The Perfect Companion to Help Reduce Methotrexate (MTX) Side Effects

Click here

Protection from MTX-Induced Side Effects


Rheumatoid arthritis (RA) is an autoimmune disease where the body’s immune system mistakenly attacks the joints, causing inflammation of the joint lining. This inflammation of the joint lining (called the synovium) can cause pain, stiffness, swelling and redness in and around the joints, especially in the hands and feet.

Although RA is a chronic disease, the severity and duration of symptoms vary greatly over time. People living with RA experience periods of increased disease activity, called “flare-ups”, alternating with periods when the symptoms fade or disappear, called “remission”.

While each individual’s journey with RA is different, it is a serious disease and should be treated as early as possible to preserve joint function, help relieve symptoms, and improve quality of life. Following the doctor’s instructions and taking all medications and treatments as prescribed is essential. By doing this, many people living with RA can lead happy and productive lives.

Methotrexate (MTX) is considered the primary therapy for many people suffering from active rheumatoid arthritis (RA). Methotrexate is one of the most commonly prescribed medications for RA and it has a well-established record of effectiveness for over 30 years.

Healthcare practitioners may also recommend taking folic acid along with MTX. However, there are some potential risks with taking traditional folic acid for combating MTX side-effects.

Why RA Patients on MTX are Folate Deficient

Traditional folic acid has to be changed to the active form of folate or L-methylfolate before it can be used by the body.

Methotrexate blocks the change of folic acid to folate, leaving the body lacking the bioactive folate it needs to fight MTX-induced side effects.

According to the Centers for Disease Control and Prevention (CDC), nearly half of the US population has a genetic defect (MTHFR polymorphism), that blocks the conversion of folic acid into L-methylfolate.

Patient Experiences


“I cannot say enough about Rheumate… all the symptoms I was experiencing disappeared. I really could not believe it. ”

- Lee


What Happens with a Lack of Folate?

When the body is unable to process folic acid and remains folate-deficient, the following may occur:



Nausea



Fatigue



Flu-Like Symptoms




Stomach Pain



Mouth Sores



Hair Loss




Elevated Liver Enzyme Levels



Low Number of Blood Cells (Leukopenia and Anemia)

Key Ingredients in Rheumate



*Rheumate is dispensed by prescription and is to be used under a physician's supervision.

Patient Resources




Have questions about Rheumate? Contact one of our dedicated Patient Advocates at 1-888-546-2735 weekdays from 8:30 AM - 5:30 PM Arizona time.


Frequently Asked Questions

Rheumatoid arthritis (RA) is a chronic disease where the body’s immune system mistakenly attacks the joints. This causes inflammation of the joint lining. This inflammation can cause pain, stiffness, swelling and redness in and around the joints, especially in the hands and feet. People living with RA have periods of increased disease activity, called “flare-ups,” and periods of activity where symptoms fade or disappear, called “remission.” Without treatment, RA causes loss of normal movement and joint deformity. RA should be treated as early as possible to maintain joint function, help relieve symptoms, and improve quality of life. Because RA occurs throughout the body, the skin, heart, lungs, and eyes may also be affected. There are more than 200,000 new cases of RA in the US every year.

Methotrexate (MTX), a Disease-Modifying Anti-Rheumatic Drug (DMARD), is the most common treatment for people with RA. Methotrexate is one of the most commonly prescribed DMARDs because it has been proven to work well. MTX decreases the body’s autoimmune response, which means less inflammation and pain.
Although MTX is effective, it can also decrease the body’s much-needed supply of folate. Folate helps the body produce red blood cells, supports adrenal function and maintains a healthy nervous system. When your body is low in folate, you may experience nausea, fatigue, flu-like symptoms, stomach pain, mouth sores, hair loss, elevated liver enzyme levels, and a low number of blood cells (leukopenia and anemia).

Rheumate is a prescription medical food for the clinical dietary management of metabolic effects of methotrexate therapy.

