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.
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.
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
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, 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!