Methotrexate Injections for Rheumatoid Arthritis, part 2: Needles

Why methotrexate injections?

Methotrexate is the most widely used treatment for Rheumatoid Arthritis. Almost every Rheumatoid Arthritis patient will be prescribed methotrexate at some point. Doctors are thankful to have something they can prescribe that works well for most patients with fewer serious or irreversible side effects than the older disease treatments. Methotrexate is a big topic and there is much more about it on the Methotrexate and RA section of this website.

Methotrexate can be administered by tablets, but injections are the first choice of many doctors. When methotrexate is injected, it bypasses the digestive system. There are two simple benefits to that: First, the patient may be spared some annoying intestinal side effects of methotrexate tablets. Second, the methotrexate dose is more potent since none of it is lost during digestion. All of the medicine is more directly available, so it can be more effective.

Does size matter with methotrexate injection needles?

If a patient is prescribed injectable methotrexate, she will eventually face the needle question. What is the “right” needle for injecting methotrexate? It’s more confusing than which topping to pick at Cold Stone Creamery. And a lot less fun.

Last year, I was watching a video from Johns Hopkins Universityabout methotrexate injections. What a surprise when I heard the nurse describe the tiny needle used to inject methotrexate subcutaneously (into the fat layer under the skin). All of the rheumatologists that I had met had advocated an intramuscular injection (into the thigh or hip muscle) with a larger needle for better absorption. This is pretty confusing for patients.

Determined to find an answer, I pressed my new doctor and a couple of pharmacists for their best recommendations. They agreed that injecting into the muscle is slightly better, but not critically important. It seemed like the most important thing is that the patient is comfortable enough that the injection actually gets done.

My needle solution for methotrexate injections

I had an idea for making the injection process more comfortable and I found a pharmacist who helped me put together a new best-of-both-worlds plan. Here is my new method for injecting methotrexate.

I got smaller needle tips that will fit onto the larger syringe since they are the same brand. First, I use the larger 3 mL syringe with a 25 gauge tip to draw the methotrexate out of the bottle. Then, I replace the cap on the needle. Next, I twist off the “sharp” and drop it into my used sharps disposal container. That tip is now dulled from piercing the bottle top. Finally, I attach the smaller fresh tip and do my injection.

For me, this has made a significant difference in comfort. The larger 3mL syringe is easier for my RA hands to manipulate. I can easily inject into a relaxed thigh muscle and not even feel it with the smaller fresh tip. I dread my injection less.

Note: This workaround helps me. It is always good to ask your personal doctor or nurse what is recommended for you. Click here to read Methotrexate Injections for Rheumatoid Arthritis, part 1.

Postblog: One small study comparing subcutaneous injections with intramuscular injections of methotrexate found no difference in serum levels.

Recommended reading:

Kelly Young

Kelly Young is an advocate providing ways for patients to be better informed and have a greater voice in their healthcare. She is the president of the Rheumatoid Patient Foundation. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. Through her writing, speaking, and use of social media, she is building a more accurate awareness of Rheumatoid disease aka Rheumatoid Arthritis (RA) geared toward the public and medical community; creating ways to empower patients to advocate for improved diagnosis and treatment; and bringing recognition and visibility to the Rheumatoid patient journey. In 2009, Kelly created Rheumatoid Arthritis Warrior, a comprehensive website about RA of about 950 pages and writes periodically for other newsletters and websites. Kelly served on the Mayo Clinic Center for Social Media Advisory Board. There are over 42,000 connections of her highly interactive Facebook Fan page. She created the hashtag: #rheum. Kelly is the mother of five, a home-schooler, Bible teacher, NASA enthusiast, and NFL fan. You can also connect with Kelly by on Twitter or YouTube, or LinkedIn. She has lived over nine years with unrelenting Rheumatoid disease. See also http://www.rawarrior.com/kelly-young-press/

66 thoughts on “Methotrexate Injections for Rheumatoid Arthritis, part 2: Needles

  • May 11, 2010 at 8:31 am
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    From what I have experienced, in India doctors mostly prescribe methotrexate in form of tablets….(may be because most patients are vary of injections….atleast I completely was 😛 )….I started taking it in injection form only when it became impossible for me to even complete dosage because of nausea. With increased dosage increased I started throwing up after taking every single tablet (and I was suppose to take 6 of them a week)…I used to have sleepless nights because of that strange discomfort….thats when my doc pressed that I take it in injectable form and she prescribed to take it subcutaneously (with small syringe)at very first instance……I took a couple of months to come around…but now I am happy that did….

    Its hard to beat nausea and pain….but atleast I have the satisfaction that I am completing my dosage and letting the meds do their job!

