Mtx injection vs tablets

I'm due to start mtx next week, In a last ditch attempt to get my steroid dose down before it comes to biologicals. I have been given the option to go straight for the injections rather than trying the tablets first, due to worries about GI intolerance.

Has anyone had both? Are the side effects different with the injections? And how easy is it to inject yourself?

Thanks in advance

29 Replies

  • I use injections,it's like a Eipen very easy to use. I had some nauseous for a couple of weeks . I feel so much better since I started injections.

  • Hi fg27,

    I was on the tablets for about 7 months, but the effects caused stomach problems and was feeling sick for three days after taking them. I am now on the Injections. I was worried about self injection because I hate needles and hate having my bloods taken ( have palpatations and go dizzy) but I have found once I did the first one it wasnt to bad, which shocked me. I will say that the worst thing was you get a little medical wipe, to wipe the area before injecting .. make sure your skin dries before injecting .. gosh it stung after lol .. But now I know its not so bad.

    Keep a tissue handy as sometimes after the injection it can bleed just a little. I do mine before I go to bed weekly on the same day. I found doing it at night (after showering) the effects are way less .. After the first or second injection you get used to it .. Ive now been on Metoject for about 6-7 months now .. it has been working but sadly for me my Flares have turned up and now have to take steriods too ( but only when I feel my flare start)

    For me, the methotrexate stopped my hair loss and inflammation for a while and damped down my rashes and lesions .. But now it seems Im having flares again every 5-6 weeks and takes a while to damp down .. just hope the steroids nip the flares in the bud ... Hope that helps :) But remember we are all different and any med can effect us differently as with our Immune System .. Xxx

  • Thank you. Hope you mange to get the flares under control. Xxx

  • Thank you Fg27 :) Im in the middle of a flare so I await for this one to go and another to start before I see if the "nip in the bud" steroid use will work .. Its all trial and error .. Xxx Hope all goes well with you too xxx

  • Hello FG,

    Yes, I have had both and have a tendency towards GI issues, even having internal bleeding at one point.

    I was started on the Mtx pill form many years ago and was unable to tolerate them for more than 5 days. A horrible experience for me. They were discontinued and I have been on a biologic of one sort or another. This is working very well but due to my anti phospholipid now not being controlled they wanted to add in Mtx instead of changing to another biologic.

    The first week of the injectable Mtx was a mile version of the pill form and I was worried. Nausea and stomach upset, but once I started on a balance to counter it, I would never know I have added it in. It is great, and a very effective drug that is now available to me with no side effects.

    One thing for sure to ask for if you go this route, make sure your injection is subcutaneous, meaning the ultra fine needle and extremely short. It is what diabetics use and you don't even feel it. I pop mine in my stomach just below the belly button on one side or the other and feel nothing.

    If you do go this route, message me and I will give you details on how I have avoided the side effects of the nausea and potential hair loss. I'm in love with my doctor, he made sure to take the time to get this right.

    Good luck and I hope this drug works as well for you as it does for me


  • Thank you Susan, I'm glad I. Is working for you. X

  • Susan, I was reading your post and would like to know how you avoid side effects if you don't mind sharing. I'm kinda new here and I'm still figuring out how to navigate around. Thanks in advance for your help.


  • Hello Loopy,

    Absolutely, I was determined to give this drug a good try after going through so many, and a long discussion with my Rheum. He was committed to helping with the side effects and my system is working for me.

    Having said that, you may have to adjust this to your needs.

    I take each day:

    2- MTX Support Suppliments by Theralogix- am

    (Except on day if injection)

    2-Acid Controllers, generic- am/pm

    (Famolidine 20 mg each)

    24 hours after my injection, in the pm, I take

    1-Leucovorin Calcium 25mg (prescription)

    Used for chemo nausea but naturally replacing what chemo strips from body

    As you can see, what is happening is that I am having replaced what is being stripped from the body by the chemo, that in fact is what causes the nausea. I do have breakthroughs and I find it has a lot to do with what I eat.

    So for these times I have on hand and invaluable prescription:

    Zofran or generic Ondansetron Hcl 4 mg

    I take these just a half at a time to get through any difficult bits, mostly as I also get IV rituxan

    And btw, in the beginning, I was on a higher amount of the zofran to go to bed at night, and the antacids during the day and then backed off as I adjusted to the MTX. It took me about 3-4 weeks. I am on 60 mg injections so you may have to adjust accordingly.

    Oh, and I take my MTX injection as late at night as possible and then go right to sleep, that way I sleep through any side effects. I am not above doing injection, taking 1/2 Zofran and rolling over to sleep. Otherwise I never take anything to sleep, this is for nausea.

    I do hope this helps and I wish you all the luck, this is a good drug so I believe worth the effort. Don't hesitate to ask any questions or if I need to clearify something.


  • Thank you Susan you are so kind!!!


  • You are most welcome. Now you see why I was not going to write it all up unless someone really wanted the info. Ha

    Good luck to you!

  • Yes I definitely do see!!❤

  • Sorry but just had a rant about methatrexate I've only had tabs they have not upset my tum but if I get a cold I get man flu had a uti last yr was in hospital for a wk with sepsis so I'm thinking of coming off methatrexate

  • Gosh sounds awful! Thanks for your reply x

  • Aaaaggghhhh typed a big reply but it didn't post. I'll reply again more full tomorrow when I've done my first solo injection as just had the one under nurse supervision last week 😊

  • Thanks. Hope it goes well. 😊

  • Sorry about rant I know people on it with no side effects I just think it really dose not suit me

  • Right back to what I tried to put last night! (It was a long day lol)

    I was on the tablets at a really low level for 5 weeks and first couple I felt good on it but as it built up slowly my stomach just got worse and worse until I couldn't live with it any more - I literally couldn't leave the house and everything I ate made me want to be sick even with upping the folic acid to 6 days a week. I switched down to a half dose for a week or so and then had a week without it and switched to injections last week.

