1st Dose of Methotrexate for Rheumatoid Arthritis: 15 Questions

Uncertainty with the 1st dose of 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, some of these answers will hopefully put you a little more at ease before your 1st dose of methotrexate.

If you are looking for more information on methotrexate and RA:
Check out the Methotrexate and Rheumatoid Arthritis section of the site
Click here to see a list of 31+ articles on methotrexate.

1st dose of methotrexate

     15 Questions on the 1st dose of methotrexate (UPDATED 2016)

1.       How will I feel after I take methotrexate?

You will probably not feel any different right after your 1st dose of methotrexate. It 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 methotrexate 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. There are also rarer unusual side effects.

3.       How soon will methotrexate help the Rheumatoid Arthritis?

It takes about 6 weeks for methotrexate to effectively reduce Rheumatoid Arthritis symptoms, if it works for you. 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. If the medicine makes you nauseous, you might want to avoid foods that upset your stomach.

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. Even a low dose of methotrexate can also help to prevent the immune system from creating antibodies to the Biologic, which make it become ineffective.Lego Indiana Jones: The Original Adventures video game

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 blood tests to insure that your liver continues to function well. If your liver profiles become elevated, it doesn’t necessarily 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. This might make it more effective for you. There are usually fewer side effects with injections. You might be able to get a little more sympathy 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 tends to have 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.

Update Bonus 2 questions about the 1st dose of methotrexate

16. What’s new with low-dose methotrexate?

Pre-filled injection pens (Otrexup, Rasuvo, or Metoject) have been approved by the FDA for treating RA.  So people with rheumatoid disease (PRD) can now use injectable methotrexate without the difficulties of filling needles and stabbing oneself. One study showed PRD much prefer injection pens to even pre-filled syringes.

17. Isn’t there an alternative to methotrexate?

Yes and no. Nothing has worked exactly like methotrexate, but there are other drugs that can reduce disease activity (DMARDs). This page has a chart showing all of the common DMARDs. Also, I suggest this article about research to create a methotrexate alternative.

After the 1st dose of methotrexate

1st dose of methotrexateMethotrexate 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, at least to some degree, for a good percentage of patients. After the first dose, you’ll need to take good care of yourself and keep up with your blood tests. It also might help if you try not to think too much about the methotrexate, whether it will help, or whether there will be side effects. Either way, you’ll know soon enough.

TIP: There is always a methotrexate link in the “Tags” dropdown list: Just click on the arrow near the top of the page by the word “Tags” to see all the topics. This will lead to every page on the site about methotrexate – or 99 other topics!

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/

113 thoughts on “1st Dose of Methotrexate for Rheumatoid Arthritis: 15 Questions

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  • July 12, 2010 at 8:52 am
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    I felt absolutely horrible on any dose of methotrexate when it took it orally as a pill form, but generally can tolerate the injections fine. The day of or day after I may feel a little sick to my stomach, but it passes. On the pills, I felt like I needed to be near a bathroom to throw up 24/7. So if one form does not work for you, try the other before giving up. My experience is that the injection has no pain (I had a lot of pain with injections of Humera.)

    About 6 years ago there was a contamination at the main plant for mtx injectable meds and so I tried the oral again – at Christmas time. Life was miserable the whole 2 weeks, so my rheumatologist scrounged the country for the injectibel and I found them at off the wall little country pharmacists for a few years until it was back into production. The company said “6 months or so” but I knew not to believe that. It was years before my regular pharmacist could order it again and receive it. So… never give up!

    Reply
  • July 12, 2010 at 10:34 am
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    Thank you for posting this! I am about to start mtx soon and I’m a bit nervous about side effects. This put my mind at ease a little bit.

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    • July 12, 2010 at 10:51 am
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      Heather, Good luck. It will probably help you since it helps most people. Try to expect the best. :rainbow:

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  • July 12, 2010 at 1:43 pm
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    Thank you for this post! When first dx’ed a little over 3 years ago, I took mtx with Enbrel. But the combo of the 2 made me pretty sick, so I decided not to take mtx. Forward to today…I am now on Rituxan and had to wait until Medicare would approve my next treatment. I had to be in a full flair before approval. (wish the decision makers suffered with me) The pain was so great that I decided to start taking mtx again. This is my 3rd week and it still makes my stomach turn, but I do feel better.
    Does anyone suffer from extreme tiredness on their mtx day?

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    • July 12, 2010 at 2:20 pm
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      Yes, Arlene. I hear that a lot. Some recommend taking it at night to at least sleep of a good amount of it. And plan a more quiet day when you are resting, if possible. Also, your system may adjust to it & then side effects improve.
      Good luck with the Rituxan. Delays with certain illnesses (by referrals, doctors, or insurance) are just not acceptable.

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      • July 12, 2010 at 11:04 pm
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        Agreed on the insurance thing! This is my “first” time dealing with strictly Medicare (newly divorced :-)& happy sans insurance) It has been very frustrating.

        Next Tuesday, I will do mtx at night. Thank you for all you do on sharing so much information! I think Women’s Day should provide you an Emmy!!

