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When to take methotrexate

Hello all, I am about to begin methotrexate after my diagnosis has been amended in that my rheumatologist is now not ruling out sero negative RA, when she previously did so.

My question is ...what day do I take methotrexate ? I know I might be nauseated after taking it, and need to feel well on a Friday daytime when I usually go out, so won't take it Thursday. Do the effects begin to wear off before the next dose is due ? Therefore it might not be good to take it Monday if I see friends and family on a Sunday ?

Decisions , decisions!

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I found the injection is much better then tablets I inject on a Friday still knocks me for six but not as bad as it did good luck x

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Once I switched to the injections the only side effect I had was hair loss. The nausea, mouth sores and fatigue went away.

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It pretty much wipes me out for about three days. You may find you're Ok though. The sickness wore off for me after about a month. I'm just left feeling I have been sat on by an elephant!

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I'm into my fourth week of MTX and was sick as a dog on the first week. Absolutely whacked too. The nausea has passed, the fatigue was half a day this week so it can certainly wear off. Unfortunately, I've got a gob full of ulcers and the less said about my guts, the better.

Anyway, have a think about the foods you can usually manage when you feel a bit dicky and make sure you have them in. Peppermint tea is quite good too.

Hope the MTX does the trick for you x

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Hi Anne I had mouthful of ulcers too: advice line said 6 days folic and reduced Mtx dose: helped, just get odd one now. I'd ring yours, RD bad enough without drug side effects making you miserable x

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I have a telephone appointment with the Rheum nurse on Monday so I'll be sure to mention it. Thanks x

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Takes 3 days out of my week; nausea seemed to improve with injections but back again now as wakes me up at night plus headache. I used to take Sunday night but pushed forward to Monday so i get weekend 'off' tho' never feel really normal. Lot of others on here do seem to get used to/tolerate effects so you may be one, good luck.

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I usually take my methotrexate injection on a Thursday night in the hope I sleep away the nausea but I need to take an antiemetic with it and throughout Friday. I don’t work Friday and the weekend to the nausea and fatigue to ease.

I drink good amounts of water to ease the symptoms.

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I have been experimenting over the last couple of weeks. I’ve opted for Monday night. I’ve suffered feelings of nausea but now put this down to taking Mtxt with coffee or tea. No adverse affects with water but did result in a disturbed night. I’ve tried it after breakfast but suffered nausea all day.

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I was one of the lucky ones and didn’t have any side effects from it. As the dose was increased and time went on unfortunately it affected my liver so had to come off of it. I take it you have been prescribed folic acid as well so depends when you are taking that. You might be one of the lucky ones as well. Hope it works for you

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Hi Mrr, don't know whether this will help, but I've been on mtx for years (tablets) and always struggle the day after takin them. A few months ago I decided to try taking them in the morning and I've found that to be much better for me. Less nausea and although I get tired in the afternoon I seem to cope better.

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I count myself really lucky as I've never had any problems with my methotrexate injections which I have every Monday. You may find that you have no adverse reactions too, hope so. It is important to take the folic acid to prevent the mouth ulcers though.

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I’m mtx injections and despite some nausea at first or whenever I increase the dose, I’m fine. I’ve never felt particularly gritty the following day. We’re all different. Good luck

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I have been taking MTX for 7 yrs with Rituxamab. I find it depends on which brand I take,my Pharmacist makes sure I have a brand called Teva, the tablets are smaller, so the makeup is different. I take mine on Sat tea time every week. I take 15 mg. It takes a while to get used to MTX, pain relief out ways side affects. Good luck.

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I was started on 20 mg just over a year ago and remain on that. Best time for me is I put the tablets out when I go to bed and when I wake up at stupid oclock I take them with water. That has really helped with nausia. The day or 2 before I sleep badly and am very tired and achy. I take 5mg folic acid once a week 4 days after mtx. Have not had mouth ulcers. Hope that helps. All the best.

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Not everyone has problems with MTX. People who don't have issues don't post on here. I hope that you will be one of them.

The only issue I have had was mouth sores when I was on the maximum dose of 25mg. Hope for the best but be aware of the problems which may occur.

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Thanks Scottishlad, I'm hopeful I will manage okay, without major side effects.

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I also have mouth ulcers too and also very thirsty with a dry mouth. I drink loads of water all day long. On work days I take a water bottle and fill it up throughout the day.

