Started on MTX 5 weeks ago. First 2 weeks 10mg ok no nausea or anything, next 2 weeks 15mg still ok but now on 20mg and so far 2 days of bad nausea. I'm taking it before bed as others have said to do, will the nausea stop or is it not suitable for me?
Methotrexate : Started on MTX 5 weeks ago. First... - NRAS
Methotrexate
Written by
Alan7690
To view profiles and participate in discussions please or .
Read more about...
52 Replies
•
I’d give it a bit longer. When this happened to me we moved to injectable.
Reading through the forums I would say injectables are better (that's what I have because my stomach is not great with tablets). Also if you're not on folic acid six days a week, talk to your team as this helps massively. And final tip, keep hydrated. Good luck, hope you feel better soon.
Thanks I'm on 5mg folic acid the other 6 days.
You are moving up quite quickly. Perhaps drop back to 15mg fir a week, then 17.5mg and then try 20mg again. It takes a while for you body to get used to it. Took me months. And drink lots of water.
Thanks. This is what the rheumatology nurse said 10 - 2 weeks - 15 - 2 weeks then 20. See how next week goes then if the same I'll email her
Always best to take advice from your medical team. I’ve had RA for 13 years so now I do go it alone and listen to my body much more. I know I m slow to adjust to new drugs.
ask to go on the injections rather than oral pills.
My rheumatologist recommended taking it after dinner, rather than before bed. I guess you could try that - but I don't know if the food would soften the impact on your stomach or make things worse! I only ever had a slight headache with mtx, but obviously don't know whether that was because I took it with food, or whether I was just lucky.
I remember I was told I might feel terrible for a few months. I think so many people are nauseous from the pills that switching to inje table would be a good idea.
I was switched to injections after only a matter of a few weeks as my gastric reflux got very bad. Contact you nurse or Rheumatologist you don't need to suffer. Good luck.
I’m surprised you moved up in mg’s so quickly!
Why? I went from 15mgs to 20mgs in 2 weeks. No issues.
Hi Allan It took me 16 weeks to get a bit of relief with mine I think it all depends on what suits the individual as you know its a strong drug I'm on 20mg so maybe 15mg could be better for you .
I was always told to split the dose with higher doses of MTX, so I take 25mg but as 12.5 mornings and 12.5 evenings and always after food. Hope this helps!
I wonder why this isn’t recommended more often. This makes a lot of sense. I split my leflunimide into morning and evening.
Moving up too quickly I would think, as you need to allow time for your body to adjust. I started off on 10mg and was on that for a long time, a good few months even, before I could drop to 7.5mg. I've now been on that dose for a few years, but it takes time and we are all different. I don't want to worry you but do you have a gastrologist on board as well? Have you ever had IBS etc, sometimes this can be aggravated with the meds for RA, so that's why it might be worth discussing the stomach upsets with your GP or team.
I was told to take it with my evening meal. I always make sure I take it before the last bite of food, so that I taste the food and not the meds.
Hi Alan. I had a similar problem. I decided to take half the MTX in the morning and the other half in the evening. It works for me. I also take folic acid on the other 6 days.
Those pills really turn my organs upside down , that and someother meds i would take .I stop all meds ,looked into natural organic way of life
And..does natural work? Would be great if you could share what works as all drugs have awful side effects.
Please let me know how you get on? I totally trust in natural organic way of life. But I suppose it depends how bad the RA is. Can you function normally without any meds. Or is there a med that takes the edge off? I would appreciate tips please on natural way.
Thanks
Plenty of books out there on drug free approaches for me balance is the key sensible diet and minimising the impact on RA
I was a fortunate one. Like you I ramped up 10 to 15 to 20mg, much the same timescale. At first the 20mg gave me nausea and brain fog the next day or two. I used to say I wasn't safe in charge of my brain! But over the following months probably 3 -4) all that subsided so I now barely notice it's 'the day after MTX'.
I am on 5mg folic acid the other 6 days and I do all the things mentioned above...good evening meal on MTX day, take it late on, and plenty of hydration before and day after.
If I take a short pause (eg for covid booster or some surgery) the MTX hangover comes back for a couple of weeks when I re-start. But I now know it will pass.
Best of all, my RA is in remission!
Hang in there and take advice from your Rheumatology dept. Hopefully oral MTX will work for you, but if not there's step up to injectable, and if it's still not the drug for you, there are others.
Wishing you all the best.
Is the advice to stop methotrexate when you have covid booster. Hospital advised pneumonia. flu one which I have had and covid booster which I am not keen on not sure why had covid this year all the negatively gets to you I think
You could ask your GP for some anti sicknesss medication
Watch the palms of your hands. If you get tiny pinprick red spots then it is not for you. This happened to be so consultant said NO 😀
I started on 15 mg of methotrexate and then moved to 20mg after a month. This left me with a constant feeling of nausea. I switched to metoject pens after 12 weeks but at the end of another 3 months I was vomiting 3 times a day. I have now changed to leflunomide which comes with its own side effects but the sickness has gone! Methotrexate is not for everyone.
