NRAS
22,869 members26,574 posts

Methotrexate what is a low dosage ???

my doctor is going to start me on another drug in conjunction with methotrexate . cant remember the name hydro something ..

what got me thinking , when i got home , its never at the time .. its always afterwards .. was when he said i am on a low dose of methotrexate . so no need to reduce this ... we`ll introduce something along side it ... now !!! i am on 20 mg weekly . if that is a low dose . what is medium and what is high considered ???? i started on 10mg was on that for a few years then was increased to 15mg then on to 20 .. so if 20 is low .. 10 and 15 are very low .. i take it ..

so whats high ?? and medium ???

many thanks steve

30 Replies
oldestnewest

hmm I would consider 7.5mg TO 1Omg to be a low dose??? top dose to be taken for RA is 25mg!. not sure what you were told at your consultation.

Any thing above 25mg has never been seen by me for RA or skin and I work (when well) in busy hospital pharmacy!). I am both a patient with RA and registered a qualified health professional too,

Chat with your rheum team.. think in rare cases 27.5mg is used but not common.

Reply

thanks summer .

this is how i see it . i was somewhat shocked when he said i was on a low dose . when i am taking 20mg ... if i had been abit smarter at time , i could of questioned him about it .. nevermind ..

steve

Reply

I currently take 25mg subcutaneous injection but due to bad flare over xmas my consultant said she would consider increasing this to 30mg. But she said didn't want to do so if didnt have to as im slight in stature so she didnt think it especially wise - till then I thought 20mg was quite high dose.

Reply

not ra related . i had some tesco burgers the other night , i have still got a bit between my teeth .. he he he he ..

Reply

Asshole

1 like
Reply

I wonder whether he was referring to the general way in which RA patients take MTX compared to cancer patients, as this is very low compared to them? Our max dose of 25/27.5mg is pretty small in comparison.

I'm on Hydroxychloroquine as well as MTX (and Sulpha), and I've found the combination works better for me. I was on 20mg tablets, plus 400mg Hydroxy, but have now dropped to 15mg by injection.

Polly

Reply

Hiya I am on 15mg of Methorexate and 400mg per day of Hydroxychloroquine, I thought the highest was 17.5 for methorexate, for RA patients, Well you learn something every day......From what i have been told on here it is a very good combination, are you on folic acid to?

Take care, hope it works better for you Xx

Reply

hiya shirl . yeah i am on folic acid to . that hydroxy sounds like the stuff .. i get it on monday all been well .. whats it like to take any side effects ? is it not doing any good for you ?

i thought 20 mg was the highest . thats way i was shocked when he said , im on a low dose . xx

Reply

Yes i have been having some, like most people do on here, but they do say it doesn't last for long, I am on my 6th dose today, the first few weeks i was fine and then on my 4th dose i am feeling sick, dizzy and also i had a very bad chill,My nurse at my GP told me of and said next time to call the Rheumy nurse, but last week it was just the sickness and dizziness, so i tend to get everything out of the way first then i take it...

but not everyone get side affect, everyone is different, i have appointment on the 30th so i will mention it then Take care XX

Reply

Sorry as i have only been on it for a few weeks, I not completely please with the results so far, but everyone will tell you it takes time,XX

Reply

hi shirl i had all those symtoms from methotrxate the nurse from rheumo told me to take the folic acid every day except when i took mthx some weeks i would be in bed for days from the sickness in the end the rheumo doc took me off them as i was so ill .

I am now on leflunomide 20mg a day they were workin great but now having a bad reaction to them so today im to take noting for a week ask at ur appointment for other meds i also get a steroid injction now n again xx

Reply

I don't think they will change my meds as it is a bit soon, i am only on week 6, but they my up my Folic acid, i will have to see what they say on the 30th January, I did take my methorexate last night 2 hours before i went to bed, As i also take Amitripline i was knocked out by 11ish. But i didn't wake up feeling sick or dizzy this morning, all i had was a bit of a heavy head, which i sometimes get with taking the Amitripline....

thanks for your advice,,Take care Xxxx

Reply

Highest I've been on is 25mg and I'm down to 10mg now which I thought was low.