I have checked my blood sugar in the past and was in normal range. It was a while ago so will check again today.

My partner is a diabetic so will use his meter but will use a different lancet device.

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Oh you poor thing, I'm ulcerated and thirsty too. Passing you a Rinstead pastille...

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Level taken 0945 was 4.1

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I'm on methotrexate injections and take mine on a Friday night. Am ok on the Saturday but on Sunday just want to sleep almost all day. I have a horrible taste in my mouth.. metallic and feel slightly sick for most of the day. So for me only one day is really affected. I started on 20mg injections which have slowly been decreased to 10 mgs as my liver can't cope, as the dose is lowered I'm feeling less sick. Good luck and hope you find a good time to take it for you. Xxx

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I'm on 15 mg tablets, been taking for 8 years, always take them on a Tuesday morning after food, I feel fine for the weekend and even well enough to have a few glasses of wine - I know alcohol not allowed, but so far no side effects showing up in blood tests! I wouldn't recommend taking alcohol to anyone without discussing first with a doctor, my doc fine with it as long as it is just a few drinks.

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I take my methotrexate tablets on a Friday. I tend to spread them out 4 in the morning and 3 in the afternoon. I have never suffered from nausea doing it this way, and my arthritis seems to be at bay most of the time, I suffer from tiredness sometimes. I don't drink alcohol, not even the odd glass.

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Thanks Munchkin, I'm starting on a very low dose as I have had bad side effects to every drug I tried in the past year, but will remember the advice about splitting the dose, if needed. A few months before I became unwell I went off alcohol completely, as a bit of a wine buff, I initially found it a bit disconcerting to say the least, but don't miss it at all now!

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Good to hear you decided to give up alcohol. Like you I was also a bit of a wine buff, but keep clear of it now.

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Be assured not everyone has bad side effects. I have been on mtx for 20 odd years and take on a Mon eve. I do suffer with exhaustion( but that is constant) the mix of 22.5 mtx, Enbrel injections and hydroxychloroquin seem to keep this dreadful disease at bay most of the time. Fingers crossed for you. Wishing you success.

Delainey

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Hi,

I too have taken methotrexate for 20 odd years without too many side effects, a bit of hair thinning, occasional mouth ulcer and occasionally feeling as if I have a hang over. Folic acid 6 days a week, not on methotrexate day, helps with any side effects. Too much alcohol and methotrexate are a no no as it does hit your liver hard. I tend to take mine after my evening meal on a Thursday. In the early days we weren't allowed any alcohol whilst on the drug, now I drink within British guidelines for women but avoid alcohol the day I take methotrexate.

Methotrexate did give me my life back. I hope you aren't one of the few who can't tolerate the drug and it does the same for you.

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Hi

I’ve been on methotrexate since June.I take mine on Friday night When first started I suffered badly with nausea and mouth sores and high liver count.My nurse stopped them till my liver count came down.I was restart at lower dose and folic acid was put up to every day but mtx day.I don’t suffer with mouth sores now.But I do also drink loads of water before and after and cranberry juice and also feel drained for few days after.always follow advice from your nurses.When I first started I was on phone all time I used to say sorry to ring again lol but only they can help. I’m just saying what Happened to me.good luck x

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I take 25mg Methotrexate on Monday afternoons. That way I find any nausea can be pretty well slept off on Monday night although it does run int Tuesdays in varying degrees. I take 5mg Folic Acid on Fridays.

I have been on this regime for over four years now and it works for me. I know that some folks don't tolerate MTX well at all but let's hope it works for you.

All the best.

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I have absolutely no side effects Than God. I take it last thing at night. Hopefully you will have similar results.

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Hi

I take mine on a Wed night. That way I can enjoy life again come the weekend!!

I have moved from tablets to a jab which has improved things gut wise but did not make any difference in terms of being wiped out or nauseated.

What did improve the side effects for me:

1 - some side effects wore off over time, guess that is just the body getting use to the drug

2 - drinking about 4 pints of water on MTX day - stops the 'MTX headache' I use to get the following day

3 - folic acid every day except MTX day

4 - keeping my carbs up on MTX day - even though I inject it helps with the nausea the following day

5 - injecting just before I go to bed, that way I sleep through the worst of it. If your on tablets then I use to have a small bowl of porridge with my tablets for supper and again sleep through the worst of it.