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        • July 13, 2010 at 9:40 am
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          Yeah with better awareness maybe someday it will change. Don’t know about an Emmy. I’m obviously no actor. But I can play myself. Hahaha. 🙂

          Was there any difficulty w/ Medicare and RA? Were you easily covered?

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          • July 20, 2010 at 10:54 am
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            Kelly, there was a problem with my Medicare and RA. Seems that NM Medicare will not allow a biologic med such as Rituxan until it is PROVEN a full flare. 4 months of my doc fighting for my meds. Today is my 2nd IV dose…hopefully, the last for 6 months. Still taking MTX. And will take your advice once again…take it before bed. Peace to you!

          • July 20, 2010 at 8:47 pm
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            That’s just dumb. Should be up to you and your doc. Hope your IV went well!!

          • July 20, 2010 at 10:56 am
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            Oh, and one more MAJOR thing about Rituxan. I have been on it for over a year with no problems with insurance until this last time!!! Go figure reform. 🙁

          • July 20, 2010 at 8:48 pm
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            I think it may just be Rituxan. It can work for longer periods for some people so maybe they thought they want to see proof you need it. But should be up to doc when it’s appropriate.

    • November 20, 2013 at 7:42 pm
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      I suffer from extreme fatigue everyday of my life, from the drugs and also from the RA, not sleepy, just tired, fatigue. I think fatigue goes along with RA and RA drugs.

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    • May 12, 2015 at 12:02 pm
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      I have extreme tiredness and nausea some days after taking my dose of mtx, but not all the time. I do take mine in the evening. I also have some hair loss which I found was worse at a higher dose. I went back down to 4 pills. I even went off for a few weeks. That seemed to be a mistake because I ended up with extrme pain all over. I am back on the 4 pills a day and take folic acid. I found taking my 50,000 unit dose of vitamin D that day after I take it helped with that extreme tiredness.

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  • July 12, 2010 at 9:20 pm
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    Very timely post. I just took my 4th dose tonight and still see no effects…bad or good. Hopefully that 6 week mark is my magic date! Just found your blog…thanks for all of your encouragement and wisdom.

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  • July 12, 2010 at 10:22 pm
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    Kelly,

    I had more hair than you, same length…I lost almost all of it. Every week I gave myself the injection, I had chunks of hair falling out, no matter how much folic acid. After five years, and losing most of my hair, I finally asked to be switched to arava.

    I also know about 3 other women that experienced a lot more than “minor” hair loss.

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  • July 13, 2010 at 10:18 am
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    This is for SB post:

    Oh my god that is horrible SB, so sorry I am guessing that you went bald? Did you document it? That seems to be really irresponsible that your docs left you on it that long if you had went bald! 5 years???? Have you asked your doc why he would do that to you and make you stay on something that obviously was not working for you? I also take Arava along with the MTX and am doing so much better I love the combo! Thank goodness SB that you are in the minority of losing so much hair as I think it is such a wonder drug and has done so much to help me walk again. I have had very minor hair loss and now hardly ever lose anything except what I naturally would. I do lose hair when I am really stressed as well though.

    Kelly loved the article, great as usual. Was scared to the nines about taking MTX originally and had read some scary posts of extreme side effects and was so glad to come across your site at the time to give me the courage to try it and have faith in science. I ♥ MTX and my body begs for it the day before injection night.

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  • July 13, 2010 at 11:34 am
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    I have been on antibiotics (sinus and ear infection) for the last 10 days, so I did not take my MTX or Humira last week. I am definitely feeling worse. Sometimes you feel the meds aren’t doing much, but when you have to go off of them, you suddenly realize they are working. Just not as well as we would like for them to work.

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    • July 13, 2010 at 11:37 am
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      Yes, that is always the test…
      Your work is hard work. You prob. could not do it at all w/out your treatment.

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  • July 13, 2010 at 11:03 pm
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    Kelly, thanks for bringing up this topic. I’m on week 6 of mtx. I’m feeling a pretty big improvement in my RA symptoms and overall have noticed a decrease in the side effects of the med over time, with one exception.. I am very irritable and tired the day or two after I take the med. The irritability is making me so frustrated with myself. The 1-2 days after I take it, I really feel like I’ve been hit with PMS x 10. . My pharmacist husband tells me that this is not a likely side effect of the med (the irritability) because I’m on a dose much lower than what they use for chemo. I am so afraid to bring it up to my rheumatologist…as he has been doing a good job so far of listening to my concerns and taking them seriously. I don’t want to have him dismiss me as crazy!! Is there anyone else you have heard of with this issue?? If not, maybe I’m just going through an irritable phase 🙂
    This disease really makes me doubt myself. What a nasty invisible monster.

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    • July 13, 2010 at 11:18 pm
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      Hi Kari,
      Your pharmacist is right that it’s not a likely side effect. But I guess that doesn’t mean it’s impossible! I have heard a lot of things & it’s hard to know exactly what is the cause of each one when you are already dealing with this very complicated disease. Are you taking any other medicines since there are other ones that are more likely to produce that side effect?