Reply

Depending on the brand you get given, some people find the pill has a bitter taste, so swallow it straight down! I've had no side effects from it, and just get my eyes tested once a year as in rare cases it can form deposits on the eyes. But my eyes are fine too. Px

Reply

Hi I've been on 15 mg for 18 weeks,its just stopped its effectiveness so I'm starting 17..5 mg tomo to see how I go.25 mg is the highest dose my hospital give off mtx a week xx

Reply

It is more quickly absorbed by injection and so people who take it this way are generally put on a lower dose. The rheumy just told me that 15mg = 25mg oral dose so presumably a syringe of 15mg is quite a high dose and yes I would agree that 20mg of MTX by tablet is also quite a high dose too. I think Polly is right to say he was probably meaning in comparison to cancer patients - but then the dont take it for very long periods unlike us.

I'm about to start 17.5 by injection and in tablet form that was too high for my body to tolerate with so I doubt I would ever make it up to 20mg in either tablet or injection. I'm also on Hydroxy and I think for me it made the MTX significantly more effective once I started this additional DMARD. I have been told that on its own it wouldn't do much for me but as a combination drug it seems to work well. I had my dosage reduced to 200mg but the rheumy said I can go up to 300mg by taking 1 tablet and then 2 on alternate days if I want. Good luck with it I've found it works just fine as long as I remember to have it with food or some milk. Sometimes I get a little nauseous afterwards though but not for long. TTx

Reply

when checking over the counter meds, it said not to take with a high dose of MTX which was 15mg or over.

hope you managed to get that burger out of your teeth :) haha

Reply

Hi, I had MTX via a drip for cancer some years ago. Before the MTX went through I had lots of saline and sodium bicarbonate put through, and then again after the 6 hours (I think) of MTX. After about 12 hours, a rescue formula went through the drip. When the MTX was running I was told to stay in bed because if I fell over and the bag of MTX was split open, it would burn a hole in the carpet!!!! At the time I was told I was getting many times the normal lethal dose, hence the rescue formula being added. As you can imagine I was terrified and scarcely breathed, let alone moved! I am now on 20 mg MTX weekly injection which seems to be chicken feed! This procedure was done twice - didn't lose my hair and am alive and kicking today. Xx Virge

Reply

I think the 'low' might refer to the difference between using methotrexate for RA versus for cancer. It's usually a much much bigger dose for cancer, so although 20mg is relatively high when treating RA, it's low compared to around 50mg-500mg for some cancer treatments. From memory the official term 'High dose' is over 500mg, 'intermediate' is 50-500mg and 'low' is less than 50mg.

Reply

Hi, I don't take mtx,so I don't really know much about it but I do take hydroxy 400g a day the only thing I've noticed is a tingling sensation when I'm in the sun apart from that it's been all very positive x

Reply

Hi Steve

Just to re-iterate your thoughts and what others have said, I would say that 20mg is actually a high dose. Working on the helpline I have spoken to thousands of RA patients over the years, and I would say that doses range from 7.5-20 or 25mg. Some hospitals will go up to 25mg but some will only go up as far as 20mg, so in some hospitals this would be the highest dose they have! Might be worth just double checking that the rheumatologist hasn't forgotten the dose you're on?

As you have probably now gathered, the name of the other drug is hydroxychloroquine. If it helps, the standardised shortening of this drug is HCQ.

Kind regards

Victoria

(NRAS Helpline)

Reply

Hi, I am confused. Does 25 mg MTX tablets equal 25 MTX subcutaneous ???

Tilda's rheumy has told her (as above) that 15 mg oral = 25 mg subcutaneous.

I am asking because I am on 25 mg subcut and think a slightly higher dose might be beneficial to me.

I hope you can clarify this.

Many thanks Jan

Reply

Hi Jan

Basically, if you are on 25mg MTX by subcutaneous injection, you are getting a full dose of 25mg MTX when you take it each week, as the full dose is absorbed into th blood stream.

If, on the other hand, you had 25mg by tablet, you would not get the benefit of the full dose, as the body's absorption of the drug, and therefore its effectiveness varies among individual patients when the drug is taken orally.

