Increased mtx dose

[Drmjl18]

Hi all,

After 4 months on 15mg mtx with no side effects but not quite enough improvement in my RA symptoms, I am moving to 20mg them 25mg, but am also starting hydroxychloroquine.

Has anyone else made this change and, if so, what was your experience please?

Thanks everyone.

[SpaghettiIsGood]

After getting my dose increased to 23.5 mg, I think it was, my joints felt better but I felt worse, which is a side effect of mtx. Wasn't taking a second drug though until a year later. Then I couldn't live with the mtx making me sick for so long, so I just stayed with the second drug, which is almost as good as mtx.

[Boxerlady]

I started on 15mg Methotrexate along with Hydroxychloroquin. Like you, there was some improvement but not enough so I was moved onto Metoject and eventually up to 25 mg. When Sulphasalzine was added, things really improved so Methotrexate was dropped back to 20mg with no noticeable effect. On two occasions they've tried to drop the Hydroxychloroquin but each time things have deteriorated quickly so, although it's thought to be a fairly mild medication, it's obviously having a positive effect. It was described to me as an "enabler" as it increases the efficacy of Methotrexate.

As always, we're all different but hopefully the changes will help you 🤞

[Drmjl18 in reply to Boxerlady]

Thank you. Very helpful.

Can you remember how much time passed between the increase in your mtx and adding the sulphasalzine please?

[Boxerlady]

Less than 3 months. I remember because I rang the nurse helpline and thought that they might say that it was too early to tell but they said that there should have been some improvement. It was during lockdown but they called me in for a joint check (which I was pleased about as it was hard to do it myself!) and said that I definitely needed something else but things weren't bad enough to warrant a biologic which I was happy with.

[Sunshinereturns]

Yes I have direct experience of this. 15mg pills of methotrexate to 20mg pills to 20mg meto-inject to 25mg meto-inject. Tolerated it well, and still fine on it. Didn’t work well for me until 25mg. Then three months later, sulfasalazine added. No side effects still (lucky). Helped a lot.

[Mostmoses]

I did the same and it didn’t go well in my case. I ended up in hospital with. a dangerous reaction to the drugs. I am now ok on a biologic. The message is just to be cautious and pay close attention to any symptoms. In my case, this was a steadily rosing average heartrate over a week, and headaches increasing in intensity. Everyone is different and I know many people who have benefitted from both mtx and hydroxy long-term. Hopefully they will work well for you! Just be vigilant and take any negative reactions seriously.

[virtualreality]

Hi, my treatment took a similar path to yours - started on MTX 20mg (tablets) with HCQ then a month later moved up to MTX 25mg and another couple months after that onto Metoject, also 25mcg. The increases definitely helped my RA symptoms, and although I did/do have side effects from MTX they are manageable. Later added sulfasalazine as well, and although it took several months to take effect, it has also had further benefits for RA symptoms and no obvious side effects. All trial and error, but I really hope the planned increases help you.

[Airdale]

I changed to Hydroxychloroquine a year ago. 200 mg once a day. I have have had good luck with it.