6 - have an 'chillaxing' day the day after MTX day

The above has now meant instead of taking 2 days to recover it now takes me till lunchtime the next day.

Joy

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Joy, thank you really useful

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You are welcome.

It has taken quite a bit of trial and error working out what works for me. And I have to say that the majority of the advice has come from the wonderful folks on this site - what a wonderful bunch they all are!!

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I used to take it on a Monday night. It got me past a lot of the issues because I was asleep. I also did not work though. If you have to go to a job, maybe Friday night would be better... Best luck with however you go..

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I take mine on Thursday night. Watch out for Mouth ulcers and hair loss . Take 2 folic acid the next day, I usually take 2 folic acid for four days then drop to 1. I also take plaquinal everyday so nausea and fatigue are my friend

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Hi Diane

I am interested to hear that you take 2 folic acid tablets the day after MTX day etc. When you say 2 tablets, do you mean 10mg in total? Were you advised to do this by your Rheumatologist?

I take 1 folic acid (5mg) 6 days a week. On the day I do not take it with my breakfast I start to feel the nausea mildly building over the day. So when I wake up after having my MTX before bed I am in the land of super nausea! Just wondered it 2 x 5mg folic acid the day after MTX day would do the trick.

Joy

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If you take it Wednesday you should be fine for Friday I only feel unwell for the day after usually and when it starts wearing off it should be after Sunday

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My only side effect is an occasional headache and increased fatigue the day after taking it. I am usually off work Thursdays, so i take it Wednesday nights.

The therapeutic effects of the medication do not wear off before your next dose so i wouldn’t worry about that.

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Do not take methotrexate, I took it fir 10 weeks, felt LOUSY and then had a life threatening bleed.

I wish you well but methotrexate is a very dangerous drug

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I am sorry this happened to you. However it is very, very rare to have such strong effects. Yes it is a dangerous drug, but even aspirin can also cause dangerous bleeds if you are susceptible.

For me Methotrexate has been a life saver, and I am happy with it as living with uncontrolled RA can be very dangerous too.

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Thanks helixhelix

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Yes after I wrote what I did I realised I was reckless. However it was my experience and I know more people who have had adverse effects from methotrexate than people who have benefited from it. I'm glad it works for you, that's really good. It works for two of my cousins as well. Best wishes 😊

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Awful for you, but rare ?

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Well it's my experience. I know more people adversely affected by methotrexate than who benefit from it. Please do your research and best wishes.

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So rare it's not listed in the Patient Information Leaflet. Please try not to concentrate on how MTX will make you feel, aside from better of course, there's no saying how you'll feel until you start it unfortunately so best to pick a day before a free day to take your dose. I inject on a Wednesday, no other reason than it's the day I started it 8, nearly 9 years, ago & that it suits me. I take folic acid 6 days a week, my UK Rheumy's preference, to save her patients concern over side effects is my guess. I've been on injections 7 years but started like most on tablets. My initial dose was 15mg & my Consultant advised me to take them through the day will meals, so that was 2 tablets with breakfast, lunch & evening meal. I had no side effects, except for a little nausea & some hair thinning both of which resolved themselves after the first few weeks & with an extra folic acid added to my initial 1 x 5mg. Taken in smaller doses rather than your total weekly dose in one go also means it has greater bioavailability, in fact I read recently it's considered to be as effective in retaining the whole dose as by injecting.

Don't forget if you're not prescribed max folic acid (5mg x 6 days) & you do start with side effects ask for an increase in days you take it. Most common ones are usually easily solvable.

I hope it's a good med for you, it is for many, though of course in the main, apart from some of us here, they're don't stay around here, or haven't needed to join! All the very best Marie, hoping you get the results you wish for. x

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I've only been prescribed 5mgs of folic acI'd once a week, nearly everyone else seems to take more. I'll increase if I get any side effects. Once again thanks for the support. I took my first dose yesterday and feel okay today (only 7.5 mgs)

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I was on methotrexate for 10 weeks....then switched to methoject...12 hours later I was in ER vomiting blood...hospitalized for a week blood transfusion s etc...

Try The Roadback foundation or the work of weston a price...look for thefocal point of infection that is causing the Immune system to malfunction.

Leave no stone unturned.

