How I minimized the uncomfortable feeling after takin... - NRAS


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How I minimized the uncomfortable feeling after taking methotrexate - 31/01/2020


Recently a few RA patients messaged me to complain that they have gastric problem and felt very bad after taking methotrexate and would like to have some advice on how to minimize these problems.

I met a very good pharmacist in the early day and she told me not to allow methotrexate to come into contact with my skin to avoid any irritation. I used to vomit badly with methotrexate and felt very ill with it. I started to change the way I took methotrexate hoping to reduce all these problems. To minimize the contact of methotrexate with the lining of my stomach wall, I decided to eat half way, then took methotrexate and follow by the balance of the food.

I would like to say that it really helped in my case.

34 Replies

Have to say nothing worked for me but since I switched to injections it’s so much better. I still get a bit of nausea but take medication after evening meal and then it settles as I sleep.

Amy_Lee in reply to hotpot30

Good that you have a way to settle your problem down. Unfortunately, over here injection can only be done by the hospital as it is a control item. My rheumy could allow me the injection, I mean long ago when I had all the side effects, only if I could go to the hospital which is very far away from home to get it done weekly.

Hello Amy_Lee. I find it very refreshing to listen to your reflections on your body reacts to different meds and have a possibility discuss them with your docs and they really seem to listen👍There are an abundance of info on Mtx and its effect on gut, depending on the patients individual situation.As I remember you did have a problem with your liver results and needed to adjust Mtx before? I have often read on the forum that pas with problems with Mtx also have more gut problems as well as mouth ulcers as well as problems with Benepali.the biosimilar with Enbrel Just my reflexion. Do take care and let me hear more from you👍😊Simbaxx

Amy_Lee in reply to Agoodlife

Hi, Agoodlife. Yes, I did have a lot of side effects including liver problem. All the side effects have since gone after mtx has been reduced to 7.5 mg per week.

Since a few RA patients messaged me personally, I therefore decided to share my own experience hoping it would be helpful.

When I first starting taking MTX tablets my nurse told me to take them standing up! And not lie down for at least an hour - I was allowed to sit down tho’. No idea if it made a difference or not!

The osteoporosis tablets have to be taken when sitting upright. No idea why though.

Many tabs should be taken in an upright position if they are taken at night or evening to avoid stomach irritation as an example.

Amy_Lee in reply to Agoodlife

Agoodlife, unfortunately this has not been told to most of us. Thank you for the great information!

Mmrr in reply to medway-lady

They can cause damage to lung tissue, hence taking them upright. If you are lying down and regurgitate, there us more chance of a small leakage into the lungs.

Amy_Lee in reply to Mmrr

Dear Mmrr, this is a new information also to me. Thank you so much.

Hidden in reply to medway-lady

Osteoporosis tablets should be taken first thing in the morning, before you have anything to eat or drink and before you take any other medicines. Stay sitting or standing for 30 minutes so the medicine doesn't irritate your food pipe (oesophagus).

medway-lady in reply to Hidden

Cheers and I always take tablets sitting up, its just the sitting up for 30 minutes afterwards, puzzled me. In any event I had the DEXA and bones are fine as the alondronic acid I think it was called is not licensed for kidney patients. My Nephrologist wrote to RA consultant a very definite letter as that sentence was in capitol letters just shows how taking the pesky list of medications does come in handy as a safety measure and my GP spotted it too and rang me to say would not carry out prescription instructions from RA.

Amy_Lee in reply to helixhelix

This really open my eyes. Many RA patients take mtx just before going to sleep!! I think to take mtx standing upright for at least an hour may help in this case to avoid the contact with the wall of our stomach!!

You really had a good idea😊And it really worked😲

Amy_Lee in reply to Agoodlife

I am glad it works for you also. The important thing is to avoid contact with our tissue.

I wish it had fewer side effects for me because it certainly helped my joints.

I could cope with the nausea. It was the brain fog that lasted for up to 3 days and that led to depression that caused my biggest problems. I tried it twice both times for more than six months but depression kicked in after about 4-5 months of losing 2-3 days of life each week. I didn't try the injections because it wasn't the nausea that was a problem, though it wasn't pleasant, I coped with the aid of ginger and peppermint teas.

If you can tolerate Mtx, it is excellent because it is effective against RA.

Amy_Lee in reply to Brushwork

Dear Brushwork,

When I complaint to my rheumy, she told me to same "just tolerate with the side effects and I will monitor your liver". I did and finally after a few years, the vomiting and nausea effects were gone after the dosage has been reduced to 7.5 mg.