      I’m glad you asked out loud. Your doc should not dismiss you as crazy. I’m sorry you are doubting yourself. How long since you were diagnosed? There is a definite period of adjustment and shock with RA. We go through all of the grief stages – often more than once b/c RA deals out another blow… You are right – a monster. :no:

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      • July 14, 2010 at 6:41 pm
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        Hi Kelly, thanks for the response. I was diagnosed March 2010- so this is all very new to me… prior to this I had absolutely no medical issues. The only other med I’m on is 5mg of prednisone, and on my max of 15mg had no mood issues- so I ruled that out. I don’t know, maybe it’ll get better like the rest of the side effects did if it really is related. I’ll bring it up when I see my rheum tomorrow and see what he thinks. I really have been lucky with him so far. ..so I guess I should trust that he won’t judge me! Your blog has been a great source of info and support. Please keep it up!

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    • May 12, 2015 at 12:18 pm
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      I would imagine that irritability comes from not feeling well. It makes me feel nauseous and tired and I’m not very happy like that. I doubt you are alone with that feeling. Think about how people are when they are sick. I know the folic acid and vitamin D (I take a 50,000 unit once a week)help with my nausea and tiredness. I also found taking mine at night helped. Maybe it will get better over time. Good luck. Don’t ever feel like you can’t tell your doctor. They may have a good suggestion for you.

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  • July 14, 2010 at 10:42 am
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    I am on week 6 of MTX. My first dose was a half dose, and I felt light headed and fluttery most of the day, but that was the only day I had those symptoms so it could easily have been caused by something else. I take my dose Saturday mornings and haven’t noticed any side effects, but no significant improvement yet either. Unfortunately, I am a prime candidate to have my dosage bumped up, so wish me luck. Thanks so much for posting this info- I’ve been trolling for other MTX experiences hoping for a preview of what I’m in for. Btw- I do take folic acid daily except for on my MTX day. I was also cautioned not to take my b complex supplement on MTX day, and no more than one alcoholic beverage a month, if any.

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    • July 14, 2010 at 11:17 am
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      Hi Elisabeth,

      I’m sorry you haven’t seen improvement yet. The initial dose of mtx is seldom the ideal treatment dose. Your body learns to tolerate the medicine better gradually, then you get to the therapeutic dose.

      The alcohol debate is mostly in the US. Did you read this yet? I agree its best to wait a while on that until you know how well you tolerate the treatment. Good luck to you! 🙂

      Reply
  • July 14, 2010 at 2:13 pm
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    I’ve been on Mtx for 4 years now and have not had any problems at all. I take tablets.

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    • July 14, 2010 at 3:55 pm
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      That’s great, Chloe. It’s good to hear about good experiences. Mostly the negative side is told. Thanks. 🙂

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  • July 15, 2010 at 9:33 am
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    I have been taking 25 mg of MTX by injection for years and have had no hair loss. I have other side effects for about 24 hours after I take it but I just resign myself to a quiet day. The side effects have diminished with the years.

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  • July 16, 2010 at 6:36 pm
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    I’ve been taking methotrexate since November 2009. Started out with 15mg per week, later increased to 20mg per week. Initially my side-effect was fatigue. I take the pills Sunday night after dinner. The first seven doses brought on fatigue. I’d start to feel better about Thursday, only to have to have to face another dose a few short days later. Then, like magic, after that 7th dose there were no untoward side effects. I’m reaching the point now that I begin to feel when the effects of the latest dose are wearing off and almost look forward to my dose of “poison” on Sunday. I have a healthy respect for the drug. My late mother took it in the 90s for her RA. It did such a good job suppressing her immune system that when she got shingles, she had an unusually bad case. Although methotrexate has not eliminated all symptom of my RA, I can truthfully state that I feel better now than I did this time last year. I attribute that to the methotrexate, folic acid and sulindac. I bless my rheumatologist for taking me and my symptoms seriously, and for aggressive treatment to stem the consequences of this disease.

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    • July 18, 2010 at 9:31 pm
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      Thank God for your good result, Pam. And thank you for sharing it. :yes:

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  • July 24, 2010 at 9:29 am
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    Today is my first day on Mthx…..just finished a week on predisone….July 16th my first visit with my Rhuemy….had started having severe pain in my joints since January…..my grandmother had RA and OA. Thanks to all of you for sharing for those who are just beginning….love the website ….found it on FB….

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    • July 24, 2010 at 9:49 am
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      Welcome, Andrea 😀 Did you see the Newly Diagnosed Mall Map? Tons of info all in one place for newbies. Good luck with mtx!

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  • September 25, 2010 at 5:15 pm
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    Well this helps relieve the stress from thinking about what to expect from this medication, time will tell how I adjust to it.

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    • September 25, 2010 at 8:01 pm
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      Hey, Mike. I hope it helped some. There is a methotrexate tab on the menu with a lot more pages if you want more. Good luck.

