Log in
23,348 members27,228 posts

MTX 20mg feeling sick

Hi there, I’m 43 and been on MTX since Sept but only just on higher dose of 20mg. Have felt nauseaous all week, not just on Tuesdays. Is this normal or do I have a bug? I’ve been popping pills Lansoprazole and Colofac in the hope it will make me feel better. But keeps coming back. Any advice would be good. Plus my hair, which was fine anyway is a mess!

9 Replies

It can happen when your MTX dose is increased, it did with me but it wore off the longer I took it. There are some measures you can take pro tem. If you're not on max dose folic acid then you could ask if that should be increased. You can go up to 5mg 6 days just not MTX day, this is what I'm prescribed. If that doesn't help & you're currently taking tablets changing over to injections often helps as this way it goes straight into the bloodstream & bypasses the digestive system. Another bonus of injecting is the dose can sometimes be reduced as there's greater bioavailability. You could try conservative methods though, ginger often helps as does a more bland diet whilst you're feeling nauseous. There are also antiemetic meds (anti sickness) your GP may prescribe one for you if all else fails.

Of course this time of year there are all sorts of bugs going around so play it by ear & see if anything develops. I hope you feel better soon whatever the cause.


Thank you for response. Makes me feel like I’m not alone! I’ll try the ginger too!


Are you on the highest dose folic acid? If not definitely mention your nausea & ask if an increase would be appropriate. I'm on 17.5mg MTX subcut, I did try 20mg twice but my liver doesn't like it so I can't go higher, & I take 6 folic acid, each day except Wednesdays, MTX day.

I hope you can get it sorted one way or another & in the meantime ginger helps.


No I'm only folic 3 days. I have asked my rheumy nurse for more but she told me I didn't need it. I might ask her again. Thank you for your reply.

1 like

Ask her how she'd feel being nauseous all week when there may be a simple solution! Kidding of course, but it does tempt to ask her to walk a week in your shoes. All you can do is ask I suppose, or if she won't budge on the folic acid ask if your GP will prescribe an antiemetic. I was nauseous on sulfasalazine & I was prescribed prochlorperazine, there are others, your GP will know the best one for you. Good luck.


Sorry to hear this I was the same on Mex nothing helped me with the nausea. Ask for anti sickness tablets and if it persists ask for the dose to me lowerd.

They took me off Mex and sulphasalasine last November I'm on leflunomide since them 20mg daily. My hair better now so far but have had awful flare this eeek so have to be like this for another month then they will review how I am at that stage. I have urgent rheumy appt Monday so see what they say then. Mex does work though really well to control RA. It was the depression that it caused that made me try a change.

Take care and keep smiling we will get there in the end. Janet

1 like

Thank you for your reply. I’ll persevere for a bit longer and try some anti sickness. Xx

1 like

Hello I’ve been on 20 mg mtx for a year and a half now. I also take 5mg Folic Acid once a week Nausea has slowly gone now since I started. Sometimes it just takes a while for your body to adapt Not sure about your hair haven’t really had a problem there but my fingernails have gone really crappy Hope this helps




I'm on 17.5mg MTX subcutaneously.

nomoreheels offers some really good solutions.

What works for me:

5mg folic acid 6 days a week (not MTX day)

Drinking 3.5 pints of water on MTX day + the day after

Having a good diet

Having my folic acid with my breakfast

And time - my body got use to the MTX and side effects began to die back

Going from MTX tablets to jabs solved my gut issues in terms of not having to go to the loo 3 times a day but did not solve the nausea.

I read some time ago that the nausea feeling is not triggered by the stomach but is triggered in the brain. Can't find the link at the mo.

1 like

You may also like...