Has anyone found that symptoms of fatigue are reduced when switching to Methotrexate injection?

[Spaniellady]

Morning everyone and Happy New Year! Quick question to the RA hive brain. Has anyone found that symptoms of fatigue are reduced when switching to MTX injection?

I currently take MTX tablets. I can tolerate 10mg MTX without side effects. I'm trying to increase it as 10mg isn't quite enough (I take 200mg Hydroxychloroquine as well). However, I start getting a MTX sore throat and fatigue as soon as I increase. (Previously was on 20mg but ended up in A&E with chest pains, and a whole heap of other side effects which completely floored me). Consultant has suggested trying switching to the injections with a higher dose as I may tolerate them better. I'm prepared to give it a go but sceptical as the symptoms injections appear to improve are nausea and diarrhoea, neither which I have. (MTX gives me constipation!) So wondering if anyone else found that symptoms of fatigue are reduced when switching to MTX injections, and if they are able to tolerate a higher MTX dose subcutaneously? Many thanks, x

[Thingybob]

Yep and yep. I changed to injections, due to nausea etc etc even on a low dose, and have gradually increased the dose to 17.5mg. It takes a while to get to be effective, about 8 to 12 weeks each time the dose is increased. I think the fatigue and fog is less because the higher dose has more impact on the RA. 🤔. All the best x

[Spaniellady in reply to Thingybob]

Thank you for replying. One of the more unpleasant side effects I get from MTX is the fatigue. At 10mg I'm fine, it starts creeping in at 12.5mg. It's such a fine balance isn't it. I need to work, so need enough MTX to control the symptoms but not enough to cause too many side effects. I'll give the injections a go.

[nomoreheels]

Your Rheumy is correct of course, generally we can tolerate a higher dose by injecting. That said I went from 15mg oral to 20mg subcut & it was too much for me, my liver wasn't happy so it was reduced to 17.5mg which it tolerated. More often though we can have a reduction in subcut dose to the previous oral dose due to the administration, less of the MTX is lost.

Whether or not you'll have fatigue is a difficult one to predict, given it's one of the side effects of MTX anyway. Of course if you're better controlled when you've switched then the fatigue may lessen. Unlike Thingybob I notice a difference in dose (< or >) within 2 to 3 weeks, I suppose proving we're each different in how we respond.

I hope you find it's worth the change. I've been injecting nearly 10 years & tried 15, 17.5 & 20mg, recently had a reduction from 20mg to 17.5mg again due to side effects. Generally though I much prefer injecting. Just a thought, as you're only on a daily half dose HCQ is it worth asking if that could be doubled if you don't respond favourably or still have issues to an increase in MTX?

[Spaniellady in reply to nomoreheels]

Thank you for coming back to me. The extreme fatigue is caused by the higher dose of MTX which is why I'm concerned about increasing the dose. I had awful drug toxicity with 20mg MTX, and the nurse recommended moving to something else, but MTX is an amazing drug, so I wanted to see how much I could tolerate. 10mg definitely makes a massive difference, but just isn't enough to keep the RA in check. I think I need to try every option with MTX, which I guess has to include injections before I move on to add sulfasalazine into the mix, which the consultant was suggesting last visit. At the end of the day, I'm not going to know whether the side effects are less subcutaneously unless I try, and having had awful reactions in the past, I'll know to stop way before I get to that state again. She hasn't suggested increasing HCQ, so that's definitely worth discussing further. Thank you for the advice.

[Buckybri]

Hi I’m currently on 20 mgs and have struggled now for 18 weeks so next Friday I’m switching over to the injection, they say my dose can be brought down as by taking it in tablet form you lose a bit of the medicine through the stomach etc . But my problems were not fatigue it was sickness . Can’t wait till my symptoms start to improve I have had enough now .

[Spaniellady in reply to Buckybri]

Good luck! I hope you see an improvement very soon.