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  • October 4, 2010 at 1:16 am
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    I’m 65 years old and was diagnosed with RA in August after complaining to my PCP about morning stiffness, fatigue and feeling like my joints were on fire. I tested positive for RA, was referred to a rheumatologist who broke the bad news to me and immediately put me on 10 mgs methotrexate once weekly plus I take naproxen 375 mgs twice daily. I am also insulin dependant diabetic (Type 1 1/2 since I exhibit symptoms of both kinds). This means my autoimmune system is having a grand old time with these two diseases fighting against my body. I was frightened to take the MTX the first time since is is a chemo drug. But I bit the bullet and waited for the bad side effects. It is true I have experienced some diarrhea and nausea (both of short duration) but I feel like this drug is going to do me some good (as long as I don’t start losing a lot of my hair), and I am encouraged. Already, and this is probably the Nsaids, my joints don’t feel nearly as inflammed. Now, if I can just get by blood sugars back down from the epidural steroid inj I just had on Friday. I also wonder if when the RA inflammation is aggressive, does it cause your blood sugars to rise? Has anybody else noticed any difference. I have to take 7-8 injs of Novolog a day when those joints are hot to keep my numbers below 200. I also have osteoarthritis, osteoporosis and it’s time for my next Reclast IV. Would be interested in hearing from others who are on this journey. God bless.

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  • February 19, 2011 at 6:11 pm
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    Hi, I’m 34, and I went to the docs about a year ago about my wrist which was mildly swollen and aching, and finally after a year of blood tests, x-rays and an MRI (don’t know how it is in other countries but here in the UK it’s usually at least 1-2 months wait for each hospital appointment :-\), I was finally diagnosed a few days ago with Psoriatic Arthritis. In the last couple of months things have gotten rapidly worse and my wrist, hand knuckles and 2 of my fingers are now very painful, swollen and virtually useless, and I’m also now having trouble with an ankle, my back and my neck (which is proving the most debilitating).

    Anyways so since Psoriatic Arthritis is very similar to RA the treatment is also and the Rheumatologist wants me to start Methotrexate (I’m currently also taking Diclofenac, but that upsets my stomach a bit and doesn’t seem to be making any difference at all), he’s given me a few days with a leaflet about it to decide what I want to do, but really it all it did was scare the h*ll out of me. My GP is on holiday so since I couldn’t go see her for advice Ivdecided to do research of my own into the disease and the pros vs the cons of mtx, and came across your site 🙂

    Have only checked out a few pages so far, but already sooooo helpful in guiding me towards a decision and I just wanted to say a big thanks for this website 🙂

    Reply
    • February 19, 2011 at 6:48 pm
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      Thanks for stopping by. I’m sorry you’re sick, but I’m glad to hear you got a diagnosis.

      I have to agree about diclofenac: It was one of those things that did nothing at all for me. And since it’s only supposed to treat symptoms and not the disease, I refused to take it more than a few days.
      There is a lot of information on mtx here and many of the articles have comments pages too. Use the Tag: Methotrexate in the tags list. I hope reading will make you feel more comfortable. Did you see this recent post on “Dangerous drugs”? click here

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  • February 19, 2011 at 7:31 pm
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    Thanx Kelly, yeah I do feel better for actually being able to put a name to it now, though it hasn’t entirely sunk in yet. I guess I knew it wasn’t going to be something that would have a “quick fix” but at least before I still had that tiny hope!!

    I think my biggest issue is thinking that hopefully I have a good 40+ years left of life yet, and I would obv prefer not to be in a wheelchair in 15 years, but if mtx could eventually cause liver/blood/lung/stomach problems then perhaps I’m better off not taking the mtx!! Of course in 5 years time though I could be kicking myself (if I can do that!!) for not having started it. I already suffer from depression and anxiety so I’m trying really hard to stay as positive as possible, and feel better when I feel in control which is why I want to do as much research as possible 🙂

    Thanx for the link, I’ll check that post also. Lots of reading to do this weekend methinks!!

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  • February 19, 2011 at 7:37 pm
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    The other thing I’m worried about, is that I’ve had a bad dental and sinus infection recently, and after 4 courses of antibiotics and a root filling I’m feeling much better but still have a swelling on my gum so I’m not sure they caught it all, so I’m concerned now that if I take the mtx then things could flare up bad again!! I guess it’ll just be a case of “suck it and see” though, or else check with my GP when she gets back from holiday 🙂

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    • February 19, 2011 at 10:50 pm
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      It’s true there is a lot to consider and you have to be the one to decide about your treatment. The link that I mentioned discusses the post by a doctor saying that the problem with most of the information given about methotrexate is that it’s much more frightening than need be because the comments are actually suited for a cancer patient’s dose which can be many times higher. There have also been some new studies about the beginning of the autoimmune process of citrullination being sometimes connected to a periodontal bacteria. Here is the link. If this is the beginning of your disease, you have a better opportunity than most patients to slow it down. Which medicine is best for you, I don’t know. There is not guarantee that any treatment will work, but most say the earlier the better. Damage does not take 5 or 15 years. It often occurs in the first 2.

