The 1st Dose of Methotrexate for Rheumatoid Arthritis: 15 Questions

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Uncertainty about methotrexate for Rheumatoid Arthritis

Some reports say that 95 percent of Rheumatoid Arthritis patients take methotrexate to treat RA at some point. It’s the most searched for item on this website and one of the most repeated topics in questions sent to me. Doctors write it mtx or mtxe. Patients also say mex / meth / metho. However you spell it, hopefully, some of these answers will put you a little more at ease.


1.       How will I feel after I take methotrexate?

You will probably not feel any different. Methotrexate is a slow-acting drug. If you are worried, it helps to take it after an evening meal and go to bed.

2.       Will I have side effects?

Most people don’t have severe or dangerous side effects. If they happen, they usually appear gradually and can be reversed by discontinuing the treatment. Nausea is the most common side effect. There are lots of strategies to help fight side effects, so we don’t have to just accept them.

3.       How soon will methotrexate help the Rheumatoid Arthritis?

It takes about 6 weeks for methotrexate to effectively reduce Rheumatoid Arthritis symptoms. By that point, many doctors will increase the initial “low dose” to a bigger “low dose” unless RA symptoms are well controlled.

4.       Will foods I eat interfere with methotrexate?

There’s no need to restrict diet, but some say grapefruit should be avoided on methotrexate day.

5.       Do I still need to take methotrexate if I take a Biologic?

Probably. The methotrexate-Biologic combination is believed to provide the best control of moderate to severe RA. Methotrexate can also help to prevent the immune system from creating antibodies to the Biologic, which make it become ineffective.

6.       Will I get a sunburn?

Like antibiotics and birth control pills, methotrexate causes increased sun sensitivity. Strong sunscreen is recommended, and prolonged exposure could lead to more severe sun reactions. We have to treat our skin like we would a baby’s.

7.       Will methotrexate damage my liver?

The liver is a filter, removing impurities from the blood. Medicines give it more work to do. Your doctor will require regular liver profiles to insure that your liver continues to function well. If profiles become elevated, it doesn’t mean there is damage. Usually, reducing or stopping methotrexate will allow the liver to return to normal function levels. Often, methotrexate or other RA treatment can eventually be resumed.

8.       Will I have hair loss?

Maybe. Some people experience hair loss from methotrexate; however, it is usually minor and temporary. Increasing folic acid (a B vitamin prescribed with methotrexate) often helps. If there is increased hair loss, it’s good to call the doctor to ask about more folic acid.

9.       Can I drink alcohol while taking methotrexate?

Most doctors in the US advise alcohol consumption be limited with methotrexate. In other countries, there are more liberal standards. Whether some alcohol consumption is safe for a particular individual depends upon personal history of alcohol consumption and liver health.

10.    Why are methotrexate tablets better?

Tablets are better because they are usually cheaper. There is no needle to buy or dispose of. And no needle to make you feel creepy.

11.   Why are methotrexate injections better?

Injections are better because the methotrexate is better absorbed. There are usually fewer side effects. You might be able to get a little more sympathetic response from friends who don’t understand RA.

12.   How much folic acid do I take?

Folic acid prescriptions can range from 1 mg to 5 mg daily. Some doctors say to withhold folic acid on methotrexate dose day. There is not clear evidence showing whether that is necessary.

13.   Will methotrexate cure the Rheumatoid Arthritis?

No. Sorry. Methotrexate only cuts the disease activity as long as it’s used. Most RA has a pattern of flaring and remitting. Patients in clinical remission are often required to continue methotrexate even if at a lower dose.

14.   Will I be able to have children?

Methotrexate is used (in higher doses) to cause abortions since it is a toxic substance. If an RA patient wants to have a baby, she will need to stop methotrexate. Most docs recommend that either parent quit methotrexate for 3 months prior to conceiving since methotrexate remains in the body longer for some people than others. More information on pregnancy with Rheumatoid Arthritis.

15.   Can I quit taking methotrexate suddenly?

Yes. Methotrexate is not a narcotic or a steroid. The body does not become dependent upon it. It can be stopped at any time no matter what the dose.

More on methotrexate for Rheumatoid Arthritis

Methotrexate is probably the most important medicine used to treat Rheumatoid Arthritis today. It is the staple of RA treatment since it is effective at reducing disease activity for a large percentage of patients. If you are looking for more information on methotrexate and RA, check out the links below or the Methotrexate and Rheumatoid Arthritis section of the site on the red menu bar. There is also a methotrexate link in the “Tags” dropdown list at the top of the page which will lead to every page on the site about methotrexate.

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Kelly Young. All rights reserved.

This entry was posted on Monday, July 12th, 2010 at 7:00 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.


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