    Reply
    • May 11, 2010 at 9:25 am
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      Shweta, that is very interesting. In some countries, injection is the primary method. In the US, it varies a lot with by the doctors.

      Reply
  • May 11, 2010 at 8:56 am
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    My doctor is planning to put me on methotrexate once I get on birth control, and I’m completely freaked out at the thought of giving myself injections. Eurgh.

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    • May 11, 2010 at 9:28 am
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      Erin, I’ll never forget – When I finally saw the good dr, I was so disabled. I was put on mtx that very moment & the rheum even prescibed the birth control! I did wait a couple of weeks because I had to wean the baby. The injections are probably not as bad as you think. :heart:

      Reply
  • May 11, 2010 at 9:51 am
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    Mtx was never my drug, it made me feel awful, could hardly drag myself to work back in the day, the feeling lasted about 4 – 5 days, and well, it sucked, made my depression horrible. Had to try it several times before I just refused to take anymore. It never did help my symptoms.

    OXO Good Grips designed a new syringe for Cimzia. Search OXO Good Grips syringe, sorry I don’t do links 😀 . I hope this wonderful design becomes generally available and isn’t too expensive. I think it looks like my dream syringe (ack, a sure sign of crazy in an RA patient – oh wow, look at that syringe; not, wow, look at that great pair of heels). But it was designed for Cimzia, so we may never see it. Maybe we should petition OXO!

    With the steroid fat and the short needle, like a insulin needle, I don’t think I could ever get a true IM shot. Think it hits fat either way! All my docs and pharmacists have said about a 45 degree angle on the needle. This is the only instance for me where the ability to numb myself comes in handy. Do it as fast a possible and get it over with. Just let the alcohol dry completely, or it will burn when you drag it in with the needle. But as a qualifier, I have been reduced to tears when I first had to do my own shots, now it’s just another crappy part of my RA job.

    Well off to the dentist to try and find out why a tooth keeps abscessing, I know the answer, just don’t want to think about it. Tooth problems have always gone hand in hand with bad flares for me. Wish I had someone to hold my hand, because going to the dentist is a huge nightmare, I’d rather have 4 trigger point injections, in one day, which I’ve done, rather than open my mouth for a dentist. Wimpy, wimpy, wimpy.

    I hope someone out there is having that unexpected day, the one where you feel kinda normal, with some energy and some peace.

    Reply
  • May 11, 2010 at 10:24 am
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    Good post, as always. I am going to change over to the injectable methotrexate soon. Hopefully, it will help some of my tummy troubles.

    Reply
      • September 27, 2013 at 10:02 am
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        Ok, so I am a few years late to the party here. I was diagnosed a little over 2 years ago (I am 45). I have been on several drugs and see the doc every 2 months (with labs). I was given steroids…no no no. Side effects were bad. Within a week, had to weaned off due to profuse night sweats that woke me up on max dose Ambien! Also weight gain…22 lbs! I was also on Arava, but was stopped after a few months for tanking my WBCs. My mainstay drugs were Vimovo, Methotrexate, Plaqunil, folic acid…Let me fill you in on a couple things. I started out on a lower dose of oral MTX…which was not catching all my flares. Then was bumped up to 8 pills. Still had flares. Moved up to 10 pills. Yes, 10. I didn’t experience nausea (possibly due to the Vimovo content), but I was losing my hair. Was finally talked into Humira and was not happy about it. Drugs scare the CRAP out of me. But life has been a little better on the Humira. I am able to function a little better than before. I saw the PA and she decided maybe a special test should be run to test the effectiveness of the MTX. Thank you Janie for running that test. It was a shock that despite my chucking the 10 pills back like Skittles every week, I HAD NO THERAPEUTIC LEVEL OF MTX IN MY SYSTEM! What?! Yes, that is what I said. They told me that the effectiveness of the pills from the manufacturers have gone down hill over the last few years and the injectible would be way, way more effective. So, I picked up the yellow goop and the needles yesterday and will see what happens. Let me also share this with you because it will save time, aggrivation and cash:

        If you or your doctor feels that there are still concerns about the flares while on MTX pills, request they do the MTX blood test that tests the effectiveness. Don’t be shocked when you get the bill! BCBS paid like $16.14 and the remaining $215 bill came to ME! Out of network provider. Don’t panic. I called the company Exagen Diagnostics. As it turns out, they are the only company in the world that runs this test. I was told to sign the back of the $16.14 check, send that and the EOB from my insurance company and they would adjust my bill and send me a new one. They said that they don’t charge a patient over I think they said $47 because of your insurance company’s refusal to pay any more because it is not covered out of network. They felt that patients deserve to be able to get tested without the fear of affordability, so they help out. That is great news. So, have that test run if you keep having the increase in dosage without significant results.