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      • February 20, 2011 at 7:51 am
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        Thanx, that link is really interesting. My dad also has psoriatic arthritis in his back (he coincidentally only just got diagnosed also), he has a fused spine, and he’s always had trouble with gum disease, particularly recently. And now thinking back, my recent tooth issues started about 6 months before my wrist swelling and pain started so it could feasibly be that that was what triggered my PA if the association is correct. Wishing I didn’t have such bad dental/medical anxiety now or I might have had my tooth fixed earlier and potentially prevented or delayed the onset :-\ It’s done now though I guess and I will be ringing my rheum on Monday to confirm that I’ll give mtx a try 🙂 Thanx for all your help! xx

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  • January 16, 2012 at 4:14 pm
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    2nd week of Methotrexate and I havent noticed well anthing, bad or good. I do take prescribed folic acid with it. First tried Plaquinil and had a terrible time, swollen lips, throat, rash, vomitting. Was terrible so thus far Im ok with mex. But I really appreciate all the info on here, RAD is a little itimidating.

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  • January 19, 2012 at 2:17 am
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    I hope that someone might benefit from my experience. Never take your methotrexate with augmentin. Unless you enjoy severe stomach upset, vomitting, shakes, weakness, 2 days in bed and a headache so severe you are ready to amputate. My fault, I should have called Rheumy to confirm the GPs orders. In my defense on a prior such call, they never called me back so I trusted GP. Advice of Rheumy, since my near death experience, is to discontinue the MXT until the antibiotic is finished. Seems so basic, right? I should have known.

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    • January 19, 2012 at 8:32 am
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      I guess with so many other things, there is no standard protocol. I’ve never been told to discontinue mtx with antibiotics. I know people who’ve had docs tell them varying things about that. It would be good if we can “get to the bottom of it” and I’ll work on it.

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  • January 29, 2012 at 1:58 am
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    Kelly – Thank you so much, You are the RA(D) Warrior!

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  • January 29, 2012 at 8:21 pm
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    I just started taking methotrexate, I am in my 3rd week. I am taking 5 – 2.5 mg tablets, every Friday night with dinner. I am also taking Folic acid and B 12 in the morning along with 125 mcg of Synthroid for thyroid issues. In addition, I take 10 mg of Crestor at night for high cholesterol, and CoQ10 with it.. I have found that late Friday evening, I feel like I am under a mild sun lamp. On Saturday morning, I feel a bit queasy and sometimes slightly dizzy, but not too bad. Later on Saturday, I just feel tired and still queasy. My symptoms from the RA seem to be better already, although it’s sooner than I would expect ?. I still have some finger joint swelling, but my overall body pain index which was high, is a good bit reduced.

    Reply
    • January 31, 2012 at 8:58 pm
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      Sounds like you might be responding to the mtx – I sure hope so. Have you asked your pharmicist about the side effects and combinations of the various drugs? I’ve found that very helpful when combining so many different medicines – they know what to take with what or when to best take it – or how many hours should be between. Just an idea as you start to get the longer list of meds going. Good luck.

      Reply
  • April 5, 2012 at 9:05 am
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    I am a 38-yr-old woman with aggressive onset of RA. CRP was measured at 5 just four weeks ago, six weeks ago I started MTX (with great trepidation ) plus prednisone and it has changed my life! I feel amazing, CRP is down to .7 and so far no side effects at all. Give it a go, I think it is a miracle drug and am grateful to have my life back.

    Reply
  • April 9, 2012 at 5:09 pm
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    I’m very newly diagnosed, and had my second week’s dose of methotrexate a few days ago. I’m doing fine with it so far, unlike the prednisone, which I had to stop after 10 days – it was doing nothing for the inflammation and pain, and even at 10 mg a day made me want to slit my throat emotionally. So much for the “little vacation” from discomfort I was promised! Luckily my rheumatologist told me just to stop it if it did nothing for me, so now I’m back on 600 mg of ibuprofen three times a day, which really does help the soreness. I didn’t notice anything after the first dose of methotrexate, but by the time the second was due the inflammation was worse, and is now back down again, so maybe it’s doing something. Very glad to have found your web site – thanks!

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    • April 9, 2012 at 8:33 pm
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      Hi Susanna! Welcome aboard; I’m glad you found us. Like you, I respond somewhat to high doses of ibupr. and not well to steroids. And I agree: what a disappointment to not have that “vacation” or “relief” available and have everyone assume that it works the same for everyone… It sounds like you have a dr who listens to you. It can take a while for the mtx to really help (once the dose is high enough), but I hope it gives you a lot of relief.

      Reply
  • May 9, 2012 at 5:24 am
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    comprehensive information presented with clarity.
    Thank you very much ……. Helen

    Reply
  • May 16, 2012 at 7:52 pm
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    I like your website, however I have to disagree with number 8(Will I have hair loss) I have been taking between 10 and 20 mils of methotrexate for 14 years along with a few mils of folic acid. Hair loss is a very common side affect of methotrexae. even once the dr increased my dosage of folic acid. I still had what I consider significant hairloss. I honestly belive that it is not diferent for everyone. I have talked with both men and women that take less methotrexate than myself, and they all experiance moderate to severe hairloss. Methotrexate is a drug that stays in your system for a very long time. in order to stop the hair loss you must discontinue methotrexate.

