1st Dose of Methotrexate for Rheumatoid Arthritis: 15 Questions | Rheumatoid Arthritis Warrior

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 O'Neill Young

Kelly O'Neill (formerly Kelly Young) has worked over 10 years as an advocate helping patients to be better informed and have a greater voice in their healthcare. She is the author of the best-selling book Rheumatoid Arthritis Unmasked: 10 Dangers of Rheumatoid Disease. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. She is the president of the Rheumatoid Patient Foundation. Through her writing and speaking, she builds a more accurate awareness of rheumatoid disease (RD) aka rheumatoid arthritis (RA) geared toward the public and medical community; creates ways to empower patients to advocate for improved diagnosis and treatment; and brings recognition and visibility to the RA patient journey. In addition to RA Warrior, she writes periodically for newsletters, magazines, and websites. There are over 60,000 connections of her highly interactive Facebook page. You can also connect with Kelly by on Twitter or YouTube, or LinkedIn. She created the hashtag: #rheum. Kelly is a mother of five, longtime home-schooler, NASA enthusiast, and NFL fan. She has lived over thirteen years with unrelenting RD. See also https:/rawarrior.com/kelly-young-press/

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

  • July 4, 2014 at 10:05 pm

    Very informative. Contains more info than 5 other sights.

  • August 25, 2014 at 8:37 pm

    Hi, Kelly, where did you learn that hair loss from MXT is temporary? I’m about to start a very low dose via injection. When I tried the pills a few years ago I felt good results but the hair loss was just too great. I’m hoping that the injection means a lesser dose which means less hair loss. Plus, I’ve just stopped taking plaquenil (retinopathy) and I think I’m seeing thicker hair since I stopped the plaquenil. But your site is the only one that mentions the hair loss is temporary. Thanks

  • December 3, 2014 at 2:16 am

    I start MTX pills, 15mgs total, once a week, Folic Acid daily and Medrol 8 mgs. daily for one week, 16 mgs daily second week, then 24 mgs. daily for two weeks. Then blood work, xrays and follow up with Rheumy. This info was very helpful as I’m apprehensive about MTX. This alleviated a lot of my fear & also confirmed that my dose is in line to RA tx.

  • March 2, 2015 at 1:24 pm

    My Rheumatologist started me on RA when I was 1st diagnosed (2010) I put up with it for about a year and finally couldn’t stand loosing the day after I took it (nausea and SEVERE Fatigue, I’d end up bed ridden for ~24 Hrs) so she switched me to 20Mg of Arava daily and it seems to be doing the trick (in addition to Humira)Have been on this combination for ~ 8 months now and seems to be working.

  • April 15, 2015 at 3:43 am

    Well, had to go off plaqenil because my hair started falling out. Waited 6-8’weeks, and I am cautiously optimistic that it has stopped falling out. Have now been prescribed methotrexate, and from what I’ve been reading, I’ll lose my hair again, feel bad two days out of seven, ruin my liver, never be able to go out in the sun, our family vacations on islands , no cruises to Alaska in the future. So I’m not so sure I want to take this with a wait and see attitude. I don’t really want to put 6-12 weeks in hoping for the best but feeling crappy 2-3 days a week, nauseas diarrheal among other things. I’ve read more bad side effects than good ones.

    I was on paquinil for quite a while, after about 8-12 weeks, it made me feel great, except I was experiencing hairs loss. Methotrexate actually scares me too much. Anything else to take?

  • May 9, 2015 at 9:19 pm

    I started mtx three week’s ago and have some dizzy spells but I had the dizzy spells going through menopause so I am use to them. I take a motion sickness pill that helps. I have seen some improvement but it has only been three week’s. I have suffered with Psoriatic arthritis for many many years, so I am hopeing this work’s for me. I have tried everything else and this is an affordable option for me

  • July 14, 2015 at 2:03 pm

    I’ve taken mtx for twenty years, I’ve been through every RA drug out there, currently taking Cimzia and Mtx for the last couple of years. I experienced severe liver problems with Avera, had to go off all meds for several months. I was in terrible shape by the time I got the Cimzia, it made a real difference. I had to take mtx with it as I was still having ongoing joint damage, but things are pretty stable right now. I know there are unpleasant side effects with with RA drugs, I’ve cursed them through the years, but for me they make the difference between using a cane to get out of bed in the morning and living a fairly normal life! Don’t give up, keep moving, give your meds a fair try before you decide they don’t help, talk to your doctor, if you feel you aren’t getting help find another doctor. If your friends don’t understand show them where to get info, you need people who get what you deal with. Help is out there!!