I started on the tablets at first, made me ill with nausea and diarrhea , but stuck with it until I couldn’t take it anymore. Switched to injections , a game changer. No side effects whatsoever
Agree with others, injection seems to work well for me. I went from 15mg tablets to 20mg metoject.
Maybe need to increase folic acid to daily instead of weekly.Has there been any improvement in your pain and stiffness yet?
It did improve for me but sometimes get a sickly headache for day after meds. I find sucking a mint takes it off. By the way it was a few months before I really gelled with them but they have certainly helped to contain my painful hands etc. worth persevering.
I take mine after breakfast with two pints of water. Initially I dix as Dr said, at night but made me nauseous plus you cant really drink loads of fluid before bed. Think its important to drink plenty of clear fluids but particularly with RA snd its meds.
It seems that with just 2 weeks between being moved up to larger doses, is a bit too quick. maybe scale back the dosage and get used to that first. I've been on 15 mg of methotrexate for 3 + years but moved up to that dosage gradually and have never experienced nausea. I also take folic acid every day since I've been on mtx. Wishing you good luck with this and that you feel better soon
I’ve been taking 20mg MTX for 4 years, I still get side effects ( nausea , headache and tiredness)but strangely not all the time, I find taking it in the morning before work is better as I don’t have time to dwell on the effects, I also drink coffee and lucozade to help me get through the day, finally I eat very little on MTX day as food usually makes me feel worse , just have a banana or some rice cakes , the day after I feel back to normal. Before I was on MTX I was in constant pain and struggled to get up for work, had to take strong painkillers and naproxen couple of hours before I went to work, unable to drive and struggled to walk ! so the side effects are a small pay off , I am now fully mobile and feel ten years younger. Stick with it, it does get easier, initially I lost over a stone in weight but it settled down after several months. I only take 5mg folic acid once a week and I do find walking daily helps ( if you can)
Hi,
My daughter is 31 years old, she added 15mg Methotrexate tablets after lockdown as her Biologic was not working as well. She did settle on 15mg MTX . She does often feel sick the day after the night of taking MTX. But I do say to her if she is lining her stomach with a healthy meal before taking the MTX, and not going straight to bed but to wait until tablets are well down in her stomach after drinking water. I really don't know how everyone else takes their tablets? Most people say have you taken 6 folic acid per week, but not on MTX day. Take advice from others too and see if any suggestions will help. I am sure you will settle. Try not to drink alcohol and I think the leaflet advices against black tea, but that is hard! I am still trying to find out if Probiotic is ok to take whilst on a biologic and Methotrexate?? Good luck
Have you been given folic acid too? If so how much did they prescribe?
Hi Alan, it's different for everyone, but I was on MTX for over 13 years & had intermittent nausea throughout, but it only became really bad & constant in the last 2 years taking it. Only in the last year taking MTX were injections tried instead of pills. They made no difference as my body was effectively poisoned with it. (I then went onto Leflunamide and had no trouble whatsoever! until it just stopped working 7 years later for some reason). Hope things improve for you. It may be if MTX works well for you, you will carry on on a maintenance-dose basis (I stayed on 10mg/week for years) and you may well not have nausea at all then. All the best and good luck! (P.S. the Folic acid can help if taken for more days)
Are you taking folic acid? This helped me greatly
Righto. I hope it settles for you.
I am newly diagnosed and started on 15mg in September and have just been increased to 25mg. I take mine after dinner, and on a Friday evening so it doesn't affect my working week. I do feel a bit washed out and lethargic for a couple of days after taking it, and get a mild feeling of sickness. If I was getting bad nausea like you are getting, I would be raising it with the RA team as it isn't right you should feel so sick for 2 days every week.
Best of luck Alan.
I was told not to take it before bed.
Why was that as everyone appears to have been told to take it before bed?
I was told that methertrexate could cause you to be sick and was told not to take it late at night and to take it with food.
Does anyone split their dose morning and evening when on 20mg and does it help with the side effects?
give it time. at least 3 months. stay off caffeine and tea the following day, as this may interact with medication. i hope it gets better soon.
When I first started MTX I was advised not to take it at night but to divide the dose throughout the day with my meals. I started on 15mg & took 5 mg with breakfast, lunch & evening meal. It worked very well for me, makes sense as your body doesn't have to cope with the full dose all at once.
Not what you're looking for?
You may also like...
Methotrexate and nausea
Sorry if I've asked this before, but everyone I've heard of or asked, who is on the oral...
Methotrexate
Hi, hope everyone's well, my rheumy nurse as upped my methoject, from 20mg to 25mg, first 2 weeks...
methotrexate
i just started my weekly dose of methotrexate injections 4 weeks ago, but i'm feeling the side...
Methotrexate and symptoms
When u started mtx 4 weeks ago the side effects weren't too bad. Slight stomach cramp and a little...
Methotrexate and nausea
Hello! I’m 5 weeks into taking 20mg Methotrexate by injection.
I’ve been fine up to now but a few...
Merry methotrexate
Methotrexate side effects 
Methotrexate query
Methotrexate 
Nausea Methotrexate or Sulfasalazine 