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  • June 3, 2012 at 11:00 am
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    I”m also a newbie. 12 weeks into MTX, currently at only 10 mg /week (I had some lung issues that are, hopefully, unrelated). As near as I can tell from reading everything you all have so generously shared. I’m not only newly diagnosed (march) but also relatively newly symptomatic (<1 year) . I am seronegative (only anti CCP elevated) and into the mild/medium side of the severity scale. Nothing unbearable but with more joints involved every month. I'm 57, post menopausal. My only drugs are MTX and folic acid.

    I share all that only to provide a baseline or my 'has anyone felt anything similar' question. Approximately 12 hours after dosage my affected joints 'flare'. Shooting paints, tingling, more aching than baseline. That continues about 12 hours, then they calm down and I have one or two really good days before going back to baseline. I swear it feels like I can feel the 'Battle of the Joints' for those hours. Makes me feel better about coping with the side effects, but I wonder if anyone else experienced anything like this or if I am just I imagining the drama to make me feel better.

    Reply
    • June 3, 2012 at 3:01 pm
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      Hi Lisa,
      I doubt youre imagining it especially since you’re conscious of that possibility. Also other patients do have a bit of joint flare after the dose, as they describe in some comments. It might make you feel better to read more experiences, there are several other mtx articles with comments’ pages. If you click on the Tags List and then methotrexate, it will show you all of them. I’ll try to get back soon w/ the link to the one called “unusual” side effects where one of the rheum docs even talks about patients having that response. good thing about side effects with it is that they do tend to come and go – so hopefully it will go away or lessen for you soon!

      Reply
      • June 6, 2012 at 4:51 am
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        Thanks Kelly. I’ll follow the tags and read on. Shame on me, an old geek, for not thinking of that myself.

        Great work on the site. This is a wonderful help in navigating my way through these new waters.

        Reply
  • July 31, 2012 at 5:55 pm
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    Hi,
    What a wonderful site! I am about to start Methotrexate (15mg) today and ám feeling much aprehension. My Rheumatologist has added this to a twice daily dose of Plaquenil.

    Many of the information shared here has discusses hair loss, a subject not even mentioned by my Dr. I’d love to know at what dosage this becomes a problem, understanding that it’s not all the same for everyone.

    Many thanks for your site and best wishes to all. Sue

    Reply
    • July 31, 2012 at 11:52 pm
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      Sue, I know how you feel. Usually, most people don’t have much problem at the starting dose, say 10 or 15 mg but there is also an option of increasing the folic acid if the mtx is bothering you. You’ll want to take it with food and there are a few other tricks if you need them to lessen side effects. Here is one page that I know has some ways to try to avoid side effects: http://www.rawarrior.com/methotrexate-and-rheumatoid-arthritis/part-6-checklist-manage-methotrexate-side-effects-rheumatoid-arthritis/

      I had hairloss only a couple times over the past few years w/ mtx and it was temporary. Increasing folic acid helped me with most side effects.

      More information might make you less uneasy; there are right now 27 articles here on mtx and many of them have comments pages too. If you’re looking for information and experiences, I recommend you sort through some of them too. You can click on the arrow at the Tags List to see topics & then click & you’ll see the list of posts. Here’s the link for the mtx topic: http://www.rawarrior.com/tag/methotrexate/

      Reply
      • August 1, 2012 at 3:57 am
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        Hi Kelly,

        Many thanks for your words of encouragement and for sharing your experiences and wisdom. I’ve been prescribed 5mg of folic acid to be taken on Saturdays (MTX on Wednesdays)

        The information and comments have been really helpful and I will be following some of the tips and crossing my fingers.

        Many thanks again.
        Sue

        Reply
  • April 29, 2013 at 11:46 am
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    f you are taking methotrexate orally, is there a “typical” window for the nausea to hit? I seem to feel fine for about 72 hours before I feel nauseous, though usually not real severe. It might continue off and on for a couple days. Is that typical?

    Reply
    • April 29, 2013 at 11:11 pm
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      I felt nauseated nearly all the time when I began taking methotrexate. Taking folic acid helped me a lot and alleviates the side effects of methotrexate like the nausea and hair falling out. The levels of folic acid are much higher than what you can buy at the vitamin counter, so you will need to ask your doctor for a prescription. I have been on methotrexate for about 8-9 months now and only feel nauseated a few hours after taking methotrexate.

      Reply
  • May 1, 2013 at 11:49 pm
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    Started on methotrexate seven weeks ago, with transient nausea [GI reflux, actually] only SE for first three weeks and then very little thereafter. I felt great on it and I was pain-free. Started feeling a little sluggish about ten days ago ago though…and I had noticed a little right upper quadrant tenderness. So I suppose I was not too surprised when my first post-metho labs five days ago showed elevated liver values – three times normal. Oh joy… So now I am taken off the drug and I presume I wait three weeks or so until my liver values return to the normal ranges? I see my rheum next week…I am afraid to take even ibuprofen with these wacked out liver values, and after stopping my Tuesday dosing this week, I already have swollen knuckles. Incidentally, I am fairly new to symptoms [four months] although I was diagnosed on blood work a year and a half ago. My symptoms are left-sided only – left hand, left ankle/foot.

