Please can anyone advise regarding gradually lowering Methotrexate. Obviously it will be lowered via Rheumy permission. It's just to help with making the nausea a bit easier to cope with, as 15mg weekly is working with Enbrel currently apart from the sicky nasty feeling! So thinking of getting Rheumy permission to lower, but could it start the joints playing up?? by reducing from 15mg to 12.5mg (just one tablet lower)? If it didn't work would that mean taking monthly blood checks again? if having to increase one more tablet to 15mg again? Currently bloods are 3 monthly since last year. Have been on MTX since Summer 2020. Had to add MTX to Enbrel after Enbrel not working on its own anymore, it was great on its own for 8 years straight! Do not want to change to MTX injections at this present time.... would prefer to keep on the tablets for now! 5mg folic acid is taken 6 days a week. Any advice for MTX lowering would be great please! Thanks so much. x
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MJSlide1958
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I'm sorry to hear you are having problems with mtx and side effects. Unfortunately, we are not able to give medical advice on here. It is something which needs to be discussed with your rheumatologist. They will be able to look at the bigger picture, and work out what will be the best course of action for you.
It is commonly done so I see no reason not to ask if it's the right thing to do for you at this time, you can only try after all. Alternatively, have you considered remaining on the dose you're on & asking your GP if an antiemetic would be appropriate, considering you're on max dose folic acid ? I have tried 3 different ones & have my preference, to take when I used to increase my MTX. I'm no longer going above 17.5mg so they are somewhat redundant but were very helpful for the few weeks while my body got used to the increase.
Well, the dose we're prescribed is 5mg but you can buy it otc at 400µg (which is equivalent to 0.4mg). I think though reading my reply again I could have worded it differently, the 3 different ones relates to antiemetics not folic acid.
I did this a number of years ago at the suggestion of my rheumatologist. I moved gradually from 20mg to 10mg by taking out one tablet a time over a number of weeks.
Thanks Potatos, this is interesting to know and exactly what I was wondering. Whilst lowering gradually did you get any joint stiffness or pain/swelling. And are you combining your MTX with a biologic or other med? How are you doing now on the lower dose of MTX? Much appreciated.
I'm on adalimumab as well as methotrexate. It was after my initial consultant retired the new one noticed I had been stable for many years and suggested that 20mg of methotrexate was probably unnecessary and I could try bringing down to 10mg. He didn't recommend any lower as it is thought to prevent rejection of the adalimumab. I've had no change in my disease control and am very happy to be on the lower dose.
Thank you so much for your story, this helps alot! I am guessing you get on well with MTX? Do you take tablets or MTX injections? Do you feel sick or unwell at any time with MTX?
I'm on tablets. I take them in the morning, by 9pm I usually have a headache and irritable eyes so I go to bed and fall asleep! I was initially advised to take them at night but I found I woke up with a "hangover" the next morning, I switched it to morning and that seems to work next for me.
Thanks! no sickness feeling with taking MTX tablets in the morning? Are you able and feeling ok to go out after taking MTX in morning? Like say going to work? or anywhere after taking?
I'm fine until about 9pm. Not working these days but when I did it didn't affect my work. I take them on a Tuesday and worked from 0800 to 2200 on Tuesdays.
Thank you so much for your story, its been very helpful to know that it can work without worry about flares etc when lowering slightly! Can't tell by your name, Potatos, if you are Female or Male?
I experienced the same on methotrexate tablets, headache, sickly muzzled yucky feeling, and when I mentioned it to my specialist they suggested trying the injection method....it worked a treat. Alongside folic acid every day except injection day it worked very well for me. Maybe worth mentioning to help you. Have a nice day.
Exactly the same as tablets! Injection was easy to do..spring loaded thingy, made a huge difference to my life style. Just come off it after 5 years, alongside cimzia, as not required anymore! Good luck with it all. X
I am on MTX and Enbrel, and have managed to get down to 12.5mg MTX - dropped a dose every three months. My rheumy’s goal was 10mg, but couldn’t make the final step!
Why don’t you ask your RA specialists if you can change to injections? When I changed to injections all of the problems with MTX went away, one of the better moves for me. Hope everything goes well for you.
Hi if it's causing you lots of trouble i would contact rhrumy office as mine changed me onto injectable max which stopped the nausea. Good luck . In the meantime call your pharmacist as see if he can give you antusickness tablets .
It's horrid but will be worth it to get the RA controlled
Everything is a balance.I’m currently on a reduced dose of 10mg&take 2 Sulfasalazine twice daily.I still feel rough day after taking Methotextrate.My previous dose was 15 mg.I now have deformed hand&atrocious feet,resulting I suspect from decreased dose.However can still do uphill 10km walks,swim@gymn&I am 77
It's great that you're still doing so much but if you think that the damage has been caused by the reduced Methotrexate dose, maybe it's time for a med review with your team? When my Methotrexate (even at 25mg by injection!) and Hydroxychloroquin wasn't controlling my symptoms they added Sulphasalzine and I'm now up 6 tablets a day.
Over the past 2 weeks I’ve reduced my 15mg/week dose of MTX to 12.5. I’m being monitored by my Rheumatologist. Based on my self/reporting he will advise on whether to retain, lower or increase this dose. Please keep tuned as I’ll give reports on my status as time progresses. I hope that what you’re doing will yield good results. We keep trying!
I had my mtx reduced to 7.5mg(I'm on enbrel too and in remission). I started getting swellings and I just didn't feel right so I asked for it to go back to 10mg. It was increased and I was told I had to have blood tests every two weeks for six weeks. I was on 3 monthly bloods, my bloods had been fine for years even on 17,5mg, but I had I still had to have fortnightly bloods, I was told it's protocol when you have your dose increased.
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