    First one was done under supervision of the rheumy nurse to teach me the routine and here it is actually needles not an epipen. The hardest part of it was mentally getting myself to do the first one ... she gave me a countdown 3 times before I finally had the guts to do it lol. But I really don't know what I was worried about as it wasn't anywhere near as bad as my head was thinking - the med itself stings quite a bit but the injection was a breeze. And I HATE needles. My first solo one is tonight so I might think differently after that but hopefully it'll go as smoothly. I did feel much better on the injection though - first 3 days my hideous heartburn disappeared and I felt like I'd had a steroid injection as had a big boost from it. 4 days later all of that's back but I'm hoping as it builds up it'll kick those symptoms out altogether. I'm also prepared for the fact I might get worse before I get better too though.

    I'm hoping to persuade my gp to switch me to metaject which is the epipen though as my hands did struggle with screwing the needle on and stuff and my hospital has really bright lighting that makes me flare so having to pick my prescription up from there will be an issue too. The hospital have warned me that they cost over £3,500 a year though compared to about £1,200 for the injections so it might be a bit of a battle.

    Personally from my experience we know I have stomach problems with tablets so I wish they'd put me straight on to injections to avoid that but not everyone is the same so good luck with making the decision and hope it works well for you.

  • Thank you, this is really helpful ive had a lot of stomach problems with quite a few medications, complete intolerance to Azathioprine, regular sickness on a higher dose of hydroxychloroquine and heartburn and occasional vomiting with mycophenalate so my stomach is obviously sensitive.

    My worry was really physically being able to inject myself. Hopefully after the first few it will become a lot easier.

  • I just did my first solo and no problems with it and trust me I HATE needles. I'll admit I was a bit nervous of it in case I got any of the steps wrong and trying to find space to do it in my bathroom wasn't ideal so I think I'll find somewhere more suitable next week. I'm now shaking though so I don't know if that's adrenaline or because I've not had any lunch today as work got too hectic so it may be my blood sugars being too low. Other half is about to go and get a takeaway for us which will fix that one and save me cooking at least 😊

    Oh and I had to stop both azathioprine and plaquenil because of my stomach so the injections for me I can get past rather than have to go through that again. The heartburn I think is lupus flaring for me but some of the other meds I take don't help with that. It's really bad again today so I'm hoping the injection will stop it for a bit like it did last week but we'll see. I haven't gone as hot as I did straight away last time so I think some of my reactions then may have been an adrenaline rush from it being my first one but we'll see.

    I know everyone is different and it doesn't guarantee you'll be ok with the injections but I honestly haven't found it anywhere near as bad as I thought I would but I did also have in my head that I really want this treatment to work so I was mentally prepared to get past the fear of it if I could. If you can't get past it though then maybe seeing if you can have the metaject would be an option as that way you don't have to see the actual needle when you do it :)

  • Oh that's not good, get some food down you! Probably a combination of both.

    I think I've pretty much decided on the injection now, don't see the point in going through being unwell with the tablets if I don't have to. X

  • Oooo not sure what happened there .. it posted while I was still typing lol

  • Heartburn stopped again last night about an hour after the injection which was wonderful - unfortunately I just took my folic acid and within half an hour it's back again really badly. Interesting that it stops with injection both times though - could be the folic acid causing it maybe? My other biggest thing is that with the injections I can't sleep that night and when I do I wake up sweating buckets and really hot bit like a fever rather than just warm. That's been both times too. The nurse last week did say the heat thing is actually a sign it's working on my nervous system though so that was good to know.

  • I know this might seem a silly question but do you take lanzoprazole before taking tablets? I get really bad heart burn from mycophenalate but if I take the lanzoprazole at the right time I don't get it xx

  • I used to take omeprazole which was wonderful but out of nowhere my eyes started swelling when I took it and they were really itchy too. I was switched to both lanzoprazole and the other one, is it Zantac? Can't remember the name. Anyway the reaction was the same on each but we can't find what the common ingredient is that causes it. We tested it in isolation to check and it's definitely those so I can't get any relief from anything unfortunately

  • Oh bloody hell! Thats so annoying isn't it! I feel for you, heartburn is horrid! Xx

  • Hi Fg27,

    I was just wondering how you've been getting on with the injections? It's just that I switch from tablets to injections in a few days as I had terrible GI intolerance to methotrexate tablets. I also had intolerance to azathioprine due to GI upset. The only one that didn't effect me badly way Mycrophenalate but it did nothing for my lupus.

    I hope it's been going OK?

  • Hi, I had similar experiences with both Aza and mycophenalate. They have prescribed me the injections, but I haven't actually started them yet. Apparently it can take up to 2 weeks for the pens to be delivered and a nurse to come and show me how to use them. It's been a week now so hoping it will be soon. Although I've unfortunately picked up an infection now, so won't be able to start until antibiotics are finished.

    Have you used an injection yet,?

  • Sorry to hear about your infection, that's such a pity as it will delay things for you.

    I've been lucky in that my Specialist Nurse got me into clinic pretty quickly, actually within 10 days and taught me how to use the pens. I start them on Monday. I had the MOST horrific nausea on the tablets and I tried them for three weeks before I caved. I ate nothing but jelly in that time and lost rather a lot of weight so I'm just hoping that the injections will have less side effects.

  • Oh dear. I think a lot of people suffer with the tablets, luckily I haven't had to try them and I can just go straight onto the injections.

    I hope the injection is better for you

    Good luck 😊

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