    Reply
  • June 3, 2013 at 4:55 pm
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    Has anyone tried taking resveratrol with Methotrexate or had their rheumatologist suggest that combination? There was a study on rats titled “Resveratrol Protects Against Methotrexate-Induced Hepatic Injury in Rats” that indicated that resveratrol did a good job of protecting against liver damage in the rats. I would assume the same protectin may be possible in humans. A PDF copy of the study can be found here:
    http://ejournals.library.ualberta.ca/index.php/JPPS/article/view/7920/7301
    NIH abstract here:
    http://www.ncbi.nlm.nih.gov/pubmed/20816014
    That doesn’t mean the non-liver side effects would show any improvement, but given the other benefits that resveratrol seems to confer, it seems worth looking into. A search of Google Scholar shows a fair number of studies showing promising effects of resveratrol with respect to RA.

    Reply
  • October 28, 2013 at 7:09 pm
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    Informational and helpful!

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  • November 20, 2013 at 5:50 pm
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    I took methotrexate for years. It worked well and I had no troubles taking it. I took 5mg folic acid daily along with it. The only reason I stopped is because my rheumatologist suggested stopping since I was “at that age” and I was considering having kids. I decided not to have kids however. I am in remission at the moment, but if I ever have any problems I will ask for methotrexate to start with since I was on it in the past. Thanks.

    PS: I found that ODSP will not cover 1mg folic acid tabs since they are over the counter. I had 5mg tabs so they would be covered.

    Reply
  • November 20, 2013 at 6:02 pm
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    I had some strange reactions to methotrexate that eventually led me to stop taking it. I felt sick and tired all the time. I suddenly started getting cold sores all of the time. I was freezing all the time, but I woke up with cold sweats almost every night.. I slept with a stocking cap and gloves on along with electric blanket! (I live in Florida). My rheumy dismissed most of these symptoms as not related to MTX. I switched to plaquenil, which I felt better on, but after about a year I got such bad gastritis and ulcers I had to go off everything. I was also on Celebrex. During this time I also got a lot of brown patches on my face so take the sunscreen thing seriously. Good Luck. It’s so different with every person and everyone’s reaction to meds are different.

    Reply
  • November 20, 2013 at 6:02 pm
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    I was on methotrexate for a little over a year and I took myself off of it because my hair was falling out…not just a little bit, my nails began breaking and became very dry and I noticed a lot of ridges in them. I am currently not taking any medication, probably a bad idea but I am trying to clean up my diet. No gluten, no sugar. This has helped a little bit.

    Reply
  • November 20, 2013 at 6:04 pm
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    I was started on MTX initially with an excellent response, but when I was diagnosed with ILD (interstitial lung disease) 3 months later, my pulmonologist suggested that I be taken off of it. I’m sure I had ILD at the time I was diagnosed with RA, but they thought it was pneumonia. Only after 3 months and 3 courses of antibiotics and a C-T scan did they realize that it was ILD and not pneumonia. Because I can’t take MTX, our insurance has refused to authorize certain biologicals because they say that I need to be able to take MTX with them or they won’t be as effective.

    Reply
  • November 20, 2013 at 6:31 pm
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    I have found this forum to be encouraging and informative, so I thank you all for sharing your experiences. I have been taking methotrexate for about 4 months. My rheumatologist bases my treatment upon my monthly blood test results, and unfortunately has decided that the inflammation is gone or under control.. whereas I know it definitely hasn’t gone, as the joint pain is still spreading and limiting to my activities. The benefit of the methtrex, as I have been given to understand, is that it has less risk for long term damage to my body whilst reducing the spread of the disease. The main side affects I have experienced are nausea and diahhorea. I have started using a probiotic which has settled my stomach and returned normality to my bowels.

    Reply
  • November 20, 2013 at 7:18 pm
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    I like the overall question and answer idea, but found offensive two items. One is the statement about not having needles to make you feel creepy and then the comment that if you do use a needle your friends might have more sympathy for you. That’s all. Just my opinion.

    Reply
  • November 20, 2013 at 7:37 pm
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    As soon as I was diagnosed with RA, my rheumy put me on MTX, 6 pills a day, one day a week along with folic acid everyday, 5mg. I did OK with it until about 1 yr. later the MTX started causing me horrible abdominal pain. The MTX was also reduced to 4 pills a week, but still had the pain, so he took me off that and put me on Arava 6 wks. ago and it doesn’t seem to be doing anything to help me. I also give myself an Enbrel injection once a week. I would like to go on MTX injections, but dr. said I have to be on Arava for 2 more months because it takes longer to work in the body. So, here I wait taking pills that don’t seem to work…

    Reply
    • November 20, 2013 at 7:58 pm
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      I was diagnosed in Jan. 2012 after I went to PCP and she did xrays of hands that showed erosions and sent me to rheumy who did MRI of hands and found many erosions and then told me I have severe Ra and he put me on Prednisone first and then MTX. I was 70 yrs. old then.

      Reply
  • November 20, 2013 at 8:34 pm
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    I have been using Methytrexate for 5 years now. I was taking injections until there was a shortage 2 years ago. On the injections I had hair loss, and nausea for days after each injection. I currently take 20 mg a week in pill form. I also am on Remicade IVs every 6 weeks.
    Two weeks ago my doctor told me my blood tests were strange and they thought I might have some liver damage. They told me to stop taking it for 2 weeks so they could take more tests. The past 2 weeks I have been in constant pain and I had to buy a cane to get around.
    I know that it is not habit forming, but for me stopping suddenly has a major effect on my body.

