
Welcome to the group.  I am not taking nor have I taken Methotrexate so have
no info to share but wanted to say hi and welcome.

Sherry

the chemical issue is that the folic acid, which reduces adverse side
effects to some degree,

[methotrexate causes side effects such as stomach upset. It is thought
that these side effects happen because methotrexate blocks the
production of important vitamins called folates. with folic acid, Side
effects such as nausea, diarrhea, constipation, bloating and stomach
cramps were decreased.] conversely, the fol acid itself causes a low
percentage to have upset stomach...

and can also [possibly] reduce mtx efficacy. the last paper i read
indicated that with proper adjusts, the benefits outweighed the
reductions:

"BACKGROUND: Methotrexate is considered to have the best ratio of
efficacy to toxicity of the disease modifying antirheumatic drugs.
Recently it has been shown to enhance the life expectancy of patients
with rheumatoid arthritis. Some 30-60% of RA patients discontinue MTX
treatment within 1 year because of side-effects. In this review, the
current data about supplementation with folate or folinic acid and their
effect on the toxicity and efficacy of low-dose methotrexate therapy are
analysed. METHODS: A Medline search was performed using "folate", "folic
acid", "folinic acid", "homocysteine", "methotrexate", "cardiovascular",
"heart infarction" and "rheumatoid arthritis" as search terms. The
relevant literature was reviewed and other papers referred to as
references were explored. CONCLUSION: Both folate and folinic acid
reduce methotrexate toxicity and the discontinuation rate, and decrease
methotrexate-induced hyperhomocysteinemia. Folate is less expensive,
more secure and easier to handle than folinic acid. The efficacy of
methotrexate probably decreases slightly, but the benefit outweighs the
risk. Folate supplementation should, therefore, be routinely prescribed
to every patient taking low-dose methotrexate."

"Intake of supplemental folic acid should not exceed 1,000 micrograms
(?g) per day to prevent folic acid from triggering symptoms of vitamin
B12 deficiency [10]. Folic acid supplements can correct the anemia
associated with vitamin B12 deficiency."

Hey Jen,
Think I know you from elsewhere too.  lol We Lupies travel in packs I
guess. Been taking methotrexate for 5ish years now. My doctor has
recommended folic acid daily. It seems counterintuitive to do both...
folic acid promotes healthy cell regeneration while methotrexate
diminishes the ability. Just to not confuse my body I try to take the
MTX before I go to sleep, and the folic acid with breakfast. MTX before
sleep is good too, just so you don't have to deal with the nausia stuff
while awake. But I am on a substantially larger dose than you at this
point too... so nausia tends to be more pronounced. Always best to ask
your doc about your specific case. But in general if your body responds
well over time to a regimen, it's probably happy.

Side note: 1,000mcg (microgram)= 1 mg (milligram)

My rheumatologist had me taking it every day of the week and said there
was no problem. She said that missing folic acid on methotrexate day is
not needed. As suggested by my pharmacist, I gave it a 4-6 hour gap in
taking the two on the same day. I never had a problem. I am now taking
plaquenil instead as I could not stand even one more self injection.

Janice In BC