        Humira: my excellent insurance (according to my online insurance estimate) was going to make my copay for Humira $685 per month! I refused. I mentioned this at subsequent appointments to the nurse and PA. Wow, a wealth of information. They said there is a payment program out there that will help with my expenses (thru Humira and even Enbrel has one). I didn’t think I qualified because yes, I have a paying job and insurance. Much to my surprise, not only did they qualify me, but with a 90 day prescription (have your doctor do a 90 day prescription) I pay $5! If they write it for a monthly fill, you pay $5 each month. Also, this program will also pay for your choice of either Plaqunil or MTX while you are on the Humira. I am on both. I chose the Plaqunil and it was the best choice because now that I have been switched over to injectibe MTX, that is dirt cheap! I want to say with my insurance, I was paying about $18 a month for Plaqunil and $21 for MTX pills. Now my Plaqunil is free and I just picked up my one month supply of MTX and 3 months of needles. Whopping grand total after insurance: $2.36. I was shocked! If you choose Enbril, they also have a payment assistance program, but you pay $10 and have to renew yourself every year. On Humira, they automatically renew you as long as you continue to take the drug. Also, check out their websites. Humira sent me a free sharps container. Once it fills, they will send me a label to ship it back for free and send me a new container. I also requested and received a free travel pack so if I have to travel with my injection, it has its own soft side travel case with two freezer packs to keep it cold. They also have 24/7 assistance if you have questions about the drug, etc. I am also very forgetful about when to take my drugs. Humeria is once every two weeks and Enbril is once a week. I created an account and now I get not only a text but an email reminder to take my injection (I requested both). It has made it much easier on me. One last thing. The injection is supposed to remain refrigerated. However, you do not want to inject it cold. My PA said to take that out of the fridge and the outer wrapper at least 30 minutes before injection. Said sit and watch tv and put that sucker under your armpit to warm it to room temp and it will hurt alot less. She is right. Also, my nurse suggested I don’t inject the MTX in the leg because it will hurt more despite there being fat on the leg. He said grab that belly fat and stick it. It is much better that way and that it won’t make a difference one way or the other in absorbsion.

        I hope this helps others. I had to learn this the hard way and wanted to share.

        Reply
  • May 11, 2010 at 11:06 am
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    Hi Kelly,
    I started injections a few weeks ago & they are SOOO much better than the pills. My son actually gives them to me. Intramuscular. (IM). Sub q is harder to do at home for most and would take longer to absorb.
    From working in the medical field, I did know to draw up with one needle, & use another to avoid using a dull needle. I didn’t even think to pass that on or would have sorry… Very important also is to clean off the top of the bottle with alchohol before drawing up. They told me I don’t have to inject, I can drink it (yuk).. I rather take the shot than even think of digesting it ever again!

    Reply
    • May 11, 2010 at 9:47 pm
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      Donna, good son! I’m amazed that you had been using this method already – I’ve had this post planned for a few months & I’m glad to hear I’m not the only one who thinks it’s a good idea. It has made a big difference to me to have the sharp little needle going into my thigh. No more muscle spasms or pools of blood! ;-D

      Reply
  • May 11, 2010 at 12:04 pm
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    I use the insulin needles for my 0.8ml of MTX each Monday. ♫♪ Just another MTX Monday… ♪♫ :music: Anyway, I’ve not had but the occasional “ouch” with them – most of the time its a breeze. I always pull back on the plunger to make sure I’m not in a vein and then slowly push it in. It has worked much better for me than the pills…

    Reply
  • May 11, 2010 at 12:24 pm
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    After 3-1/2 years of doctos and joint pain they finally diagnosed me with RA, bloodwork finally showed up positives for RA. Just started methotrexate and after 3 weeks of the pills the hearbutn and indigestion was too much to take so I switched to the injections. To be honest, the minimal amount of pain from the injection is worth not having the 4 days of heartburn. The needle sticks for the bloodwork every month is worse. Hoping the methotrexate will work, taking it with Plaquinil and just was taken off the prenidsone, overnight all my pain is back so the doc put me back on 5mg, doesn’t do much but eases it a little. I guess it’s better than nothing (but not by much). This is still new to me and I read that it can take a while to find the right combo of meds. Don’t really know if the plaquinil is doing anthing. Thanks for listening, it’s nice to find others that understand what I am going thru, most people just don’t get it.

