I've recently had my Methtrexate dosage increased to 20mg and have since felt fatigued and headaches. Is it likely side effects or the RA?

[Kookymare]

? Side effects

[dawkin_S]

Morning! My experience has been that every time my dose increased, I get increased side effects back again - in my case, exhaustion, sometimes headaches but usually not. However, these then these get better over the course of a few weeks until I'm back to my 'normal' level of side effects. Specifically, I always get a period of a few hours of exhaustion on a Friday about 4/5 hours after I take my methotrexate. When I started taking it, this ran on into Saturday and after each dose increase the same happened, but now it's back to just some few hours on Friday. Hope that's helpful.

[Kookymare in reply to dawkin_S]

Thank you, it gives me hope that things might improve.

[Hidden]

I wasn’t too bad at all for side effects when I started on mtx back in Jan. Unfortunately, it wasn’t doing much at all to help me, either, so they put my dose up from 15 to 20, and I was completely....well, there’s no polite word for what I was. Within 24 hours, I felt heavy, exhausted, massively banging head: the best description I can give was like having the most horrendous hangover. It all followed me into the day after that, too, and I was only just getting to feeling mostly human again when my dose day rolled back around. Similar thing the second week, but not quite as severe, and decreasing severity every week after. It took about a month before I stopped dreading Monday (dose day), and three months on, I’m back to how I was on the lower dose. A bit headachey and tired a day or two after, but that might not just be the mtx so much as a combination of some of the other health issues I have, so...🤷‍♂️

[Kookymare in reply to Hidden]

Thanks for your reply, yes that's exactly how I'm feeling! I'll give it a few weeks to see if it settles down then. They didn't up the folic acid dose, which might help, so if nothing changes I'll give rheumatology nurse a call.

[GinnyE]

Hi. I had my methotrexate dose increased to 20 mgs in January. I do have an “off” day sometimes with a bit of a headache and feeling sickly and tired but it’s not too bad and I just rest; luckily I’m retired so I can. I was flaring quite a bit before the increase and so far the RA has been under control so as long as blood tests say I’m ok I’ll stick with the drug. I guess it depends how often and how severe your headaches are. Hope they settle. (I do take the odd ibuprofen for my headache but that’s my decision of course.)

[francko]

When I was taking pills I would have a period of sluggishness, some nausea and occasional headaches the next day. However, when I moved to injections I had no issues whatsoever. I switched from 20mg pills to 20mg injections (after a short period of ramping up from 15mg to make sure there were no serious issues with the injections). The injections have been so effective for me that I now have no significant RA symptoms and living a completely normal life. I'm just hoping it continues as it took 9 months to get to this place and only recently turned the corner.

[Hidden]

Ok I was on methotrexate injections 20 mg and I too had bad fatigue but as my disease was very active it was put down to this. Started a biologic along side methotrexate almost immediately my joints improved but fatigue stayed. I mentioned this and was told fatigue maybe with me for ever. Then In February I had what was thought to be a chest infection with a consistent dry cough 🤔🤔 ( maybe not an infection) had antibiotics but was off medication for over 4 weeks . Restarted medication thought fatigue was due to restarting. Then lockdown happened. This was the best thing because I had time to think and with my husbands help observe my symptoms. Fatigue doesn’t even begin to explain how I felt . Yes I had headaches aches and pains all over but fatigue meant I could converse or participate in life . Things came to ahead when I slept 36hours solid . I came off methotrexate for 4 weeks and restated on 7.5mg I’m much happier the best I’ve been for 16 months

[Hidden]

I've been very lucky with MTX. I was taking 25 mg for a short time and then 20 mg for 5 months. I did not notice any side-effects. Then, during December and January, my ALT (liver) results climbed very high. I had no symptoms from this, but I was taken off MTX completely for 3 weeks. The ALT went back to normal and I was restarted on 10 mg so as not to challenge my liver too much. I restarted at the beginning of March and my consultant said it would also be good to be on the lower dose because of the pandemic. Good timing! I've felt fine the whole time, both when not taking the MTX and since the restart. My folic acid dose has stayed the same whatever the dose of MTX.

All this shows is that people respond differently to drugs. I've noticed lots of people say that side-effects often settle after a while. I hope this will be your experience. Stick with it if you can as you would not have had the dose increased without good reason.

[emma88]

Hi im on 20mg mxt and now on baricitinib as well but before i got put on the baricitinib i suffered with horrendous fatigue from the mxt i felt like i had run a marathon every day, even days when i did nothing all day i would feel really tired and exhausted its not a nice feeling at all hard to say if i get the headaches as ive always suffered with regular headaches since before i got RA. since going on the baricitinib and having a steroid injection i dont suffer at all really with fatigue anymore some days i still get it but its nothing like when i was just on the mxt i used to get it really bad as the day went on. I think fatigue is one side effect most get in general but all people are different with how bad they suffer i guess

[lily2003]

I’ve been on just MTX since September, starting at 7.5 with 1 mg daily folic acid. Had mild stomach and headache day or two after taking it. Seemed to subside until I went to 12.5 in December.

When I met my new rheumy in February, she not only increased my MTX dose to 15, she also increased my folic acid to daily 2 mg, even though I told her my headache and stomach distress was occasional — hardly much.

Since the 2 mg increase in folic acid, I haven’t had any side effects to notice.

I don’t know if this would be helpful to anyone else, but thought I’d mention it.