Highest dose of MTX

[Nala_Dubh]

Hey everyone- just wonder what the highest dose of MTX is? I’ve been moved up to injectables 25mg but still having pain/issues, massively reduced but noticeable and impeding my day/life.

Thank you x

[springcross]

Hi Nala. How long ago were you increased to 25 mg as it takes a while for the increase to take effect? You could always contact your GP for some painkillers to tide you over until that happens. x

[Nala_Dubh in reply to springcross]

Thank you - I still have morphine when needed and take arcoxia which I think is doing most of the work still. Will be speaking to nurse this week in follow up x

[Hidden]

The good ol’ BNF states 25mg for R.A., with up to 30mg for unresponsive psoriasis under a consultant’s instructions. The max dose pen available from metoject is 30mg, and the clinical guidance from the manufacturers accompanying the brand is that although 30mg can be used, they would discourage going above 25mg outside of exceptional circumstances: medicines.org.uk/emc/produc...

How long have you been taking 25mg/injecting for? I’ve been on 25mg for the last 10 weeks or so (last 2 injecting) having started on 15mg in Jan and initially getting no response at all. Added in leflunomide in April/May whilst working up the mtx dosage, now at a point where I still have niggles but probably 85% better than at diagnosis, and a lot of that improvement has only occurred since the increase to 25mg. I thought it was pretty useless for me prior to that.

[Nala_Dubh in reply to Hidden]

Thank you for that I couldn’t seem to find anything higher than 25mg stated anywhere! On my 6th week but still when I cut out or lower my arcoxia it’s not helping - I find I start feeling all that pain again and they want me to stop arcoxia fully

[Boxerlady]

Are you only on Methotrexate?

I'm on the 25mg injection and was already on Hydroxychloroquine. When things weren't controlled, I asked the rheumy nurse if it was likely to be increased to 30mg but she said that 25mg was usually the highest dose and they might consider trying a biologic. In the end, the consultant decided to add Sulphasalazine and things have really started to improve.

I originally assumed that I'd need to wait until I'd been on each new dose for 12 weeks but they moved me up/added things before that so I felt that it was worth contacting them earlier to update them on the lack of progress.

Obviously it's different for everyone (and everyone's consultant has a different approach) but if you've been on this dose for a while, it might be worth ringing your rheumy nurse to ask if there's something else that can be done.

[Nala_Dubh in reply to Boxerlady]

Thank you that’s good to know!

No I take Hydroxychloroquine too (twice a day) and still on arcoxia so I know it’s not working as the minute I reduce/stop arcoxia I’m really struggling again. I have an appointment/call with nurse this week so will speak to her. Thank you