    Reply
  • May 11, 2010 at 12:38 pm
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    Kelly-sounds like a great method you have worked out! Thanks for sharing. If the medicine is to reach the muscle, some of us might need longer needles than others , to get past the fat layer. All, of course, based upon what the rheum prefers-subcutaneous or IM(intramuscular) injection for the methotrexate. Personally , I’ve done well using a very small gauge needle subcutaneous.

    Reply
    • May 11, 2010 at 9:53 pm
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      Julie, very funny. 😀 Going straight down into a flattened thigh I think I still hit some muscle – just not as traumatically as before. My original needle was longer I think. It was awful.

      Reply
  • May 11, 2010 at 3:04 pm
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    I was initially on the pill form of MTX but was switched to injections after a few months of puking. The shot has made a huge difference for me. After over a decade of anti-inflammatory medications my stomach can be a bit testy. I am currently using an “allergy syringe” that says it’s 28GB-D (kind of sounds more like a feature on my computer than a method to inject medication). It occurred to me that I’ve never really paid attention to the size of the needle or the syringe before now. I would have never thought to ask for different one. The needle I use is small so the actual injection site doesn’t hurt but getting the meds in there is a whole different story! I am scheduled for my first Remicade infusion this Thursday so I am going to ask my doctor about getting a different syringe. Thank you again and again for all of the information and support on this site – it is changing my life and my outlook on a daily basis.

    Many Blessing,
    Mel

    Reply
    • May 11, 2010 at 9:56 pm
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      Mel, you are a great encourager. Thanks for commenting. I think 28 might be pretty thin needle – if you use it to go into the bottle too, I wonder whether it gets dull? That was part of my problem. I asked my doc lots of questions & took note of everything – but the pharmacist seemed to know the most.

      Reply
  • May 11, 2010 at 5:16 pm
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    So far I’ve been on oral MTX, and it has made a tremendous difference in my level of pain and my ability to move — at ALL! I do still have pain all the time, but it is not usually completely incapacitating like it was before.

    I am needle-phobic (extremely!!!), dreading the day that the doctor recommends something with a needle involved. But I have more nausea lately, so MTX injections might be coming soon.

    Thank you, Kelly, for doing all this research to find the best solution for MTX injections. You are sharing great information and personal experience that is helpful to us all.

    Question: What combination do you think would be best for subcu..whatever-it-is instead of intramuscular?

    Reply
    • May 11, 2010 at 10:02 pm
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      Caysea, do you mean needle / syringe combo? I’m not an expert, but this is what works for me. The pharm sells me the 3mL 25 gauge to draw the fluid up from the bottle. Then I attach a 27 1/2 gauge (thinner) to stick my leg. I go straight down into a relaxed thigh muscle – just like the doc showed me – and it goes in so easily & w/no struggle. I have heard many others say they use stomach for injections with that same small needle. One rheum nurse I knew always did the buttock with a bigger needle. The important thing is that the patient is comfortable enough that it actually gets done. 😛

      Reply
  • May 11, 2010 at 11:54 pm
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    I guess I am one of the strange ones here. I started out on the tablets and did that for 6 months. I felt so awful every week from those pills! Next I went on the injectible MTX and my husband gave me the IM shot every week. A couple of times of the needle hit the bone or a nerve(ouch) and I stopped the IM shots after 4 months. I then asked my former Rheumy if I could go to sub-q (into the fat). She didn’t care as long as I got the MTX in me every week. I am one of those like you Kelly that will be on MTX forever. I now use an insulin syringe with a very tiny needle. I am now in control of where and when the injection is done!! Sometimes I have to have my hubby draw up the MTX because my hands won’t do it. We taught my daughter to give insulin injections to her dad when she was 7 years old so she is an old pro if I need someone to inject for me!! So I have been on MTX three different ways.

    Reply
  • May 12, 2010 at 12:36 am
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    Okay, Kelly, you may not want to print this, but I am so needle-phobic that just reading all this stuff, I’m about to faint! I know, I’m a wimp! Can I be a wimp and a warrior at the same time? LOL! 😮

    Reply
  • May 12, 2010 at 11:53 am
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    Caysea,

    I am a lifelong needle phobe as well. When I was younger it took more than one nurse to hold me down (and my mama) to give me shots. I promise you that when the time comes you will be ready – and the more you do it the easier it gets. I met a young woman in February of this year while at the Rheumatologist who had similar feelings about shots and needles. She discuss it with the doctor and they agreed that she could come in every week and one of the nurses would administer the shot for her. I would ask your doctor’s office if they would be willing to give you the shot for as long as you needed. Also, maybe having a loved one or trusted friend help you in the beginning. I promise you – with the right needle and the right person administering the shot you won’t even feel it!
    I’ll be praying.
    Mel

    Reply
  • May 12, 2010 at 11:57 am
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    Thank you Kelly – I am going to call my pharmacy now 🙂 You are a weath of knowelge and a wonderful blessing! I’ll keep you posted.