Therefore, if you compared the same dose of MTX by tablet and by injection, the injection would be likely to be more effective, as you are getting the full dose. The tablet may be less effective, as you are probably getting a slightly lower dose, but I have never seen a figure put on this difference, and the figure that Tilda's rheumatologist gave her is a bigger difference than I would have expected, but I think it will vary slightly between doses and patients anyway, so hard to put a figure on.

At 25mg on subcutaneous MTX you are on the highest dose that tends to be given, so if you don't feel that this is controlling your RA sufficiently it may be worth asking your rheumatologist whether they agree that it is not enough and would consider adding another medication to this.

Hope that helps, but please come back to me if any of this is unclear.

Kind regards

Victoria

(NRAS Helpline)

1 like
Reply

Thanks so much, yes clearer now. Will talk to consultant ( and not look silly when I do).

Thanks again, jan

Reply

I just started medication for RA.. am on 10 mg Methatrexate for 4 weeks now. I am completely asymptomatic (no symptoms) and Dr wants to increase it to 15mg ! Why? He said 10mg is NOT a therapeutic dose at all. The 10mg was a starter to see how I feel and then check my kidney and liver functions via blood work. I know 2 people on only 7.5mg so why increase my dose ?? That makes NO sense to me.

Reply

You've replied to an old post Dee0302, it's been 6 years since the OP was active on the site so not likely to see it, not responded to your questions anyhow. If it helps, generally the usual (therapeutic) dose is 15mg & upwards so as you say your Rheumy introduced it at 10mg to both see how your renal & hepatic values responded. Less often it's introduced at 7.5mg & usually increased at incremental doses until the best therapeutic dose for you is found. Even though you know of two people on 7.5mg it really is rarely you stay on such a low dose, unless your RD, PsA etc is very mild or other DMARDs are taken alongside (double or triple therapy). I started on 15mg but have also been on 17.5mg, I'm currently injecting 20mg. I think the highest dose for RD is 30mg but more commonly 25mg is the limit. So, the reason your dose is increased must be reliant on your DAS 28 score, imaging or blood works which will suggest to your Rheumy the best treatment plan for you, even though you're asymptomatic, be assured he wouldn't if it wasn't thought to be beneficial. Often if it's caught early it is the case, this can only be fortuitous as often the earlier it's diagnosed the better the prognosis, many would wish that had been the case with them!

I hope some of this helps. If it is really concerning you though do talk it through with your Rheumy or nurse, they'll happy to address anything worrying you I'm sure. Do remember though no one person presents the same with RD, it's a really tricky disease, there's no one size fits all unfortunately, proof if it were needed with the many treatment options.😉

Reply

Thank you so much. I appreciate the info you provided. I see a Naturopathic dr and Functional Medicine MD as well as my RA dr. I know my body and honestly do believe the alternative treatments worked in conjunction with the methotrexate. My RA dr listens & says I can do what I want but it’s his job to instruct me of the medical standards for treating RA. DAS 28 score ??? There was No mention of that ! My second opinion RA said there is a Vector measurement of RA if I want to have that.

Reply

We've each to do what we think is right for us, after all we know our own bodies best. We do need advice though & that you're covering.

I think maybe you're not in the UK? You may or may not have had the DAS 28 performed, I'm unsure where else it's used now other than the UK & other European countries. This explains it though nras.org.uk/the-das28-score

The Vectra DA test isn't used in the UK so I haven't any experience of it though it has been discussed by our US members here on the site if you wish to use the Search box to check historical posts. From memory (risky I know!) bit I think the test was around $1,000.

Reply

Hi, I started out on hydroxychloroquine and found it not too bad, unless I hadn’t eaten much - then I would get horrendous tummy ‘evacuation’!

Methotrexate was added and I’ve increased up to 22.5mg subcut. I’m still on the Hydroxy too and this combination has pretty much given me back my life. I still get flares and bad days but noting compared to how I used to be.

My poor old liver is suffering though as a result of the MXT.

My understanding is that 25mg is pretty much the limit.

I have a Rheumy appointment on Tuesday - I’m hoping the MXT might be reduced.

I have learned we are all different, react differently and what works for a while doesn’t necessarily work longer term!

Reply

Thank you - your reply was helpful

Reply

You may also like...