Hello! I’m 5 weeks into taking 20mg Methotrexate by injection.
I’ve been fine up to now but a few days ago nausea kicked in and it’s bloody awful.
I’m taking folic acid for 6 days and I have some anti-nausea pills that aren’t touching it.
Does this sound normal? I took the pills last year and had nausea right away, but I think I thought there was no nausea with the injections.
If it’s normal, does it usually take 4 weeks to start?
Thanks
I was pretty ok on the pills in terms of side effects, more or less, but had problems with nausea on the jabs within a few weeks of switching (went to jabs for 25mg), and the side effects kept getting worse the longer I was on them. After 4 months, it got to the point where I was absolutely dreading jab day every week, and the nausea was lasting for 4 or 5 days on top of headaches and feeling completely wiped out. The upside for me was that mtx wasn’t doing anything anyway, and never had done in the 13 months I’d been taking it, so the decision to switch it for something else (alongside the other DMARD I was also taking) wasn’t a hard one for me or for rheum. That’s probably not that helpful for you, though, other than to say yes, there are other people out there with similar experiences of subcut mtx.
All I can say is the longer I was on metho at 20mg the grottier I felt. Switching to injection didn’t change that! I was ok ish on lower doses. At no point did it help my RA. Not my drug….
I was horrendous with nausea and MTX - worth talking to your RA team and seeing if they can come up with a plan. I had to come off it as I then was losing days with side effects. It is a steep learning curve at the start. Some take the meds and do well straight away, some stick it out and eventually turn a corner and others have to come off meds and keep trying others to find their one. Took me 28months and a lot of up and downs but now on a JAK.Good luck
Love my JAK.
These are tablets, right? Is it much more convenient than injections? Is it as effective? Are there worrying side effects?
Mine is a tablet. Some are infusions. No side effects whatsoever on a day to day basis. Anything worrying would be picked up by rheumy/blood test. My drug is only available by tablet. The idea of metho by injection is to reduce nausea effects. I didn’t suffer with nausea in metho but I generally felt unwell however it was administered.
Hi fangrock. I was started on MTX 15 mg (subcut because of my stomach sensitivities) 2½ years ago with the Folic Acid six days a week but I had nausea from the start, the rheumatologist said the FA should be taking care of the nausea but it wasn't. It did ease for several months but never really went away. I was increased to 20 mg after about six months but had to reduce back down because of hair loss. The nausea increased about a year ago now and steadily got much worse, so much so that I began to feel quite ill. Assuming that it's the MTX, I have been told to stop, which I did a month ago and I am now waiting to see what happens next.
Gosh you are more patient than me! Good luck with next drug springcross. X
Thanks Mml but I am dreading it. I have been glad for the break to be honest but I know I will soon be suffering for it!
You might be lucky. I have no side effects on my JAK. I had none on Enbrel either but it didn’t do anything. Think positively. Sounds like you’ve put up with nasty side effects for a long time.
Thanks Mml. x
I too did not fare well on MTX tabs or injections and after 11 months stopped, despite being encouraged by rheumatology to keep injecting. MTX did nothing to ease my RA either.I am now on toficitinib and doing better.
Looking back I should never complied with taking MTX for as long as I did.
I took MTX for 10 months, first orally and then 11weeks by injection. Had both headaches and nausea which got progressively worse til I stopped the drug. MTX just isn’t for everyone. I am trying Cimzia now…we will see.
Good luck. 🤞🏻
Thanks everyone. Not feeling too positive at the moment. I’ll see if I can get in touch with my nurse tomorrow.
Don’t suffer. They may try to persist as it’s a cheap drug. A locum rheumatologist got all exasperated with me when I couldn’t tolerate it. She made me cry. She apologised and said ‘she was running out of options’. She meant she was running out of cheap options! Very stressful.
For me I just got worse and worse stomach cramps and had to stop as it was toxic. I felt sad reading this thread as so many people have suffered on this medication for so long. I hope you can switch .
Hi fangrockI too had a miserable time on MTX injections. Nausea lasted 3-4 days afterwards and nothing stopped it. In addition it didn’t do anything for the stiffness in my joints in the morning.
I changed to Leflunomide which has been brilliant for my RA symptoms but has impacted in my WBC and neutrophils, which are now low.
Just reduced my LEF to every other day to see if that helps.
Good luck
I must be lucky then. Taking 17.5mg for the last 15 years alonside Inflixabib. Feel sick sometimes, but find a couple of biscuits or similar make it go away.
It varies so much from person to person it's impossible to say what's "normal" with MTX. I had nausea to start with but thought that the benefits I get from MTX far outweigh the side effects, so I just accepted them. I'm glad I did. I hope you find a solution. All the best.