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    • May 12, 2010 at 9:11 pm
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      I have been injecting Methotrexate for 9 years now. When my Rheumatologist first asked if I would like to try it my first thought was that if it meant not puking I would be happy to try it. My 11 year old niece had recently developed juvenile diabetes and I figured that if she could self inject I could do it to. I use an insulin needle in the back of my hip. I’m pretty thin but it never hurts, it is really not a big deal. The worst part is still the side effects, for 24 hours or so my family affectionately refers to me as “zombie mom”. It is a small price to pay for how much it helps the other 6 days of the week.

      Reply
      • May 14, 2010 at 7:29 pm
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        Joanne: Haha to “zombie mom.” It is nice that your family has a way to smile about it while acknowleding your difficulty. Good word about the “small price.”

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  • May 14, 2010 at 8:12 pm
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    Thanks for posting this. It was timely for me as I had my 3 month visit with rheumatologist this morning. I asked about the injectible Metho. Dr. admitted that the injections appear more effective for the reasons you state above – more gets absorbed etc. I’ve got no problem with injections – I use the syringe form of Enbrel and gave myself allergy shots for years (and wonder many years later if that helped mess up my immune system). So I left his office armed with script for syringes and vial of metho. If it helps with my stomach issues, then that’s even more of a bonus. If I hadn’t found your blog and been following, I would never have asked the doctor and since I’m not a complainer, he never thought to suggest it, I guess. So Thanks.

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    • May 14, 2010 at 9:15 pm
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      Leigh, Thanks for coming back to share your story. Hope the mtx helps you!

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  • September 24, 2010 at 6:02 pm
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    Finally!!!
    Someone is dicussing the topic of Methotrexate injections. I too have had a tough time educating my online pharmacy about preservatives in MTX. They sent a 10 ml vial that was marked “discard after 28 days.” That only gave me a max of 5 doses in one vial but they would not send additional vials to last the 90 days as specified in the prescription. Apparently they felt I should go without for 8 weeks.
    After talking with 3 customer reps and 2 pharmacists, we determined that the MTX vials did indeed have preservatives and could be used until empty. That still left me short a couple of doses so the rheumy got the local pharmacy to fill a prescrition for the oral form to avoid gaps in dosage. For a medication that is so cheap, I feel like they think I am dealing in the black market. It took seven months to get it all straightened out.
    Anyone have good ideas on how to deal with online pharmacies? The 2 week delay to fill a new prescription is the pits.
    BTW, I inject subcutaneously. It was also difficult to get correct information about which needles and route to use. Surely many people are injecting. Why do so many pharmacies know so little?

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  • October 14, 2010 at 11:27 pm
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    My rheumy prescribed TB syringes; I inject into my stomach. The RN taught me to hold my fat into a bulge at least a couple of inches from my belly button (after cleaning with alcohol and letting dry) and inject. I rotate from left to right weekly. My pharmacy gave me a cheaper syringe like the one you have pictured and it was awful (so painful)! I made them give me the right ones after that for sure! Only occasionally do I hit a tender spot, but it isn’t bad. Enbrel (when I was on it) was much worse. I also inject b-12 into my thigh once a month for pernicious anemia, that is an IM injection and more painful. (by the way, i inject 1 mL of MTX once weekly and still get nauseated every so often). Luck to all!

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    • October 14, 2013 at 12:04 pm
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      I also use the TB syringes into my belly fat and it’s a breeze! SOOOO much better than taking the pills; I used to suffer through the nausea and stomach pain for days with the pills. If I had known how easy and painless the injectable form was, I would have switched over much sooner.

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  • January 24, 2011 at 2:57 am
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    thanks for the link Kelly.answered alot for me.I want results asap.so if intramuscular is more effective than sub,I will do it.my rheumy tried to really talk me into pill form.but said if I didnt mind being a pin cushion then ok.no I dont mind at all enduring what,10 seconds to avoid hrs,maybe days of less nausea? easy choice,for me anyway.even pharmacist tried talking me out of injections!I have driven to hosp for migraine relief,30min drive,waiting while vomiting for doc to see me and to give me needles for migraine and nausea.after countless trips to ER for a needle,why would I balk at 1 needle instead of pill form of mxt to avoid more nausea? I just keep telling myself,this (needle)too shall pass.its a short moment compared to pills to avoid more nausea if a needle gives me less grief as reward.a small pinch,literally,of time, discomfort is worth it for me anyway.of course to each their own choice.getting it done,getting thru it is what matters for hoped results.I am more concerned about side effects,avoiding depression.and to be honest,vain even,hair loss.but of course feeling better is the goal I keep in mind every needle time 🙂

    Reply
    • January 24, 2011 at 6:58 pm
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      Some docs say it doesn’t matter, so maybe do whatever works better for you. For me, I was glad to use the smaller needle and not go as deep and bruise less often. It’s not worth bruising if that makes a patient not want to do the shot, in my opinion.

