A 40-year-old female with newly diagnosed rheumatoid arthritis is picking up her first prescription for methotrexate 10 mg once weekly. She expresses concerns about potential side effects such as nausea and hair thinning. Which of the following would be the most appropriate advice regarding management of anticipated adverse effects?

Question: A 40-year-old female with newly diagnosed rheumatoid arthritis is picking up her first prescription for methotrexate 10 mg once weekly. She expresses concerns about potential side effects such as nausea and hair thinning. Which of the following would be the most appropriate advice regarding management of anticipated adverse effects?

Answer options:

• These side effects are unavoidable, and you should take antiemetics daily as a preventative measure.
• Take the methotrexate with a large meal to prevent nausea and avoid brushing your hair forcefully. ✅ You will also receive a prescription for folic acid to help mitigate some of these side effects.
• If you experience these effects, your doctor will likely switch you to a different medication immediately.

Correct answer: You will also receive a prescription for folic acid to help mitigate some of these side effects.

Explanation: Folic acid supplementation is routinely prescribed with methotrexate to reduce common adverse effects such as nausea, stomatitis, and myelosuppression, without compromising the drug's efficacy for rheumatoid arthritis. This is a key counselling point for new methotrexate users. Other options are either not entirely accurate (e.g., antiemetics aren't usually taken daily preventatively) or not the primary preventative strategy.