Doubling the dose of MTX: I was diagnosed a year ago... - NRAS

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Doubling the dose of MTX


I was diagnosed a year ago and was prescribed 10 mg of MTX until this week I spoke to my consultant (a new one) and said that my feet and ankles had started to hurt and she examined me and said I need to increase my MTX to 20 mg which is the norm she said, I am not so keen on doubling the dose. She also gave me a steroid injection and I have to admit my feet dont hurt for the first time in months. She was very surprised that I had been kept on such a low dose of MTX and had not been given a steroid injection to ease the pain when first diagnosed.

What is the normal amount on average that most people take? I take 10 mg of folic acid three times a week but dont take any other medication.

10 Replies

I thing there's a huge variation, as docs match the drugs to the person and to how aggressive their RA is, but if you're only taking MTX then 10mg doesn't seem that much. I'm on 17.5mg, and also take sulpha and hydroxy. My rheumy only gives steroid injections when I'm desperate, as really not good for you long term - and won't let me have more than 3 a year. Polly


How often do you see a consultant Lesley? And do you see a rheumy nurse sometimes to monitor your RA? If so it might be better to ask if you can go up to 20mg slowly because that's quite a big hike and it might give you side effects or affect your liver. If you can go up by one tablet at a time?

I'm on 15mg - my consultant would have got me up to 20mg if possible but I when I got to 17.5 my liver was dodgy and then when I tried a bit later when I was already taking Hydroxichloraquine I found I got too nauseous. I'm now on 15mg MTX by injection and 200mg of Hydroxy and the combination seems to be suiting me really well re my joints as I haven't had any pain for a while. I think ideally you would be started on another DMARD as well as the thinking now is that a combination of therapies is best. But 10mg is pretty low if it's on it's own and especially if it's not doing the job. Tilda

I was on mtx for 3yrs my dose 20mg , i had a reaction to it at the end of this time (hives) this was over 10yrs ago , im 51 and had 19 opperations ,after that was having infliximab by infusion every 7wks for 8yrs , this stopped working, now im on retuximab but have to tolerate 10mg of mtx to get the infusion , this is classed a low dose , as our condition worsens the drugs become more expensive ,and assesments more frequent , these drugs have given me a life for which i am truly grateful , gwen

I'm on 25mg currently. The starting dose was 10mg and it was increased by 5mg every month until it either worked or I got to maximum dose. The folic acid was also increased, so I take 5mg on 6 days a week, missing it out on the MTX day. I've not had any problems with it at that dose. It's not having as big an effect as hoped, but if I have to leave it off for infection I realise that it's helping an awful lot. Now I'm on Cimzia as well (anti TNF).

Hi Lesley, I started mtx in May and had 7.5mg for two weeks and then went straight to 15mg which I am still on. I take 5mg folic acid 6 days a week also. The drug has worked well for me and I'm glad to say I'm feeling really well right now. Yes I have some discomfort but it's nothing compared to before treatment. The steroid will help you until you're established on the correct dose. It sounds like you're new rheumy is doing a good job and hopefully you'll soon be feeling much better x

Thanks for all your answers, I am going up in stages 15 mg for two weeks then a blood test and if thats ok then up to 20mgs and a further blood test. From everyones answer it does seem 20 mg is the norm. Will let you know how I get on

Hi, I've been on 20 mgs MTX for a while now, folic acid 6 days a week. As feeling lousy my Rheumy just upped it to 25 mgs a week and have to say I feel pretty good. The folic acid is so important. Good luck, oh yeah I have blood tests every 2 weeks now.


Hi...I was started on 7.5 mg MTX by ER docs....then rheumy increased it to 25mg based on my symptoms and labs. After a few years and the addition of Kineret (anakinra) My MTX has been reduced to 10 mg. As everyone is different...meds and doses are also very individualized. Hope you find your right combination :)

I take sulpha , 6 per day and had no probs with them so far (1yr). I have tried metho tablets but what a mess i off them. I had been taking an anti-inflam etorix and lansop but had emergency dtr for chest pain and it was found these had caused bleeding off them too. Today I have started metho injections 10 mg along with the sulpha , folic acid to be taken for the 6 days in between to try and stop the side goes chums....will let you know how I go on......

oh any recommendations for taking B6 and B12 on some site they can help...any views?

Have been taking the 20 mg for a month now and have to admit that I do feel loads better. My feet hardly hurt at all and then only hurt after I have been walking around for 4 to 5 hooks which I could never do before after 30 minutes I used to have to sit down. My blood tests are all ok so all is looking good at the moment and am pain free. I wish it was so for all RA sufferers

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