Rheumate is a prescription medical food. The U.S. Food and Drug Administration (FDA) regulates medical foods in a separate category than drugs and supplements. Similar to drugs, medical foods help manage diseases and require physician supervision. Sound laboratory and clinical science must prove the effectiveness of a medical food. Dietary supplements are meant for healthy people and do not require a prescription. The term “food” speaks to the safety of these products because they must contain only ingredients that have been designated as GRAS (Generally Recognized as Safe), a strict food-safety standard set by the FDA.

For patients taking methotrexate, Rheumate replenishes folate by delivering a bioavailable form (L-5-methyltetrahydrofolate) that doesn’t need to be converted by the body. This is different from folic acid, which has to be converted to active folate before the body can use it. The folate in Rheumate is superior because MTX can decrease the conversion of folic acid into folate. Also, nearly half of the US population has a genetic defect (MTHFR polymorphism) that blocks the conversion of folic acid into the active form, folate.

Rheumate is a mixture of active folate (L-5-methyltetrahydrofolate), curcumin and vitamin B-12. Curcumin is a powerful antioxidant and addresses methotrexate induced oxidative stress (too many free radicals in the body). Vitamin B- 12 is added to avoid masking borderline deficiency of B-12 from taking folate supplements.
Rheumate also contains the following: microcrystalline cellulose, magnesium stearate, and silicone dioxide. The capsule contains bovine gelatin, titaniumdioxide (color), FD&C yellow 5, and FD&C green 3. The product does not contain fructose, glucose, sucrose, lactose, gluten, maltodextrin, tree nuts, peanuts, soy, or flavors.

The most common side effects are mild diarrhea, nausea and upset stomach. These are often mild and do not usually mean a patient needs to stop use.

Rheumate is not for people with allergies or hypersensitivity to any of its ingredients. Folate may interfere with absorption of tetracycline.

Take one capsule by mouth once or twice daily as directed by a physician.

Rheumate is safe to take with or without food. If you experience indigestion, take it with food.

If you miss a dose, take it when you remember. If it is almost time for your next dose, wait and take the next dose on schedule.

If you’re on both Rheumate and tetracycline, take them at least one hour apart. Sulfasalazine, phenytoin, statins and some birth control medications may lower levels of serum folate and impair utilization of folate.

Rheumate is prescription-only. The FDA regulates Rheumate as a medical food product, which must be used under physician supervision according to federal laws.

Pay no more than $35 on every Rheumate prescription*

Primus Care Direct is a hassle-free, mail-order pharmacy service where patients can get their Rheumate prescription for $35 for a 30-day supply or $87 for a 90-day supply ($29 per month), Medicare patients included. This is the lowest possible price available and includes free home delivery. If you have insurance, you may pay even less.

Here is how it works:

1. Your healthcare practitioner will send your prescription to Primus Care Direct.
2. Primus Care Direct will collect your insurance, billing and shipping information.
3. You are guaranteed to receive the lowest possible price on Rheumate (Medicare patients included).
4. Your prescription will be shipped free to your home.

If you have any questions about Primus Care Direct or Rheumate, contact one of our dedicated Patient Advocates at 1-888-546-2735 weekdays from 8:30 AM - 5:30 PM Arizona time.

*Offer based on 30-day supply at prescribed at one capsules per day dose

Advocating for Better Access to Rheumate

Without affordable access to Rheumate, and other prescription medical foods, patients will suffer. This is why Primus Pharmaceuticals (makers of Rheumate) started an advocacy movement to help patients, families, caregivers, healthcare providers and others have a voice to take control of their health with better access to safer medicines.

Increasingly, Medicare, Medicaid, Tricare and commercial health plans will only cover expensive synthetic drugs that merely treat symptoms and can cause serious adverse events.

Due to their safety profile and lack of drug-on-drug interaction, medical foods are often prescribed for chronic conditions in patient populations that have other diseases increasing their health risks from side effects associated with traditional drugs. Without easy access to prescription medical foods, patients in special co-morbid populations will continue to suffer.



To help keep you and your doctor on the same page, take notes on how you’re doing on Rheumate with this easy-to-use app. You can note your pain, concerns, symptoms, and even take a picture of exactly what’s bothering you. You can create a "story" about what you've been experiencing, with multiple notes about what you've experienced and your level of concern and email it to your doctor or print out before your next visit.