I have been on both hydroxichloriquin and MTX and both give me such bad indigestion and make me so sick to my stomach that I feel like it's severely affecting my quality of life. I'm hesitant, as is my Rheumy to move onto a biologic. So....what are the opinions on using an MTX injection? Do you think it will get rid of some of the belly issues? I'm assuming it may offer relief from the migraine and severe fatigue that I get after every dose, but I'm hoping to be able to keep some food down more than 3-4 days out of 7.
Thank you in advance. I welcome any opinions, even those telling me to stop whining
Written by
jessquilts
To view profiles and participate in discussions please or .
I found switching to MTX injections much better than the dreaded tablets. The nausea and headache went completely but still have tiredness for a day or two; quite a lot less though. Other issues like thinning hair and sore sinuses continue. It's worth trying I think especially as the bioavailability is also improved. Your body takes up more of the drug because it's not having to go through your digestive system so that the same dose can have more effect.
You poor thing its bloody rotten and even though Im not on Mthx I was briefly and that was very unenjoyable.
From what I have learned here alot of people get on much better with the Mthx injections so that is worth a try.
I certainly don’t get indigestion from injecting Benepali.
Hydroxy which I do take has to be the vilest tasting tablet in the history of tablet taking!
I always take it immediately aftet food and that helps.
I really hope you get relief and find something that helps you without the side effects.
Best wishes
Mx
Hi jessquilts, are you taking folic acid too? I get very nauseous on mtx and now take folic acid 6 days a week (not mtx day) and this has made a big difference. I did try mtx injections but they made me worse, sick and unwell 5 days after but others on here have the injections and taking it that way has eliminated it. Good luck.
Switching from tablets to injections and taking Folic Acid at lest four times a week has made all the difference. Greatly reduced nausea. If I think what I would have been like without the wonderful drug MTX, I am very happy to put up with nausea. I hope yours will lessen a lot once you have switched. All the best.
I suspect hydroxy might be the main culprit for your stomach issues. My indigestion/reflux is much reduced since I (reluctantly) stopped taking it a couple of months ago.
Thank you. The hydroxy upset my stomach and didn't touch the RD pain. So then I was switched to Mtx. It's helped very little and the stomach & headache issues are worse than the hydroxy, but are limited to a few days after taking Mtx, rather than every day like hydroxy.
Once someone starts having stomach issues they can be difficult to stop, at least that's my experience though no doubt there's no shortage of folks who have managed it just fine by stopping a certain med. I had no stomach trouble for the first 12 years of treating my RA, I was on methotrexate tablets for much of that time. Then about 3 years ago I started having problems and subsequently stopped taking meds one by one to see if it helped any. Started with the usual suspects beginning with anti-inflammatories even though I seldom took them. Followed by aspirin and finally hydroxy, which alas, was helping my RA. Each time I cut out a med it did make a difference for a while then things would gradually get worse again. Though I'm still having problems things have remained tolerable since I stopped hydroxy a few months ago. Fingers XXX they don't start getting worse again. I think my stomach has probably been damaged in some way after years of taking meds, and hope it will mend in time now I've stopped stomach irritants.
Apologies for my whining post, and hope things improve for you soon.
I certainly hope that no-one here will think that you are whining about something that is affecting your life so much!
It's certainly worth trying the methotrexate by injection as it will cut down the sickness effect. But I found, for me, it didn't get rid of it enough and a lower dose was insufficient to control the RD. So I changed to another DMARD.
Have a look at the treatments pages on the NRAS site and that will help your to discuss the options when you next see the rheumatology team.
When I hit 15mg MTX by mouth it was the pits! I had all sorts of issues including gut and pounding headaches.
I got rid of my headaches 'tout suite' by upping my water intake on MTX day. I take my MTX on a Wed night and spend from 1pm on wards on Wednesday drinking water. In order to have no headache on the Thu at all I need to drink 4 pints of water on the Wed. And that's it - problem solved. Quite a few folk find this works for them. There is also utube footage that talks about upping your water at it helps to wash out excess amounts of MTX through the kidneys and reduce the side effects - sorry can't find it now. Have postage footage in past.
With regards to gut issues I moved across to jabs. It did not work straightaway. It took a good couple of weeks. I also find that I need to 'chill' till the afternoon on Thu., if not I pay a price till Saturday!
I also had horrid levels of nausea; 5mg folic acid x 6 days a week resolved this.
I had loose stools with HCQ and I found to get rid of this I just took half my dose with breakfast and half with dinner. I was on 400mg at the time. I am now on 200mg so just take one with breakfast.
Other folk have suggested trying a different brand. A few folk have recommended Zentiva. But I found splitting my dose resolved the issue within a few days. I know that works for a no. of folk.
Hope your issues are resolved soon.