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I am so sorry that this happened Eileen, it must have been very concerning for you. As you'll have read I've been taking MTX nearly 9 years, others here many more. In all the while I've been here I don't recall anyone mentioning your experience so whilst it doesn't take away from your experience it really must have been so rare, or that you were very allergic. What was the explanation at the hospital?

MTX has changed my life for the good. I know how my body is without it after only 3 months, it keeps my RD under control.

I hope you're now doing well.

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I am so glad you are doing well. It is an awful disease and to get it under control Is wonderful.

It was May 2015 I had said life threatening bleed. At the time the hospital said little, they gave me many steroid injections into affected joints and intense physio. For months they said dmards. antiinflammatoies and oral steroids and oral tablets were out as my stomach was so damaged. I was treated with high doses of proton pump inhibitors iv protium to cure same.

Months later when stomach was much better I was offered a biologic roactemra, I.refused as I was terrified. I was really ill on mtx and remember the methoject threw me over the edge.

I researched and found out about the antibiotic approach, look up the road back Foundation. This eventually lead to me removing a botched job of a root canal where a dentist left a file in the root in 2012 and now said Root and Bone above the tooth were all infected. Once this tooth and infected bone were extracted my ra was cured and the hospital changed the diagnosis to reactive arthritis arthritis reacting to an infection. Soon after I developed colon cancer stage 3 in June 2016, I had half my colon removed but refused chemotherapy 4 lymph node positive cancer. I've been doing iv weekly vitamin C and am doung well now!!

I hope you continue to do very well. 😊

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Interesting what you say about your tooth. I suspect my RA is a's a result of a fall which damaged my teeth, and resulted in 14 stitches to my inner mouth. In an effort to save them I underwent root canal treatment to the same tooth 3 times (and other teeth were extensively worked on too). My teetg are still not 'right' . I've been seen at the dental hospital who say the xrays look fine, but the tooth is numb and my bite has changed.

I have asked about having the tooth removed, but have been advised not too. I'm not sure what to do, but as I am on daily steroids I can't have much dental work undertaken anyway.

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I decided myself to remove the tooth after reading the work of weston a price. The dentist told me it would not help my ra and covered up the extent of the infection. It was only when I noticed the missing bone and got a dental expert to review the notes and x-rays, the extent of infection and file in my root was discovered.

I didn't know removing the tooth would cure the RaBut I was willing to give it a try.

My solicitor says it will be the next biggest scandal to break that root canal can cause autoimmune diseases and cancer, currently no mainstream doctors or dentists will recommend removing same.

You've been through so much. If you decide to remove your root canaled tooth, make sure they pack the gum to remove all infection. Thats what I did. I removed the focal point of infection and got better immediately. I was willing to remove it as I learnt it's the only part of your body where you leave a dead peace of your body in place.

The work of the road back foundation and more importantly Weston a price hugely helped me.

I hope I've been of help.

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I only had side effects with oral methotrexate. Felt very nauseous and tired on the day and the following day. So I was changed to injection and now have no side effects apart from a bit of hair thinning. I take it on a Thursday morning. Only thing I don’t do is take folic acid or a strong painkiller (diclofenic) on the same day. Folic acid stops it working so well. I also don’t touch alcohol on the day.

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Thank you to everyone for the replies, a great help.

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I think it is very much on individual. The very first time I took methotrexate, I vomited and had diarrhea for about 3 days. I could not go out but almost the whole day holding a pot to vomit and sitting on the toilet wc only.

Then I had hair thinning and rashes all over my limbs. They were very itches but not painful. I used lotion to reduce the itchiness. I had nausea and my stomach felt very bad and at time I vomited for about a day and I was okay the next morning.

To me, all side effects subsided after about a year. However, nausea, stomach feel bad and vomiting continue. These 2 months, all these symptoms stop too, I hope it continue this way.

I find personally if I eat half full, then I take mtx and continue my food again, then I do not have much symptoms and I feel very much just like taking other kind of medicine. If I finish my meal then I take mtx, I would have nausea, stomach feeling bad and at time vomit. Therefore, I continue to take mtx this way, half full stomach and continue my food after that.

Please do not take mtx with empty stomach, that is my experience. I hope it helps.

Amy

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Monday's probably best as you may have nausea or the runs ,everyone's different but at least you'll have a few days to get over it.I have tried the metoject and it's better than the tablets ,no nausea but very tired for a few days and running to toilet for a few days ,injection is easy ,not sore ,worth a try 😁

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