  • December 1, 2015 at 12:04 pm

    I have not taken mtx and I have RA in my hip even though no one will check properly. I am prone to bronchial infection and dread mtx. Any other suggestions?

  • January 9, 2016 at 5:03 am

    starting methotrexate this week again as humira alone not controlling recent flair as before. so sorry some of you have problems with insurance for these biologics as i know its been a lifeline for me as nothing else worked when i was first diagnosed. i dont have it in my joints as such but affecting tendon sheaths so very painful, but only affecting top half of body.

    on the nhs most of these are paid for so at least i dont have the added trauma of insurance. hang in there everybody and enjoy the good days.

  • January 10, 2016 at 7:50 pm

    I want to offer a very effective treatment for the nasal sores that so many of us get when taking methotrexate. Methotrexate is a chemotherapeutic drug so it “attacks” all the fastest growing cells in our body. That is why we get sores on mucus membranes of the nose and the mouth, can have nausea from the stomach, hair might fall out and the skin is very, very sensitive to the sun, etc. Boroleum is an ointment that has been around forever and very few have heard of it. I tried Neosporin and vaseline and got no help at all. Boroleum applied inside and at the tip of the nose has kept me free of the painful nose sores for years. Try it…available at some drugstores and online. It is perfectly safe and it works. http://www.boroleum.com/ Sold at Amazon: http://www.amazon.com/Boroleum-Ointment-Nasal-Soreness-Ounce/dp/B00QJFV8RY/ref=sr_1_4/191-7715227-9333704?ie=UTF8&qid=1452473122&sr=8-4&keywords=boroleum+nasal+ointment

  • January 10, 2016 at 8:12 pm

    Have had RA for 20 years and this RA Warrior website has been my best resource on Research. Thank you KElly White! I am managing quite well these past few years after going up the ladder of prednisone, plaquenil, methotrexate, Celebrex, Darvocet for pain, and Enbrel injections for 7 years till Kidneys crashed, but recovered. Off all RA meds now but Prednisone 5mg and Tramadol for pain. Embrel really gave me normalcy and mobility back. Recently recovered from breast cancer and then viral pneumonia but Grateful to say I am doing quite well, no deformity, have hair and a desire to help others have HOPE. I AM an RAWarrior too …retired in Florida??

  • January 11, 2016 at 4:39 am

    Trex, prenosone, mobic, and orencia. The cocktail that works for me.

  • January 11, 2016 at 10:38 am

    Thank you so much for writing this. I could have used this in 2012 when I first started methotrexate (mtx). I instead read the government’s black label warnings web page and totally freaked myself out. (The gov site was mostly discussing cancer patient mtx dosing, which is much higher and has much more severe effects than RA level dosing.)

    Thanks for all you do for the RA community! It’s just good to read your posts, knowing that you have RA too and know what we’re all going through.

  • January 29, 2016 at 11:59 pm

    Hi everybody.I was diagnosed with rheumatoid last October.I am on 15mgs of Methotrexate at present and I feel better.One thing that puzzles me though is that I thought you couldn’t take NAIDs with Methotrexate.Is this not true?I notice that several of you are taking them.I used to find Ibuprofen good but I thought I couldn’t take it now

  • July 20, 2016 at 7:19 pm

    Why is methotrexate incresed if it works well. Example why not keep it at 7.5 each week. Also will a small amount such of 5.0 or 7.5 effect you with the sun if you use a sun screen?

  • October 29, 2016 at 8:32 am

    Hi Kelly,
    I was diagnosed with RA several years ago and have been able to put off the Mtx until now. I am a mom of 3 who home schools and teaches part time, my husband is also a teacher. I am most worried about picking up sickness from the children easily, this is why I have tried to avoid immunosuppresants. Is this a legitimate concern? I really appreciated this post, it has calmed down my other fears a bit.
    Thanks so much for all the information

  • December 1, 2016 at 8:16 am

    I’ve been on mtx for around 19 years all told with a gap to have my youngest daughter. I was on the pills for years but the nausea got to the point where I’d just sit looking at them knowing I was going to feel ill, probably a psychosomatic element there.
    I switched to injections a good few years ago now and the are much better. I do still have nausea some weeks, not all funnily enough but my top tips are to do it last thing at night before bed, on a full tummy of food and to eat well and drink plenty the following day. I also take an anti-emetic those two days and folic acid every day but Mondays (jab day). Oh and don’t overthink it. I have it out ready but then I just go do it without thinking about it beforehand.