My go-tos for nausea are peppermint and ginger and definitely eating little and often - preferably before I'm hungry; just a banana, a biscuit or a piece of toast will do. I've often forced myself to eat something despite the nausea and have then found that it's helped. I discovered this years ago before RA medications and have found that it helps with those too.I did that with both Methotrexate and Sulphasalzine and for me, the side effects did pass. Keeping well-hydrated on the day before and the day of my Methotrexate injection really helps; I now have a fuzzy head/hangover feeling the following day and generally feel a bit "off" - sometimes with an iffy tummy -but otherwise ok. I did find that 25mg injection was too much for me (side effects built up and got worse rather than improving) but I'm fine on 20mg. I inject on a Saturday evening and then have a quiet Sunday and the good effect it has on my joints is well worth an under-par day.
Definitely worth speaking to your rheumy team as they may well have some suggestions to help and if not, be able to give you something which suits you better.
I was on high does MTX, so i rung up my RA nurse and told her what was going on i was put onto a smaller does 10mg and found this did not upset me, i take folic acid one tab 5mg, day after MTX
I have the nausea ' methotrexate hangover' on 20mg injections. You can ask your rheumy or gp for some anti sickness tablets
The injections work better for me that tablets nausea wise.Someone suggested taking anti sick meds before injection, think they do it 2 hours before but I did it half hour before, seemed better.
I also do my injection about half hour befor going to bed to sleep the worse effects off.
Also drinking lots of water helps to flush worse effects quicker.
At times I suck mint sweets.
As others have said discuss with your RA team.
TBH the whole dealing with this condition is rock and hard place decisions.
All the best 
I’m on 20mg injection and some weeks I feel worse than others. I found that when I was taking it later in the day I felt sicker early hours of the morning and the next day. I take it at 8am now and have a headache later in the day but sleep through that sick feeling and as the next day goes on I just drink a lot of water and this seems to help xx
Took MTX for 13 years. It did a pretty good job for the RA, but I usually had nasty nausea for a day or two every week following the day of the pills. This unfortunately led to constant nausea that I had for a few years (can still taste the horrid taste with the thought of it!). I was put on injections in the last few months I was on it, but made no difference, the body was poisoned with it, that's how it felt. I'd only ever had 1 x 5mg folic acid one day a week - no one had ever suggested taking more of it!! I'll never know if that would have made a difference. It sounds like it's toxic to your body early on. I don't know if it will improve & settle, or not. You can only see your Rheumy & know yourself how you feel. One of those dilemmas - a typically nasty, toxic drug that one accepts if it does its job with minimal side effects, but if neither of those thing, definitely worth being considered for a different treatment! Good Luck!
I take 20 mg orally of methotrexate for PsA weekly. It indeed makes me nauseous. I try to make sure I have a full stomach and lots of water before taking it. That seems to help. Good luck with it.
Hi Fangrock, I had horrendous nausea with the tablets. Changed over to injections and it took several weeks before the nausea kicked in. Not as bad as the pills though and responded fairly well to the anti-nausea pills and gradually it settled down and I felt a bit iffy but not bad enough to stop me in my tracks. Since I moved to 25mg the nausea gradually came back until I needed anti nausea tabs again. However, once again it has settled down and I’ve found that if I inject in the early evening the nausea happens while I’m sleeping 😴
My nausea/side effects have always started 24-36 hours after I inject.
Good luck, I hope you get something to help. X
I've been on MTX since 2009 & nausea has been an issue for me whenever I had an increase though it usually settles once I’ve been taking the new dose a few weeks, an antiemetic helps for the interim. If it doesn't a reduction in dose does & another try once things have settled back down usually works. Nowadays I can't go above 17.5mg subcut as other side effects aren't easy & last too many days even on 6 days of 5mg folic acid.
I'm not sure about no nausea on injections, I’ve not found that, but generally it can be less of a problem, not as disruptive as when taking tablets & I can go to a slightly higher dose than before I feel too yuck. I think mostly though injections are easier, side effects tend to be easier or better tolerated.
What I have have found though is that some antiemetics work best than others for me with MTX nausea… neither metoclopramide nor cyclazine are as effective as prochlorperazine. Oddly enough metoclopramide worked well years ago for another issue, not sure why that would be. So if you're finding whichever you've been prescribed isn't working, or if anyone finds whichever anti sickness med they are prescribed doesn’t help or isn't working well enough do ask if you can try an alternative. The timing of taking it can also make a difference, as can the repeat dose if needed. Also, they are no different to any other med, some work better than others, it's just dependent on how your body reacts.
I hope you can resolve your problem, it can be wearing I know. Eating bland foods if you can manage anything helps somewhat as does keeping yourself well hydrated. Ginger too, I find crystallised or a ginger tea can help.
Sounds pretty normal. Was on tabs, nausea so bad they swapped me to injections was fine for months then bam nausea! So bad, led to vomiting and eventually they stopped the MXT. My advice would be to speak to your Rhumey nurse asap. Wishing you well.x
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