Quick answer
Ask your pharmacist or doctor before combining. Official sources document three supplements for methotrexate, all through folic acid: folate, B complex and multivitamins. The label says folic acid products may make methotrexate less effective for cancer, yet tells prescribers to give folic acid for arthritis and psoriasis, so the answer depends on the use.1,2
Key facts
- The methotrexate label says products containing folic acid may make it less effective when it is used for cancer.1
- For rheumatoid arthritis, psoriasis and polyarticular juvenile idiopathic arthritis, the same label tells prescribers to give folic acid or folinic acid to reduce side effects.1
- NIH calls methotrexate a folate antagonist and says people taking it for cancer should ask their oncologist before using folate supplements.2
- MedlinePlus names proton pump inhibitors among the nonprescription products that may interact with methotrexate.3
What is methotrexate used for, and why does folic acid come up?
MedlinePlus lists methotrexate's uses as severe psoriasis, rheumatoid arthritis, polyarticular juvenile idiopathic arthritis in children, and several cancers, including acute lymphoblastic leukemia and non-Hodgkin's lymphoma. It calls methotrexate an antimetabolite, and NIH calls it a folate antagonist, meaning it works against folate.2,3
That is why folic acid is the whole story on this page. For psoriasis and the two kinds of arthritis, MedlinePlus says your doctor will probably tell you to take folic acid to decrease some side effects, and NIH adds that folate supplements might reduce the stomach and bowel side effects of low-dose methotrexate taken for rheumatoid arthritis or psoriasis. For cancer, the label and NIH give the opposite caution. The entries below follow that split.1,3,4
Can you take folic acid with methotrexate?
Ask your pharmacist or doctor first
Folate supplements could interfere with methotrexate when it is used for cancer, and the methotrexate label says to take products containing folic acid then only if a doctor directs it. When methotrexate is used for rheumatoid arthritis, psoriasis or polyarticular juvenile idiopathic arthritis, the same label tells prescribers to give folic acid or folinic acid to reduce side effects.1,4,5,6
On the medicine's label
The answer depends on why you take methotrexate, and it is your prescriber's to give. One section of the label holds both instructions, which is why this page does not say to avoid folate. Do not start or stop folic acid on your own because of what you read here.1,6
Does a multivitamin matter with methotrexate?
Ask your pharmacist or doctor first
Methotrexate works against folate. NIH says people taking it for cancer should check with their oncologist before taking folate supplements, which include the folic acid in multivitamins, because folate could interfere with the treatment.2,7
Expected from how the two work, not shown in studies
This entry is labeled expected: it follows from methotrexate working against folate, and the entry does not cite a study of multivitamins. NIH's folate sheet says about 85% of folic acid taken with food is absorbed, and nearly all of it without food, so the folic acid in a multivitamin does reach the blood.2
Does a B complex matter with methotrexate?
Ask your pharmacist or doctor first
The methotrexate label says products containing folic acid may make methotrexate less effective when it is used for cancer, and that patients should take them only when their healthcare provider directs. For other uses, the label tells prescribers to give folic acid or folinic acid to lower the chance of side effects.8,9
On the medicine's label
The label's wording is about products containing folic acid, and the entry applies it to B complex products. What matters is whether your B complex lists folic acid on its Supplement Facts panel, so bring the bottle to your pharmacist.8
What other products does MedlinePlus name with methotrexate?
MedlinePlus names one group of nonprescription products for methotrexate, and they are medicines, not supplements: proton pump inhibitors such as omeprazole. It also asks you to tell your doctor and pharmacist about all vitamins, nutritional supplements and herbal products. The sources checked do not address other supplements, which is not a finding either way, so ask your pharmacist.3
Why do all three entries say 'ask first'?
| Supplement | Why it is on the list | How it is known | Label shown |
|---|---|---|---|
| Folate | Folic acid products may lower methotrexate's effect for cancer, and are prescribed alongside it for other uses | On the medicine's label | Ask your pharmacist or doctor first |
| B complex | The same label wording, applied to products that contain folic acid | On the medicine's label | Ask your pharmacist or doctor first |
| Multivitamin | Methotrexate works against folate, so folic acid in a multivitamin could interfere | Expected from how the two work | Ask your pharmacist or doctor first |
Two entries rest on the methotrexate label and one is expected. Each carries the ask-first label because the right answer changes with the use, so no entry here can simply say avoid.
What to ask your pharmacist if you take methotrexate
Questions people ask
What supplements should you not take with methotrexate?
Folic acid, whether in a folate supplement, a B complex or a multivitamin, is the supplement the sources checked document. Whether to avoid it depends on what the methotrexate is for, so ask your pharmacist or prescriber.1,2
What vitamins should you not take with methotrexate?
The vitamins named are folate and the B complex or multivitamin products that contain folic acid. For cancer, the label says to take folic acid products only if a doctor directs it. For arthritis and psoriasis, it tells prescribers to give folic or folinic acid.1,8
What supplements can I take with methotrexate?
The sources checked give no all-clear for any supplement. They document folic acid as the one to ask about and do not address the rest, which is not a finding either way, so ask your pharmacist.1
Can I take vitamins with methotrexate?
MedlinePlus asks people taking methotrexate to tell their doctor and pharmacist about all vitamins, nutritional supplements and herbal products, because doses may need to change or side effects may need watching. Folic acid in particular is something the label either limits or prescribes, depending on the use.1,3
What can you not take with methotrexate?
This page covers supplements only. MedlinePlus names proton pump inhibitors among nonprescription products that may interact, and asks you to tell your doctor and pharmacist about every medicine and supplement you take.3
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Sources
- Methotrexate tablets: prescribing information (American Health Packaging). DailyMed, U.S. National Library of Medicine. Published October 6, 2026. Opened 2026-10-07.
- National Institutes of Health, Office of Dietary Supplements. Folate: Fact Sheet for Health Professionals. Updated November 30, 2022. Opened 2026-10-07.
- MedlinePlus, U.S. National Library of Medicine. Methotrexate: MedlinePlus Drug Information. Last revised October 15, 2025. Opened 2026-10-11.
- National Institutes of Health, Office of Dietary Supplements. Folate: Fact Sheet for Health Professionals. Updated November 30, 2022. Opened 2026-10-07.
- National Institutes of Health, Office of Dietary Supplements. Folate: Fact Sheet for Consumers. Updated November 1, 2022. Opened 2026-10-07.
- MedlinePlus. Methotrexate. U.S. National Library of Medicine. Last revised October 15, 2025. Opened 2026-10-07.
- National Institutes of Health, Office of Dietary Supplements. Folate: Fact Sheet for Consumers. Updated November 1, 2022. Opened 2026-10-07.
- Methotrexate tablets: prescribing information (American Health Packaging). DailyMed, U.S. National Library of Medicine. Published October 6, 2026. Opened 2026-10-07.
- National Institutes of Health, Office of Dietary Supplements. Folate: Fact Sheet for Health Professionals. Updated November 30, 2022. Opened 2026-10-07.
This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.