That's exactly what I would do when I used to take it! I'd also drink a full 1.5 liter of water as well. I never experienced stomach upset, but I did get weird headaches, localized sharp pains in my scalp, and weird sinus pain. I was only on it a few months, and started low 12.5mg. Maybe that's why

Amy_Lee in reply to Jesnaskah

Hi, Hesnaskah,

The side effects you mentioned are new to me. Great that it has been over for you now.

I drink loads of water for couple of hours before I take mine. I have just a light tea salad or sandwich, then take my mtx then continue drinking diluted juice or water till go to bed. I used to drink coffee but worked out it was drinking that was causing me to fill sick and be sick. I also don’t get bad stomach now. I used to drink loads of coffee. Now only drink it until about 11. Still got side affects which are bearable.

Amy_Lee in reply to Nuttyshirlz

When I had the uneasy feeling in my stomach, I took a lot of chocolate to get over the feeling. We are all so difference in handling our problems. Hahaha..

I took methotrexate for many years.Whatever I did I still felt very sick after taking it.i reported this to all healthcare professionals at every opportunity.i was told to carry on regardless.finally,I took myself of it.i was very ill.i had a medical emergency and needed an op.i had a necrotic gall bladder and sepsis.i live to tell the tale.listen to your body.I know of two others on mtx that had gall bladder emergency ops.more research is needed.thank you.

Dear Latebird,

I am so sorry to know about your case. Mtx did put me back into my normal self though. I have been in remission after about 1 1/2 years of treatment and I have been living a very normal life since. I would not advise to off mtx on our own unless instructed by our rheumy.

Yeah I was on MTX from 2004 - 2017 when they had to stop the treatment. I tried what you have suggested amongst other things but my body really couldn't tolerate it, pills or injections. Just suffered with nausea and vomiting. Got so bad couldn't keep water down. Sent to gastro by my Rheumy, they found internal bleeding, ulcer and hernia so they took me off it and switched it to Leflunomide which has been pretty good.

Amy_Lee in reply to Paisley58

Dear Paisley,

Very sorry to know your situation. Could it be due to the way you took mtx causing the internal bleeding, ulcer and hernia? I was told by one of the pharmacist to avoid mtx in contact with our skin as it will irritate our tissue. I guess I am lucky to be told.

The effect of Mtx which is a cytotoxic med is not tolerated by everyone. Why this is so is yet not known.

Amy_Lee in reply to Agoodlife

There is a lot to learn to protect all of us.

Hi Amy_Lee I have taken MTX for many years and find some brands make me very lethargic.Ihave asked why and told the makeup of drugs is not always the same. My pharmacist makes sure I have the one that suits me. I always take it at teatime Saturday.

Amy_Lee in reply to Backy

Dear Backy,

It is a prescribed drug here hence we take what is available from the hospital. However, thank you so much of the information, I think I will check with our rheumy to see if the hospital has other brand to suit the patients. So far I have not seen any other brand yet over here.

May I know what brand you have to suit you please? We cannot get it from any pharmacy though.

Backy in reply to Amy_Lee

Hi I don't know who manufactures it but the brands I use are Teva & Mercury. We are not all the same so it may not be helpful.

I think I'm quite fortunate as I take quite a few tablets and get hardly any side effects. I've been on methotrexate for 15 months, it just makes me feel incredibly tired the next day. I take it on Sunday night's just before I go to bed. Sometimes I get up on Mondays and I feel really energetic but by the afternoon, I get a massive wave of fatigue and nausea. That probably happens once every 3 months. I had the same brand for the 15 months.

Amy_Lee in reply to Dolly260

Dear Dolly,

I guess all of us respond differently. I was not well immediately after I took mtx. I am lucky that the next day I normally okay. Your response to mtx is quite different and this is the first time I come to know this.

Agoodlife in reply to Amy_Lee

There are Many on this forum that have not been able to take Mtx because they have had too hard too hard a time with it.

Amy_Lee in reply to Agoodlife

Yes,I know that. I had a lot of side effects too but mostly stopped after above more than a year. Except the vomiting and uneasy stomach feeling, it lasted until the dosage reduced to 7.5 mg a week.

I did complain to my rheumy but she said that unless it is the process norm of liver, the rest I had to tolerate as Mtx is the key drug to suppress the immune system of RA patient. Moreover, we can’t go for injection on our own too hence I continue with Mtx though I had problem with it.

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