  • January 21, 2017 at 5:21 am

    I have been on Mtx for 4 weeks now and 2 days ago I felt a pain in my chest while walking at work. I’m on my feet for 4 hrs in the evening so I’m not sure why it only hits me then. Also I noticed that I was extremely tired on the second day when experiencing chest pain and urinated like crazy that evening. I have the weekend to see how this goes. Calling my doctor Monday morning.

  • February 19, 2017 at 12:40 am

    I will be taking my 3rd dose tomorrow. I’m am still feeling the pain and still have the swelling and stiffness in my hands.As of 3 days ago my face feels like I have been in a tanning bed.Is this a side effect?

    • February 19, 2017 at 7:43 am

      I’m not sure Tamara. Not a common side effect. Try to drink plenty of water in case for some reason you are dehydrated.
      Also I had that symtom from my liver, so if this continues call your regular GP and get a liver profile (blood test) done. You probably already have that scheduled because it’s every few weeks with mtx anyway.

  • February 22, 2017 at 10:25 pm


    I’ve been taking 7.5mg of MTX since 1999. I was wondering if there is a maxium dosage for life time.
    I never had biopsy and only have blood work. Do I need biopsy ?

  • August 5, 2017 at 3:14 pm

    I have recently started on methtrexate. I am better on my joints but seem to be having bad side affects. Nausea with throwing up continual diarrhea lots of coughing and mucas fatigue and shortness of breath. I don’t feel like getting anything done. Will these side affects only last awhile or am I doomed to have them

  • October 12, 2017 at 1:23 pm

    I am so thankful for this website and everyone’s comments that I wanted to share my experience. I was really nervous (and angry) about having arthritis and needing methotrexate. All the pamphlets and side effects really worried me. I did not want to be a zombie, I did not want to feel sick. I did not want this drug. But there’s a post on this site about why it’s better to be afraid of the disease than the drug, and it resonated with me and I went ahead with the injections. It’s better to tackle this disease as early as possible. Once the damage is done, it’s done.

    I’m terrified of needles. I felt like a wild animal being tied down with the first one. I was shaking, I was angry. I was mostly grossed out by the idea of having to have a needle every week, and horrified that I’d be expected to do it myself. Well, I’m 8 weeks in and did the first one (all by myself) yesterday. I want to encourage people to try the injection because the side effects can be less than the pills, and the injection can be more effective. Here’s what I did. I had the nurse do the first 3 injections in my arm. That seemed ok because I’ve had vaccinations and blood tests before. I dislike it, but it’s familiar. I didn’t look. I didn’t look at the prep “or tea ceremony” as I call it. I didn’t look at the injection. I just got comfortable with the idea that this was going to happen weekly, but I didn’t need to do it. The mind game is fierce. I had to coach myself that I was in control of this, it wasn’t happening to me. I was in charge, and that damn RA better sit itself down. My secret tip: I listened to Ali interviews and mimicked the tone in my voice. I’m the champ! Once I got over the drama of just getting the injections, then I started to watch. It grossed me out. I cried. I was a wimp, but I kept that Ali voice in my head afterward, always thinking about how tough and brave I was, doing something I never expected to do. One week I had to travel, thankfully with my husband, and he volunteered to learn how to do the injection. He also came with me several times and would talk and distract me from the injection. That helped a lot. I worked myself up to the point where I prepped the syringe for the nurse. Then another visit let her guide my hand to do the actual injection. Then another visit I did it all myself. And now I’m on a roll. I still feel freaked out. I absolutely cannot believe that I’m doing this.

    I can’t thank this site enough for the support and encouragement. I hope my story can help others who are feeling stuck and afraid.

  • February 20, 2018 at 8:32 pm

    I was just diagnosed with ankylosing spondilitis and took my first dose of mtx today. I am on steroids and folic acid too. Just scared about the possible side effects and hair loss. Glad i found this blog. It makes me feel better and less alone

  • August 8, 2018 at 11:06 pm

    Hi! Newly diagnosed. Had a Vectra test of 44. I had been given a steroid shot about 3 weeks before the test. I had been dealing with chronic pain for around 10 years & finally asked my primary for a referral. No swelling in hands or feet but my knees & back kill me. Just took metho 5 pills 2 days ago. She also put me on Cymbalta for nerve pain. I also have MS & she now thinks fibromyalgia as well. i would appreciate any suggestions or advice. I really don’t know what to expect.

    • January 21, 2019 at 11:45 am

      I know from experience that the steroid dose before the Vectra test can affect the results.
      Make sure your MS doctor and your rheumatologist consult about all meds and tests.

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