    Reply
  • November 20, 2013 at 10:00 pm
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    Hi Everyone,
    I’ve been on trex since 2007. I have severe RA and have tried all the injectable biologic treatments except Remicade. I’m currently on 0.10 cc of trex injected weekly along with Orencia @ four week intervals. Since September I’ve been able to stop daily prednozone, so far so good. My RA Doc says I’m in clinical remission, and I believe her because I didn’t have a flair after I stopped the prednozone. I started Orencia in 2009 with a 1.75 year gap in treatments because I lost my insurance.

    Thank you Kelly for putting up with my whimp ass posts in the past. Oh by the way I’m going steelhead fishing next week. This’ll be the first time I’ve had a fly rod in my hand since the fall of 2008, it’s been way to long and I’m vary excited about the prospects.

    To All,
    Hang in there, there’s always hope. The Lord Jesus Christ will bless your every need, he can lead to healing if not in body then in spirit.
    -Roger

    Reply
  • November 21, 2013 at 2:25 pm
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    I took Methotrexate along with Prednisone….once I stopped prednisone I had a severe allergic reaction to the Methotrexate. Now I take neither and am on Enbrel.

    Reply
  • January 5, 2014 at 5:01 pm
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    I am taking MTX @7.5mg on Fridays night. On Saturday night, I have back pain and very cloudy urine and is worse on Sunday. On Monday evening, I feel a lot better and by Tuesday the back pain and cloudy urine is gone. Anyone have this problem? Any suggestions?

    Reply
  • January 6, 2014 at 8:51 pm
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    I woke up on the morning of Dec.16th and every joint in my body hurt. I was able to see my PCP and a rheumatologist within 2 weeks. Labs were a mess -RF was way over 600 and the anti CPP was 250, CRP was 20. I was told I had RA. That 1st appt I was put on mthx 7.5 and he gave me a shot 80 mg of prednisone. I also was told to add a medrol dose pak if the pain didn’t go subside. The pain went away in days. Now I took my 2nd dose of mthx and I don’t feel anything. Is this “flare” over. Will it come back? When? What is aggressive form of RA and what is considered aggressive tx? I thought aggressive TX meant starting humira(watch TV!) now I find out I have to take mthx for awhile. Can this be nipped in the bud? I am so scared the pain will return

    Reply
  • January 12, 2014 at 3:41 pm
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    i am nearly seventy i methotrexate and have bad hair loss shall i stop it

    Reply
    • January 12, 2014 at 9:39 pm
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      Talk to your doctor about the hair loss. If it’s from the methotrexate, then a higher dose of folic acid may help. It’s important to talk to your doctor because it could be a result of thyroid levels or something else.

      Reply
  • January 23, 2014 at 11:30 am
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    Yippee — I love my Mtx! Now about 2 months in (I take 15 mg per week, plus 1 mg folic acid per day)I’m really feeling the benefits — which “came good” at about the 6-week point. It’s hard to be sure what effect it has had on pain/swelling, which I still have some of. I don’t think it’s been that dramatic, there. (Most of my aches and pains have been in the mild category). But for me the biggest benefit has been in how I feel in the mornings: for years (without realizing I had RA!)I had been waking up feeling really groggy, having great difficulty getting myself going — one of my earliest, once-out-of-bed thoughts was invariably, “Ummph! I’m exhausted!” But now I wake up feeling refreshed and energized and raring to go! I have tons more energy, which I’m really excited about and enjoying as I am able to get a lot more stuff done! The Mtx has also seen off a maddening, long-standing problem I had with eczema on the back of my neck which had resisted other treatments. I don’t think I have suffered any bad side effects at all — I’m certainly one of the lucky ones there. Just keeping my fingers crossed that things remain this way. I would say to any newly-diagnosed person out there wondering whether to try Mtx: yes, go for it! I hope it works as well for you as it has (so far) for me. But, unfortunately, there’s only one way to find out!

    Reply
  • March 1, 2014 at 7:04 pm
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    Does this lowdose of methotraxate cause body hair loss of cheat hair and leg hair ?

    Reply
  • March 20, 2014 at 7:38 am
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    3-20-14
    Where is Kelly ? Is she ill?
    Just concerned. Hope kelly and her family is ok.

    Reply
  • April 23, 2014 at 7:52 pm
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    i have ra and used to take mtx. i switched doctors whom gave me sulfasalazine for my ra which didnt help at all. im going back to my old ra doctor whom will probably put me on mtx again. i did loose some of my hair while i was on it and i was extremely nauseous. It also made me go to the bathroom alot even though i took folic acid with it. good luck to everyone whom is on it!

    Reply

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    Welcome to RA Warrior!

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    Thanks for visiting this unique site full of information and encouragement to fight Rheumatoid Disease. You'll find hope, humor, and a helpful online community. I'm Kelly & I'll be glad to show you around if you'll click right here.

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