Conflicting information

[MadisonCounty]

Since RA diagnosis in 2021 I've only taken Hydroxychloroquine. I've now been prescribed methotrexate. On the day I take it, my consultant told me to take 4 tablets , 2 in the morning and 2 in the evening, however the Rheumy nurse said that I should take them all in the morning . Does anyone have any advice or experience of this please? I don't know whose advice to follow....

[MadisonCounty]

Thank you Ajay, I think that is good advice

[Paula-C]

Normally it's taken all at once but I've heard of people splitting the dose during the.day. I'd do what the consultant said but you could always phone and speak to the consultant secretary who could find out for you.

[MadisonCounty in reply to Paula-C]

Thanks Paula, I hadn't thought of phoning the consultant secretary, I think I will call next week.

[helixhelix]

Both approaches are ok. Must all be taken within 12 hour period, but very mixed opinions about how.

Especially at first a split does may help avoid side effects.

[MadisonCounty in reply to helixhelix]

Thank you, that is useful to know. It does sound as though I should take the consultant 's advice.

[rmros]

Your consultant is the one prescribing so I would take their instruction but if it's inconvenient or you'd prefer to take it all at once, I'd mention it to them. I take 5 all at once and no one has ever told me to split it.

If you can tolerate a bit of dairy, I find taking each pill on a teaspoon of full fat yoghurt is better than water. I can't tolerate milk or low fat dairy, but this seems to help the queasiness and mouth problems.

[MadisonCounty in reply to rmros]

Thank you. I will try the dairy too, I hadn't heard of that but it sounds a good Idea.

[Wannabeabago]

Here’s a properly, peer reviewed article about the benefits of splitting an oral dose of Methotrexate and having them 8 hours apart in the one day 😊

[Wannabeabago]

Oops… forgot the article

pubmed.ncbi.nlm.nih.gov/164...

[MadisonCounty in reply to Wannabeabago]

Thanks Wannabeabago, that is a great link. A couple of other interesting articles on there too!

[Hidden in reply to Wannabeabago]

🤣.. that’ll be the brain fog 😂

[Wannabeabago in reply to Hidden]

Haha lols

[KASHMIRI1]

I take half my dose of methotrexate on the morning half twelve hours later.

[MadisonCounty in reply to KASHMIRI1]

Thanks Kashmiri, that's what I was expecting to do until the Rheumy nurse confused me !

[KASHMIRI1 in reply to MadisonCounty]

I hope you get on ok, it has suited me. I think the split dose advise is to help with GI issues.

[Scottishlad]

When I was on 25mg I took all 10 MTX tablets in one go. I wasn't given any advice on how to take them.

The only side effect I ever had from MTX was I had tended to get more mouth ulcers at the higher doses.

[MadisonCounty in reply to Scottishlad]

Thanks, that is reassuring. I've been feeling a bit worried about possible side effects.

[Tourk]

Always a difficult one, mention this to your consultant see what they say. Think you'll find they are right . But doesn't hurt to check.See who you feel as well, what works best for you.

[MadisonCounty in reply to Tourk]

Thanks Tourk, yes I will check. Luckily I do have a very good consultant.

[Otto11]

I don’t think there is a right or wrong. Personally I wasn’t told to split the dose just take in the morning. After time it was suggested that I should take in the evening before bed to lessen any side effects as you would sleep through them. Do you have an advice line for your Rheumy nurse. If so give them a call or the consultant’s secretary as others have said. They won’t mind you calling them & it’s better to be sure for peace of mind x

[MadisonCounty in reply to Otto11]

Thanks Otto. I do have an advice line number, I think I need to make a call. There are so many possible side effects that I have read about, I'm a bit nervous of starting the methotrexate even though I know it suits many people. x

[Otto11]

It is daunting I know. I remember the feeling taking my first dose 24 years ago now. It does have side effects but remember all meds do but not everyone experiences them. I had awful nausea in the beginning which is one of the reasons they suggested taking it at night before bed. For me this went on for about 5 months slowly reducing as my body got accustomed to it. I was on Methotrexate for 15 years & it worked really well for me. Good luck x

[MadisonCounty in reply to Otto11]

Thanks Otto, I will keep my fingers crossed x🤞

[Zoey10]

Good Morning, When I first started taking Methotrexate my Rheumatologist told me I could split the dosage within the same day to help with potential side effects. I never did though and took all 4 tablets after dinner. The drug made me very tired so I opted for taking it at the end of my day.

[MadisonCounty in reply to Zoey10]

Thanks Zoey, It's good to hear that there is a certain amount of flexibility.

[colleenowensodie]

Hello, just a quick response to your question. I am on 10 pills of methotrexate, once a week and in the morning I find is the simplest. I was told to take it on the same day each week, and all in the morning is ideal. I have been on this over a year now.

[MadisonCounty in reply to colleenowensodie]

Thanks Colleen, if you are taking 10, then I should be ok with 4. Maybe that is just my starting dose.

[Hidden]

I take 10 tablets all in one go; and always have. I would recommend taking them with a ‘proper’ / main meal and with plenty of water.

If you feel nauseous you can take an antiemetic. Or first try upping your folic acid to 6 days (not Mtx day).

[MadisonCounty in reply to Hidden]

Thanks for that, I will remember to make sure I have them with a meal. Do you know if the rheumatologist prescribes an antiemetic if required, or can the GP do that ?

[Hidden in reply to MadisonCounty]

I can’t remember! If you are due a Rheumatology appointment soon ask them. They usually opt for upping your folic acid first.. see how that goes.

[MadisonCounty in reply to Hidden]

Thank you x

[jocascanet]

I was on methotrexate for seven years. It doesn't matter when you take them just as you take them all on one day. Your doc was dividing them to ease the side effects.

[MadisonCounty in reply to jocascanet]

Thanks, that makes sense. It seems a good idea to split them if it reduces side effects. He didn't really explain why.

[KathleenMary]

I take 4 at night ,I was advised to do that to minimise the side effects

[MadisonCounty in reply to KathleenMary]

Thanks Kathleen, hopefully I won't have too many side effects.

[football64]

Maddison, interesting. Why did you start on Hydroxi….. and now moved to MTX. What symptoms have you experienced since 2021?

[MadisonCounty in reply to football64]

I have quite a lot of swelling and stiffness in my hands, feet and knees, but can't say I have too much pain or fatigue on a daily basis only if I over do it. I must say I was a bit surprised that my rheumatologist decided to put me on methotrexate.

[football64 in reply to MadisonCounty]

so the hydroxi….. didn’t work?

[MadisonCounty in reply to football64]

I assumed it was working and this was as good as I'm going to get because I know some people are a lot worse than me. But perhaps it isn't doing much and it will be great if methotrexate helps with the swelling and stiffness.

[tanya1981]

I was never told to divide them and have been taking them before bed time (6 pills) with no side effects so far. To make it easier k. Yourself, try taking them in one go and if you suffer with side effects, then divide in two

[MadisonCounty in reply to tanya1981]

Thanks Tanya, it's encouraging to hear that you haven't had side effects.