      Hang in there. You seem like a very tough girl.

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  • April 1, 2011 at 11:07 pm
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    my daughter has been on methotrexate injections since she was 8 she is now 16 but she does not have ruematoid arthritis so i am confused now she has 17.5 mg per week and always has

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    • April 1, 2011 at 11:10 pm
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      Hi Paula,
      What is her diagnosis? Does the treatment help her?

      Reply
  • June 6, 2011 at 12:46 pm
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    I am 45 and was diagnoesed about 5 months ago. I have been on methotrexate for about 4 monts now, I have really lost track of time. I started with the pills, oh what fun that was dealing with the pains in my stomach. I have been on the injections for about 2 months with no side effects so far. I still have a hard time injectiong myself, just not fully confortable with the needles yet. I have not seen any real major improvements as of yet, oh I also take mobic on a daily basis, my rheumy started me at .5mil now I am taking .7mil and I use insulin syringes. The syringes work great its just my getting over the fear of sticken myself once a week. I don’t know how long it takes or at what does it will take to get me over the hump or if the metho ever will. I know that it must be doing some good, if I compare to where I was over six months ago, but I still have a lot of pain on a daily basis. I try to stay positive about all this, but it is a daily challenge to do so.

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  • July 8, 2011 at 12:20 pm
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    I have been on methotrexate injectable for only 4 weeks. I was supposed to take my shot yesterday and just could not do it. I had so much anxiety over it that I called my Dr. who suggested I just put it off till today. Problem is I still can’t do it today. I don’t know why, I just can’t. So since I have no one readily available to help me I just don’t know what to do. I feel like such a baby,but it is what it is. I am going to try again as soon as the hives go away from this mornings attempt!I have gotten myself so worked up over it my head is pounding. I only hope I can get used to this because the pills did not work well with my tummy. Help!

    Reply
    • July 8, 2011 at 1:37 pm
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      Oh poor you. I hope your hives are gone – did you take benedryl? I have been there too – I’ve procrasintinated & I am was not kidding at all when I say it’s a battle for me to stick myself each time. I wish there were someone to help you with it.
      I try to entice myself with peppermint or wintergreen candy (that overcomes the smelll of rubbing alcohol) or olives (that tend to fight the nausea) – or chocolate as a reward when I’m done. What helps usually is telling myself “It will probably help me live longer” and asking my kids to give me a hug when I get it done… Can you think of it as an empowering moment when you are trying to take control – wish I could be there to help you.

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      • July 8, 2011 at 2:04 pm
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        Thank you Kelly for your response, I did take Benedryl and I tried the chocolate bar. I ate the whole thing but still no shot, LoL…but instead of being so anxious now I am laughing because “I can’t believe I ate the whole thing”!Now that I have reread your response I see I was supposed to wait till after shot to eat the chocolate. I am going to keep trying until I get it done. Thank you for everything you do!

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        • July 8, 2011 at 2:37 pm
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          ply and bribe yourself any way you need to dear. if chocolate first helps I’d say yes. 😉

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  • July 8, 2011 at 5:18 pm
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    Kelly – why can they not offer the Methotrex in a eppi pen – like the Humria pen or a diabetic – with the “tiney” needles. we need to all push for this – I take methotrexate orally and my stomach is a total mess.

    Reply
  • July 9, 2011 at 12:07 pm
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    I had to skip my oral dose of MTX this week because of nausea that just won’t go away. I have been on MTX for 6 mos now and did not have nausea at first. Now that I have really paid attention to when it occurs, I realized it is much worse for the first 4 or 5 days after I take my MTX then I have a few days when it eases up. Plus after reading this I realize I have had severe heartburn from the start, just not nausea. Of course my DR didn’t ask me about that, sure he assumed since he put me on Omeprazole that I would not have any problems. And I am so concerned about not whining and also being focused on describing my pain because he doesn’t appear to get it that I don’t go there either. I did get a copy of my records, on every single progress notes he put: Pt in no acute distress, gait normal and independent. Yeah buddy, that limp I have from my left hip is normal. And I did explain to him that I don’t do anything the day before I come to see him. I have an hour plus drive and I have to drive myself. I pay enough for that without starting the day off with swollen hands and ankles. I told him I was willing to find someone to drive me and work the day before so he could see what it does to me. But he didn’t want me to do that. I will the next visit anyway, tired of not being believed.

