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Clinical studies and meta-analyses have demonstrated that daily folic acid supplementation (typically 5 mg or more) significantly reduces the incidence of gastrointestinal side effects, elevations in serum transaminase (liver enzyme) levels, and the overall rate of patients discontinuing methotrexate therapy for any reason (Friedman & Cronstein, 2019)

What about older adults

Further research is warranted to gain a better understanding the underlying mechanisms that drive these effects and to clarify the complex relationship between diet, TMAO, and IBD risk (163)

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In very rare cases, allergic reactions like itching or swelling may occur