Quick answer

Ask your pharmacist or doctor before combining. NIH says people taking methotrexate for cancer should check with their oncologist before taking folate supplements, which include the folic acid in multivitamins. NIH's multivitamin sheets name only warfarin as an exception to their general statement. The folate sheets and the methotrexate label speak to this question.^1,2,3

Key facts

NIH's multivitamin sheets say basic products do not ordinarily interact with medicines, with warfarin as the one important exception. They do not mention methotrexate.^3,4
NIH's folate sheets name methotrexate and describe it as a folate antagonist.^1,2
NIH says prenatal multivitamins in the United States typically carry 800 or 1,000 mcg of folic acid.³
The methotrexate label says to tell your healthcare provider about all the medicines you take, including vitamins and herbal supplements.⁵

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.^1,2

Expected from how the two work, not shown in studies

Does a multivitamin count as a folic acid product?

A multivitamin can be a folate source even when folate is not why you take it. NIH's consumer sheet names folic acid among the nutrients people can get too much of from a multivitamin, and its folate sheet explains that folic acid is the form of folate used in fortified foods and most supplements.^2,4

The methotrexate label's folic acid warning uses wide wording, covering products that contain folic acid or its derivatives, and it does not mention multivitamins by name. Whether yours counts is a question about the folic acid line on your panel and about why you take methotrexate. For cancer, the label says patients should not take such products unless their provider directs it. For arthritis and psoriasis, it tells prescribers to give folic acid or folinic acid.⁵

Why NIH's multivitamin sheets do not settle it

The multivitamin sheets say basic products with nutrients in recommended amounts do not ordinarily interact with medicines, and they single out warfarin because of vitamin K. They do not discuss methotrexate. The folate sheets do, which is why this page rests on them and on the label rather than on the multivitamin sheets' general statement.^1,3,4

Multis have no standard or regulatory definition. Each maker decides which vitamins, minerals and other ingredients go in, and in what amounts.³

Do prenatal and other multivitamins change the answer?

They can, because folic acid amounts vary. NIH says the folic acid in US prenatal products is typically 800 or 1,000 mcg, which it calls much higher than the recommended 400 mcg. If the multivitamin you have in mind is a prenatal, tell your prescriber. Methotrexate also has its own pregnancy warnings on its label, and that conversation belongs with the person who prescribes it.^3,5

Questions to bring to your pharmacist or oncologist

Does the folic acid in my multivitamin matter for the reason I take methotrexate?
Does my product list folate, folic acid or both, and in what amount?
Should I stop the multivitamin, switch to one without folic acid, or leave it as it is?
Does my prescriber already give me folic acid or folinic acid, and do the two overlap?

Bring the bottle. MedlinePlus advises keeping a written list of everything you take, including vitamins and supplements, and showing it to every provider you see.⁶

Questions people ask

Can I take multivitamins with methotrexate?

Ask first. NIH says people taking methotrexate for cancer should consult their oncologist before taking folate supplements, which include the folic acid in multivitamins, and the label gives different advice for arthritis and psoriasis.^1,5

Can you take a multivitamin with methotrexate?

That depends on whether yours contains folic acid, how much, and why you take methotrexate. Your pharmacist can read the panel against your prescription.⁵

Do multivitamins interact with medicines?

NIH says basic multivitamins do not ordinarily interact with medicines, naming warfarin as the one important exception. NIH's folate sheets separately name methotrexate, so it is worth asking about despite the general statement.^1,3

Is a prenatal vitamin different with methotrexate?

It can carry more folic acid, typically 800 or 1,000 mcg in the United States according to NIH. Tell your prescriber, since methotrexate also has pregnancy warnings on its label.^3,5

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This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.