    Anyway he is gone and I see my new DR next month, praying this one is more patient friendly! The Dr covering suggested I stay off my MTX for a week or two to see if the nausea goes away. I am going to ask if I can go to injections. Also I can go to the VA clinic here in town to get them to inject me, know I would have a hard time doing that. Choosing my battles for now. Sorry to rant.

    Reply
    • July 9, 2011 at 2:33 pm
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      Hi Becky, I hope you can figure out the nausea & get rid of it. It can be really distracting. I think I kinda moan about it so your ranting doesn’t bother me. 😉 When I had to go off the methotrexate for a while, I was surprised that some symptoms that I blamed on side effects did not go away (like my nausea), showing me it can also be the RA itself. Either way, the injections might help so it’s worth a shot!

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      • July 11, 2011 at 11:18 pm
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        So far, so good. I have been off for eleven days now, no nausea and very little indigestion. Wow, so glad to know what it is. I am willing to try injections although I haven’t had much relief from the MTX. Any relief is welcome tho, so here we go…

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  • February 9, 2013 at 5:58 pm
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    I’m 31 and was diagnosed w/RA last November. I’ve been having increasing problems for 6-7yrs, but the last year has been excruciating. I was hesitant (read as terrified) of methotrexate, so we started w/sulfasalazine. Bad bad bad idea. It caused severe abd pain, nausea, and vomiting. Every dose I took just made it worse. So, I got over myself, put on my big girl panties, and started methotrexate. My rheumy started educating me about the pills, and when I stopped her and said “no pills. If I’m taking this, it’s gotta be injected” she was flabbergasted and astonished (happily, though). She said that she prefers the injections, but very few patients will do them, and she certainly had never had a patient demand the injections! I’m using a TB syringe w/a 25g x 5/8 needle and so far, that’s worked OK for me.

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  • July 9, 2013 at 12:50 am
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    Thanks for this article! I am 17 and just recently diagnosed with rheumatoid arthritis. I have one question though. Have you ever heard of being able to go to a cancer chemo center to get the methotrexate administered through the vein? It’s not that I hate needles (I have multiple diseases so I am used to them!) but I would just feel “safer” having a professional do this, and my mom said she had read online that they do this often, especially since I live right next to Cincinnati Childrens, which has a huge oncology center. I was just wondering what you think, as methotrexate is the next step for me!

    Reply
  • July 16, 2013 at 1:50 pm
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    I was just diagnosed with RA as well as Osteo Arthritis back in December at the age of 48. My Mom has both kinds of arthritis as well. After seeing all the problems with side effects from taking methotrexate in the pill form that my Mom has suffered with, I opted for the injections. I absolutely HATE needles, so this was a very big step for me. But actually it hasn’t been that big of a deal. Unfortunately because of all the other health issues and medications my mom must take, she seems to be very limited on her treatment options. Her ra dr now has her taking about 3 different meds for her ra but nothing seems to be helping very much. Apparently she is not a candidate for the biologics. I refuse to let my ra run my life, i consider it just another speed bump on the highway of life.

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  • September 7, 2013 at 2:12 pm
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    What guage is the smaller needle used to inject and what is the length of the needle? Is this an intramuscular or subcutaneous fat layer injection?

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  • September 25, 2013 at 10:27 pm
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    I am 57 years old and was officially diagnosed with RA 6 months ago. I had knee surgeries, carpal tunnel surgery and inflamation since age 41. I have a twin sister and we always laughed at how old we feel because our hands hurt and we could barely crawl upstairs. Since I have found out what I am dealing with, I have found out that my biological fathers family is full of RA. I started out with Predisone and Mtx. Found some relief with 20 extra pounds. I am still having too many flares so my Dr. has added another drug today. I have had no nausea, heartburn or problems on the oral medicine. He doesn’t feel I am benefiting enough by the oral and I would do better on the injections. I am so scared of hair loss. Does it happen to everyone? Your site has been a Godsend to me. Please know that you are truly making a difference in this world!