MTX has given me my life back. So me it was certainly worth persevering and trying all the tricks till I found what works for me.
Finally I also find unless otherwise stated, having meds half way through a meal reduces side effects.
I wonder about the water intake since Sjorgren's is part of my RD issues as well as Persistent Perceptual Dizziness (PPD), which is related to migranes and I take medication that makes my brain less overstimulated by environmental causes that end up in migranes and vertigo like symptoms. Anyway, back to my point, I think being suseptible to migranes combined with being "extra dry" and taking Mtx might push my system over the edge. I'll have to give upping the water intake. Thank yo ufor the suggestion.
Yes do give it a go. It's an easy one to try. On non MTX days I drink 3 pints of water a day. I have done so for many years. Way before RA came on the scene. I am a food scientist and it's been known for a long time that we do not drink enough water. Our bodies often confuse thirst for hunger.
I have a bit of Sjorgrens too. One dry eye and a wee bit of a dry mouth.
Hiya jessquilts. No they don't because being an injection the MTX goes straight into the blood stream bypassing the oesophagus & stomach. Often it's possible to reduce the dose a little too, 20mg was reduced to 17.5mg for me (though I've had to go back up to 20mg), that may have an effect on the nausea. More or the med is effective because it doesn't go through the digestive system hence the possible reduction of the dose.
If there's room to an increase in folic acid may help too, even if the injections help it's a further consideration though hopefully it won't be necessary.
I wonder about your HCQ though. Two things, if you take a PPI such as omeprazole leave 3 hours before you take your HCQ, both your symptoms may ease. It could also be that the particular brand you're prescribed is causing the indigestion & adding to your nausea. Quinoric is the brand most often reported as having gastro side effects whereas Plaquenil made by Sanofi Aventis, now a generic version (hydroxychloroquine sulphate 200mg), tends not to.
If this is the case I'd ask if your prescription can be changed & I hope it helps ease the indigestion... & you're not whining, it can be misery making having indigestion & nausea so many days a week.
Hi are you on tablets or injections, I was the same as you on tablets but git funded fir injections, the sick & migraines are much better on injections as MTX doesn’t enter the stomach. Hope you feel better soon, it’s a bummer isn’t it.
Hi, the injections have reduced my gastric and bowels a lot, but not removed them totally. I find the injections much better as it is only once a week, rather than taking tablets everyday. Definatley worth trying.
In my case as soon as I switched to injections the nausea stopped. On injection day I have a taste in my mouth but lots of water deals with that and you get used to it. I find that certain foods re-activate the taste, especially green veg like broccoli and also pineapple, so identifying those foods and avoiding them has helped. Bowel problems I have are unfortunately very excessive and anti-social wind! That is due I think to the Hydroxychloroquine and it is on my agenda to experiment with splitting the dose to see if that makes a difference - however it may be best to restrict the effects to hours when I’m at home rather than out and about! Best of luck with this and any hints you have for the ‘f’ word will be welcomed!
Thank you everyone, you've all convinced me. I'm going to contact my Rheumy Doc to see if He will prescribe the injections of MTX, so that perhaps I can avoid some of the side effects. I don't take Hydroxychloriquin any longer. That was years ago. It didn't help and the side effects were similar, but were everyday. At least taking the mtx tablets is once a week, but the side effects are terrible. I do take folic acid 6 days a week, not on mtx day. However, I wonder if the other prescriptions that I take might be a bad combination with mtx.
I take sertraline for Persistent Perceptual Dizziness (PPD) which leaves me with migranes and vertigo-like symptoms, if I don't take the drug. In any case I am prone to migranes and dizziness to begin with, so anything that messes with my head or stomach, or perception of my environment is not a good combination.
I also have a new mtx symptom that I've never had before. I am freezing, like from the inside, when you eat ice cream. This is interesting, since normally, I'm always warm, super warm.
In any case, I feel like I need to try something else. I either need to try injections of Mtx or a biologic, or put up with the consequences of getting off all RD medications. I simply can't live being sick all the time. I have a hard time with the pain, but I'd rather put up with the pain because I can stay busy enough to put it out of my head a bit. Whereas the stomach upset and migranes are so dibilitating that I just can't function. It leaves me unable to do much at all and that leaves me focusing on how terrible I feel.
Thank you to everyone. You've all been very supportive.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Each time I cut out a med it did make a difference for a while then things would gradually get worse again. Though I'm still having problems things have remained tolerable since I stopped hydroxy a few months ago. Fingers XXX they don't start getting worse again. I think my stomach has probably been damaged in some way after years of taking meds, and hope it will mend in time now I've stopped stomach irritants.
Are injections or tablets most effective?
Methotrexate; Tablets or Injections?
Switching from Methotrexate tablets to injections 
