Questions about Drug Effects

[Windonmyface]

Hi Everyone,

I’m sorry to bring up an issue so often discussed on this forum, but it would help me greatly just to be able to discuss this with someone. I’m talking about stomach upset caused by methotrexate.

Does it really help to inject rather than take the pills? My stomach pain doesn’t even really start until the day AFTER I take my pills (8 of 2.5) so I’m wondering if injecting is really going to make things better.? My stomach roils off and on for a good two days after my day of dosing.

My rheumy spoke of switching me to Leflunomide, saying her patients don’t report stomach problems with it as much as with MXT. Has anyone found this to be true? I’m leery of going on it due to what I’ve read about it raising blood pressure and cholesterol (I already have high cholesterol).

Are biologics easier on the stomach?

By the way, I was diagnosed with RA in January, started on prednisone, then tapered off while starting and staying on hydroxychloroquine and slowly increasing MTX dose.

Any insight about any of this would be appreciated.

Thank you!

P.S. I must say, my episodes of stomach pain are quite alarming, but at the same time I’m learning to ride them out (belching helps). Also, I’ve felt on the verge of overwhelming panic that seems quite drug-induced (not just regular fear/anxiety). Does anyone else have moments like this on methotrexate? Again, I train myself to sit or lie still and wait for them to pass.

[Marionfromhappydays]

Just my experience and its different for everyone, my rhemy nurses switched me over to MTX injections after only 1 dose on the tablets and that was due to side effects on my gut.

I do have a very sensitive gut so it wasn't surprising, unfortunately I had 5 days of nausea and severe fatigue. I was really anxious about taking the MTX injection but I've just taken my 2nd week last night and so far (touch wood) no side effects. The difference for me between injection and tablets has been like night and day.

Because everyone is so different I guess we have to try these drugs and just see how they affect us, alot of people take the tablets.

I am glad I switched to injections as MTX works for alot of people so it's great to give it a good bash 😀

Take care x

[Windonmyface in reply to Marionfromhappydays]

Thanks, M. It helps to know others have experienced multiple days of pain with the pills. I’m so glad to hear the injections are aren’t causing side effects for you!

[janmary]

I found stomach problems were much better on M/X by injection - the drug builds up a level in the body so that although it’s only taken once a week the effects aren’t limited to the days its taken.

I can relate to feelings of panic related to hydroxych. - I had to stop taking it and have never had anxiety like that ( without reasonable cause!) before or since.

[Windonmyface in reply to janmary]

Your insight that “the drug builds up” is very helpful. Multiple days of pain have been so baffling to me. I never thought about the panic being related to hydroxychloroquine!

[Summerrain14]

Hi Windonmyface, I have been experiencing the same for a couple of months now of starting MTX. I spoke with my rheumy team this week and we have decided to give the injections a go to hopefully get rid of these side effects. It will take a few weeks to set up my injections and training so I am carrying on with the tablets of MTX until the week of starting of my injections. I’ve given it a good couple of months of settle but do need to change to the injections now I think. My blood tests will go back to every two weeks for six weeks once I start the injections as we get more of the MTX with the injection as it goes straight into our blood stream I have been told by my team.

Good luck with whichever you decide. x

[Windonmyface in reply to Summerrain14]

I hope fervently that the injections work better for you. Thanks for your input.

[Hidden]

I was on MTX tablets for 2 1/2 years nausea now and then but did have bloating and the belching it effected my reflux. I’ve been on MTX injections 16 months and all the above have disappeared. The injections by bass the digestive system so are less likely to give you stomach issues and as the digestive can destroy the effectiveness of the tablets you get the full benefit of the dose from injections and often have a lower dose. Do try you never know it might work and if it doesn’t there are other options.

I’m on a biologic ( entanercept) it’s not working so am due to try another. It’s do individual what works for one doesn’t for another that’s the hard part finding the right drug or combination and unfortunately it takes time and we all react differently . Patience is what we learn with RA ... well I try 😁

[Windonmyface in reply to Hidden]

Isn’t it weird how everyone reacts differently to these drugs? I had bad reflux for years before taking HDX and MTX, and it’s so much worse now. It’s so good to hear that the injections have eliminated your digestive issues.

[helixhelix]

Belching is quite symptomatic of stomach acid....do you take a stomach protector like omeprazole?

Every now and then I have a black MTX night. The first time it happened it scared me, as it was like a wave of deep dark depressive thoughts - to a suicidal level which is really not me. Now I’ve learnt to ride it out by telling myself it’s the drug, it’s the drug... It usually only last a few hours.

If you are in the UK you are unlikely to be offered biologics yet, you have to have tried and failed on 2 DMARDs and have a pretty high disease activity level. So don’t think about them but concentrate on the here and now.

[Windonmyface in reply to helixhelix]

Yes I take omeprazole, and often feel like taking a second one each day now! Thank you for sharing about your own “black MTX nights.” I agree the only way to cope is to ride them out—and pop a half Xanax if possible!

[Hidden in reply to Windonmyface]

I had reflux pre RA and it had got worse while on MTX tablets I was taking omeprazole and had to increase my dose I was up to 3-4 a day. Changed too lansprazole this suits me better

[Windonmyface in reply to Hidden]

I didn’t know you could take that many omeprazoles in a day, but I’ll take that as permission to pop a second one at least (yes, I’ll pass it by my doctor). I haven’t heard of lansprazole—thanks for the heads up.

[medway-lady in reply to Windonmyface]

Make sure you don't just throw back the Omeprazole and get the blood tests done, it gave me kidney failure back in Oct 2018. Its widely prescribed but like a lot of drugs does have risks so please, please talk to your GP or RA team before taking more.

[Windonmyface in reply to medway-lady]

Good to know. Thank you.

[Hidden in reply to Windonmyface]

My gp approved it but it wasn’t working. I only take one tablet now

[AgedCrone in reply to Windonmyface]

Please don’t take more Omeprazole than you have been prescribed...it can be dangerous....speak to your rheumy nurse or your pharmacist.They are not Smarties

[Windonmyface in reply to AgedCrone]

Absolutely

[Barrister]

Just an aside - I have colitis and my rheumatologist said that Leflunamide was out of the question because it is known to cause stomach issues so I would query this with your rheumatologist who seems to think that it is less of an issue than MTX. Just to be on the safe side. I changed from MTX tablets to injections with no problems.

Clemmie

[Windonmyface in reply to Barrister]

Good to know, Barrister! Thanks.

[Thingybob]

I changed to mtx by injection quite rapidly and certainly found I have fewer side effects. And those i did get decreased gradually over time. I have recently increased my mtx dose and the side effects are worse again....nausea and fatigue the day or so after and out of character waves of doom and gloom / panic especially at night ( pack of black dogs churchill called his). But I am hoping this subsides over time again.

Also you will find lots of good advice on here re eating carbs and hydration on mtx which helps. Good luck 🙂

[Windonmyface in reply to Thingybob]

Sorry the side effects have come back with your increased dose! I’ll remember that if I do go to the injections. “Pack of black dogs” is a perfect description. Ugh.

[Windonmyface]

Thanks everyone for the helpful comments. I’m definitely going to discuss going the injection route with my rheumy. I feel much less alone on this journey now. BTW, I live in the U.S. near Atlanta.

[Hidden in reply to Windonmyface]

We won’t hold it against you 😜😁 nice to chat to others from different countries and be there for each other