    Reply
  • October 14, 2013 at 11:25 am
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    I am just starting with subcutaneous injection and have no problem drawing from vial and injecting with my 31 guage 5/16″ needles. I also do intramuscular testosterone injections. My research indicates only a minimal benefit to intamuscular injection of methotrexate over subcutaneous. There really is no contest here. Any slight advantage to intramuscular injection can easily be compensated by slightly higher subcutaneous dose. I am injecting one half of my weekly starter dose every three and one half days to keep the amount in my system fairly constant and avoid up and down serum levels. I had to do this with testosterone to avoid loading up and nasty tension issues. Although dosing is somewhat individualized, there seems little reason to go oral since bioavailability and side effect avoidance all point to subcutaneous injection.
    My doctor and I agree that aproximately 1 mg folate per day is a good idea. Please be aware that many people have a genetic variation that inhibits the first step of the bodies breakdown process for B-6 (folate). This problem can be avoided by taking 5-Mehtyltetrahydrofolic Acid form of folate available cheaply from Swansons among others. This form does not require the inhibited first step of the absorption process.
    To sum up the best way to start to maximize convenience and minimize side effects is to inject subcutaneously (eg belly) perhaps with biweekly injections and 1mg per day of 5-methyl folate.

    Reply
  • November 25, 2013 at 8:37 pm
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    Hi all thanks for all your great comments. Very helpful. I just got diagnosed with overlap RA and start mex injections this week along with prednisone (yuk!) I am so confused though as to what type syringes and needles I should ask for? I think I’ll go the sub-q route, use the large needle to draw the dose, but what guage or type of needle should is best to use for the actual injection?

    Also, I’m starting out with .5cc and will go up in about 6 weeks. Have any of you lost your hair? Mine is already falling out for unknown reasons and I’m so scared of losing it. I was prescribed folic acid so hopefully that will help. Any other thoughts, experiences or suggestions?

    Reply
    • November 25, 2013 at 11:17 pm
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      The size I bought is 27 gauge, but you could get any small size that the pharmacist says will still fit on the larger barrel you buy. I only bought that size because he had a box of them that would last a while. I think 28 is a common size for insulin so they might have that.

      I had some hair loss in the beginning but it was slight & it came right back when we increased folic acid. Have you read a folic acid post?
      If you are losing hair already, it might be stress (about your diagnosis & medications or something else on top of that) – or the most common reason is thyroid levels. Make sure your docs check your thyroid levels since it’s common to have thyroid problems at the same time as rheumatoid.

      Reply
  • November 25, 2013 at 8:38 pm
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    Also, it seems like this is a life sentence with mex and other drugs… Is that the case?

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    • November 25, 2013 at 11:05 pm
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      Heidi, if the medicine is helping, most people do stay on it for a long time. Remission does happen sometimes, and some people can go off of medicines and stay in remission. It’s a very individual thing, based on the course your disease takes and how you respond to the medicines, and the philosophy of your doctors – we are still learning about this disease.

      Reply
  • February 19, 2014 at 1:25 am
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    I have never had any hair loss with oral or subq injections. have used subq for 2 years now, it is starting to not work as well, might try to switch to IM.(maybe it will work a little better) I am also a nurse, so shots don’t bother me at all.

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  • July 14, 2015 at 11:41 am
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    Hi I’m in the UK so things may be different. Have you experience of using metoject pens..pre loaded automatic methotrexate syringes..

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  • January 19, 2017 at 12:31 pm
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    How much is it for the bottle and the needles in total for Canada without insurance

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  • January 22, 2017 at 1:52 pm
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    I was diagnosed with RA a year ago, and started taking oral methotrexate and prednisone. It made me nauseous so I quickly switched to injections. At some point after being diagnosed (I don’t really remember when it started) I have started having horrible stomach pain almost daily. I can’t seem to find what causes it, or what makes it go away. It feels like the stomach pain I’ve had when I have a stomach virus but no vomiting. My gallbladder has been removed, so I know that isn’t the culprit! Could the injected methotrexate still cause stomach problems?

    Reply
    • January 22, 2017 at 9:47 pm
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      Yes it can Ronda. It’s less common but it can still cause nausea. I’ve often called it the “kicked by an elephant” feeling (I really was once). You could talk with your doctor about lowering the dose, if the mtx might still help you. Or you could talk with your doctor about taking something to help this side effect. Back then, my doctor prescribed zofran for mtx day.
      You might also consider that it’s not the mtx. Are you taking NSAIDs? Do you take the pred with food? Other things might need to be ruled out. Good luck Ronda.

      Reply
  • October 8, 2018 at 1:05 pm
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    Hi
    I just recently started on the methotrexate injection’s. I was wondering if there is any new 2018 info on this drug. Also more info on the Sub q and IM as far as which may be the better option. I currently take Enbrel 50 mg 1 x weekly along with my methotrexate. Any other information would be greatly appreciated.
    Respectfully
    Kim

    Reply

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