First day of Methotrexate 15mg

[Baner]

Saw Consultant last Thursday and it was decided that Methotrexate was best option as I am having a lot of gastric problems with Pred. Tapering from 25mg down to 20mg for a week then down by 2.50 each week till next appointment. Wasn’t told best time to take Methotrexate but after reading Mrs Nails in FAQs am going to take after lunch. As well as taking Omeprazole for the nausea in morning and evening have been prescribed Famotidine 40mg to take at night. Not familiar with this but will try it.

[DorsetLady PMRGCAuk volunteer]

Good luck - no experience of MTX, hope it helps

[MrsNails]

Hi Baner

Has he given you written directions on the reduction plan?

Has he prescribed MTX Tablets?

This is a rapid reduction, what dose of MTX has he started you on? As it’s usual to start on a half dose & if you tolerate it increase it.

Have you had base line blood tests & are you booked in for any more tests - it’s normally 2weekly until you are settled.

Did they have you on enteric coated Pred or plain?

Kind Regards

MrsN

[Baner in reply to MrsNails]

Thank you for prompt response, I have read your story on FAQs, very helpful.

Written instructions for Pred reduction are 20mg for week then 17.5 for another week then 15mg for further week. I should have received another appointment by then, when presumably I will be told about further reductions.

I was then told to start the 15mg of MTX, which I got at hospital pharmacy on same day, on Monday (today) followed by one 5mg Folic Acid tablet once a week on following day. All tablets seem to be plain. Don’t know if this is standard with hospital pharmacies.

Had all blood tests at appointment and received a phone call next day to say inflammation seemed under control, and to remind me to start the MTX.

Thanks for all your help.

Margaret

[MrsNails in reply to Baner]

Hi Banner

We’re back - No suit as yet 🤦🏻

Anyway - what l was concerned about was tapering down by 2.5mg each week but now understand that’s only until 10mg…..

A light lunch is best followed by the tablets & drink plenty of water to flush them through your system - that really helps….

I generally ate a plain chicken sandwich on MTX day & had a light evening meal. If it does make you nauseous there is the option of injection (Metoject) which is very easy.

My best tip is to keep the following day ‘free’ incase you feel tired & if you don’t it’s a bonus.

It doesn’t affect me now - l had mine yesterday & l was out n about early (by my standards) today.

There is always an option of increasing the Folic Acid if necessary - l take it 6days per week but am on 25mg MTX

I’m happy to answer any questions you may have.

Good Luck 🍀

MrsN

[Baner in reply to MrsNails]

Thank you so much. Have almost forgotten what a shopping trip is like, my husband has now taken over shopping as even a trip around the local supermarket leaves me shattered.

Had a cheese sandwich for lunch and now taken MTX with loads of water. I feel nauseous most mornings, which does improve as day goes on. Hoping it won’t be any worse.

Thank you again, appreciate your advice.

M

[MrsNails in reply to Baner]

No probs - a plain biscuit can help too if you feel a bit nauseous. 🍀

[MrsNails]

In town shopping - looking for a suit with my other half - will message you later. MrsN

[PMRpro Ambassador]

My rheumy's advice for timing was half the dose before bed on the chosen day and the rest next morning on waking. He said he finds that minimises the nausea.

I'm really rather surprised he went straight to adding MTX rather than trying you with enteric coated pred first which often solves the gastric effects of pred. As it is you now have 4 more drugs to take!

[Baner in reply to PMRpro]

I have to say timing was not mentioned, and I was in such a brain fog I didn’t ask. Didn’t want to take MTX at same time as Pred, so after reading FAQs thought after a light lunch seemed a good idea. Talk about a steep learning curve, this forum is keeping me sane.

[Sharitone]

Also take mine with lunch, and keeping the next day free is good advice. Also, I too started on folic acid once a week, then it was increased to 4, then 6x - every day except MTX day. This was because I was losing too much hair, and now I wish I'd been on to it, and asked for more FA earlier. I cut my hair today, a good inch all round, and there was a very pathetic little pile of cuttings!

[Baner in reply to Sharitone]

Thanks for that. I have an Rheumy appointment on Monday I will ask about taking some more folic acid, thought once a week seemed a bit light. My hair is a bit of a mess at moment as haven’t felt up to a visit to the hairdresser, losing some of it won’t improve things I’m sure.

[Caloo650]

I lasted on methtrexate for about 4 months but gave up because of the nausea. Down to 4.5 mg of pred but because I'm stiff a lot of the time rheumie wants me to try leflunamide. I'm reluctant because my experience with these drugs is always my digestive system and this can cause diarrhoea. Good luck with it.

[MrsNails]

Did they not offer you MTX by injection thus bypassing the digestive tract?

[Baner in reply to MrsNails]

Injection wasn’t mentioned, I have a Rheumy appointment on Monday, will ask about it as last couple of days have been having very bad nausea and not sleeping well

[MrsNails in reply to Baner]

They really need to get that nausea under control and/or investigate it’s cause before they start adding in DMARDS - it may be something your GP could look into for you. There are many Antiemetics on the market that you shouldn’t be suffering all the time.

What type of Pred are you on? Plain (white) or Coloured (enteric coated) also All Your Meds should be reviewed for interactions & possible cause of nausea, your Pharmacist could do this for you - best to book a Meds Review with them - they are always happy to do this but can’t always manage it there & then.

I can send you a link which you can put your Meds in & check for Interactions & side effects.

Sometimes, Drs make a decision to let you take a particular Medication even if there is a risk of interaction but it’s usually only for a short duration. I had to have a particular antibiotic last year & it had a warning on it re MTX but the GP was happy to try as my bloods were good & l left my MTX off that week.

[Baner in reply to MrsNails]

I am on plain Pred, got them from the hospital pharmacy think that maybe the only ones they issue. Will emphasise problems with nausea at Monday’s appointment. Please send link to check interactions for meds, thanks. I have read through the leaflets that come with the pills, but they are so long difficult to remember all the info.

[MrsNails in reply to Baner]

Well, there’s an option they could try is to change you to Enteric Coated Pred

This is the link but sometimes it scrambles it’s self but hopefully it’ll be OK

bnf.nice.org.uk/interaction...

[Sweetpants]

Oh oh, under drugs.com one is advised not to mix Methotrexate with Omeprazole as bad interactions. Advise you look it up yourself..

[PMRpro Ambassador in reply to Sweetpants]

That is mainly for high dose methotrexate as used in chemotherapy - which can be up to 1000mg per week compared to the usual maximum 25mg/week used in rheumatolog.

"When used as a chemo drug, methotrexate is given in medium to high doses. The dose is determined by the patient's size, the type of cancer being treated, and kidney function. Doses greater than or equal to 500 mg/m2 are considered high, while doses 50 to 500 mg/m2 are intermediate. A low dose is considered under 50 mg/m2.

When methotrexate is used to treat rheumatoid arthritis, the dose is considered low — usually starting at 7.5 to 10 mg/week. If needed, the dose can be increased incrementally up to a maximum of 25 mg/week."

verywellhealth.com/is-metho...