Increase in MTX dose

[Manzana1]

Hi again everyone, I recently had to increase my MTX from 17.5mg to 20mg and I'm finding the injection more painful. I don't self-inject as I'm in Spain and the nurse asks me to come to the surgery for the injection. She did point out last time that the 20mg injections were an older type so I'm now wondering if anyone can give me some more info on the different types used. I feel a little in the dark, I miss the NHS nurses so much as I always felt comfortable asking if I had doubts but it is neither expected nor well-received here. Thanks

[helixhelix]

20mg will also be more liquid to inject, so that could be the difference? And is it a pre-filled syringe or a pen? As that can make a difference as well if nurse doesn’t take care - but neither should be painful!

Can you see what name is written on the syringe or the box?

[Manzana1 in reply to helixhelix]

Hi and thank you for your reply. I only know that the 17.5mg box was a pink colour and this one is a dark blue colour. I don't think it's a pen. She is usually very fast, she injects it into the back of my upper arm. But since the 20mg change, it really hurts. I felt very little with the lower dose.

[helixhelix in reply to Manzana1]

The boxes change colour with the dose. It’s a safety thing so you can easily tell the dose. If your new box is blue then check as that’s normally 25mg.

Can you ask her to inject your stomach? That’s usually the least painful spot.

[Happy5 in reply to helixhelix]

Good call Helix

[Runrig01]

It may be a different preservative in it that’s resulting in the sting. As helixhelix says I would ask for her to do it in the stomach. I’m supposed to rotate and use thighs but they are excruciating, so I always use stomach. Would they not be happy to let you be trained to do your own, it would free an appointment for another patient.

[Boxerlady]

I was taught to do it myself and told to use stomach or thighs - maybe she's just using your arm because it's quicker for her so time to tell her that it hurts! 😉

I've found both 20 and 25mg painless and use alternating thighs.

[stbernhard]

Hello Manzana , I would definitely ask to get the injection in the tummy area. I was taught to pinch some skin/fat and inject there. Never ant pain at all. ¡Buena suerte!

[Happy5]

I'm on 20mg metject MTX prefilled injection with press button.Was advised to used rotation of 4 sites both thighs and abdomen left and right I do it anti clockwise. It does sting so I press the area a few minutes after.

Can't imagine having it in my upper arm.

metoject.co.uk/uk-patients/

[Manzana1]

Thank you for all your replies. They have their own way of doing things here and I just try to go along with it. I go to the surgery early on Tuesday morning before work and before the nurse starts her appointments. They never encourage me to self-inject at home but I think I'll ask, also about having it in the abdomen, as a lot of you have suggested. Thank you again xx

[nomoreheels in reply to Manzana1]

When I first started injections my Spanish Consultant asked if I was happy if I was to inject myself if I was shown how to, rather than them offering to do it. It was the only time I met with the Rheumy Nurse. She showed me how to do it with a dummy syringe then watched me as I did my first injection. These were pre filled syringes at the time. I was only shown to inject into my tum & it shouldn’t hurt. With the pens what you feel more is the release of the needle as you press the top… you don't have the control you have with the syringes.

It's surprising how different experiences of the health system are, only just over half an hour down the motorway from you & mine was so different. If you're happy to I'd ask if you can be shown how to do it. If it's still the same you will have to go to the pharmacy who fills yours scripts each week to get your injection but at least you can do that at your convenience.

There are 3 options for injecting, pen (which I have now, started on them when I returned to the UK), pre-filled syringe (which is what I had there) & drawn from a vial with a syringe, not normally done when self administering any more but may be done in hospital or health centre. Boxes are clearly coloured according to dose as helix says. The background colour of the dose for 17.5mg is pink, 20mg is burgundy, 22.5mg is green but it's 25mg that is blue. That would seem like a quite a big increase from 17.5mg.

I hope you'll be listened to, it is your choice & I don't see any good reason for you not to do it yourself. Let us know how you get on.

[Manzana1 in reply to nomoreheels]

Thank you! I will let you know. As I said, I miss the NHS a lot, the nurses were always incredibly kind to me. I don't want to complain about things here but it's different. Gosh! I hope she hasn't been giving me 25mg! I'll definitely check that on Tuesday!!

[nomoreheels in reply to Manzana1]

I preferred it but my experience was different. My only contact was with my Consultant, every 3 months, & always the same one. He even gave me his mobile number, & I’m sure I couldn't have been his only patient he gave it to! Here I’ve not seen the same one since mine left over 3 years ago, & I only saw her once a year… & the last one, a locum, was the worst yet. Ho hum. If my h was in better health we'd have the discussion about returning I'm sure.

[Manzana1 in reply to nomoreheels]

Hi again, sorry it's been a while! Quinux is the brand name on the box and it is definitely 20mg she has been giving me.

[Hidden]

I only injected for a short while, but I think you are supposed to inject into fat, hence thighs and stomach rotation. Your arms are not suitable so it will hurt ☹️. Maybe explain to her, or talk to the GP.

[jf211]

IVe had 3 caesarians so I always inject into the numb bit near my scar!! Hardly ever feel anything