methotrexate by injection - side effects better or worse?

[Japsquar]

After 5 months on oral methotrexate with failure to reduce below 20mg prednisolone for very long my rheumy suggests methotrexate by injection. The last week of MTX has produced worse (digestive) side effects than usual. Would they be avoided if it is injected?

[PMRCanada]

I started with weekly injections from the start and no nausea/digestive issues at all. Have heard injections are easier to process than taking it orally.

[Japsquar in reply to PMRCanada]

thanks for your quick reply, that's encouraging!

[SheffieldJane]

I asked my Rheumatologist this question and she wouldn’t commit herself. I trust her implicitly so I reckon “ it depends”.

[Japsquar in reply to SheffieldJane]

I guess I'll have to see, we're all different! Thank you

[PMRpro Ambassador]

Only one way to find out! Injections are supposed to reduce the gastric adverse effects - but who knows?

[MrsNails]

Hi - l have taken both & am now on Metoject ie the injections - l was changed over not because of digestive issues but because of possible absorption issues at 25mg MTX

The injections are much better, it by passes the digestive tract so no indigestion, it is absorbed better, it’s a lot less fiddly than taking 10x2.5mg tiny tablets. It’s quick, efficient & doesn’t hurt at all.

If you have any questions - please ask - l am always happy to help

Kind Regards

MrsN

[Japsquar in reply to MrsNails]

Thank you, that's helpful. There is absorption issue too. Are the injections weekly too and you do them yourself?

[MrsNails in reply to Japsquar]

Hi - yes weekly & yes you do them yourself - it’s very easy & straightforward.

Good Luck 🍀

[Japsquar in reply to MrsNails]

Sounds like the way forward, thank you!

[Topcar]

Hi I was switched to metoject 3months ago because of absorption and gastric issues and have had no problems since, as Mrs Nails says it's simple and painless and seems to work better too!! Fingers crossed it'll work for you if you decide to go ahead.

[PMRpro Ambassador in reply to Topcar]

It is effectively a higher dose - 100% bioavailability, tablets are always less.

[Japsquar in reply to PMRpro]

Interesting, didn't know that.

[Japsquar in reply to Topcar]

That's encouraging. Did I already say that? Losing it here!

[Bramble2000]

side effects should be less if injected

[Japsquar in reply to Bramble2000]

thanks, will give it a go!

[Louiseiw]

I spent 4 months on oral Methotrexate and the side effects were dreadful, I literally had diarrhoea for the whole time. I switched to the injection and the only side effect I have is a bruise if I am not very gentle! And I have reduced the pred from 40mg to 15mg.

[MrsNails in reply to Louiseiw]

Good to hear!

[RoomsonFire in reply to MrsNails]

hello Mrs Nails 🌞 please can you comment on my medication query from your experience, I have got down to 3 mg Pred daily and 10mg Meth injection weekly , With the usual side effects of Headache , Nausea ,

However I’m experiencing a return of pain and stiffness which isn’t disabling like 2 years ago .. but is more a problem than when I was on higher Pred - should I maybe increase Meth or Pred ? My Consultant Rhuemy said I have lost Muscle strength on Pred - suggested Physio , I feel Weak definitely and very quickly tired , Stiff too in my Hips and Shoulders - Hope Meth is still good for you , You were pleased to lose 2 stone I read in a Post From you a while back , I have gained 2 stone on Pred so would really like to lose that ! All the best dear 🥰 Michelle

[MrsNails in reply to RoomsonFire]

Hello RoomsonFire

We can’t change our dose of Methotrexate (MTX) without the go ahead from our Consultant, we can however, stop it if we are ill & you should have been advised of this.

The point of Injectable MTX is to bypass the gastric tract so you should not be suffering from nausea.

Are you on any other Medication that could be causing the nausea?

How quickly have you tapered to 3mg & from what dose? You may have overshot the ideal dose for you at the moment.

You should have a Rheumatology Helpline who can be very helpful, l personally use mine when l have a query such as yours.

I will have a look at your Bio & see what your history is & come back to you

Kind Regards

MrsN 💐

[MrsNails in reply to MrsNails]

RoomsonFire l’ve looked at your history & maybe you’ve come down a little too fast? So l think a chat with Rheumatology would be the way forward.

Let us know how you get on

MrsN

[RoomsonFire in reply to MrsNails]

Thank you Mrs Nails 🙏 I have a GP appointment on Thursday this Week , my Rhuemy Consultant has asked her to take over prescription writing , for All my Meds , But he will see me again in 6 months , I have an Acid reflux thing which I take Omeprazole for , mainly aggravated by Fats like Pastry , Which I’ve stopped eating , But as Vegetarian I still have some Cheese , I cannot have much ! I’m really bored with my Bland diet and Weight gain too - there’s not much I like except Cheese on Toast ! 😂 Summer fruits have been welcome , Summer heat has not ! I’m still plagued with Flash sweating which is horrible- On the Plus side I can get in the Bath this year 🥳👏🏻👏🏻 thanks for your support dear 🥰

[MrsNails in reply to RoomsonFire]

Good Luck 🍀

Just a side note - your GP can prescribe your MTX but not change the dose - that needs a Rheumy’s request.

[RoomsonFire in reply to MrsNails]

Thank you dear 🙏 take care 💐 Michelle x

[Japsquar in reply to Louiseiw]

That sounds awful, worse than my experience. So glad you've had success since. My target is 15 for the cataract op and 10 for a CT pet scan to see what is going on, rheumy is a bit baffled.

[Japsquar in reply to Louiseiw]

So glad for you after that experience. Encouraging! Thank you

[Myfoe]

Methotrexate was also added to my war on PMR I am also stuck at 20mg the oral methotrexate was horrible to my stomach plus diarrhea, headache, dizziness I started injections about 8 weeks ago it is much better

[Japsquar in reply to Myfoe]

Good! Sounds encouraging, hope it works for me too

[Topcar in reply to Japsquar]

I'm down to 6mg now after being stuck at 15mg ! Just need to get to 5mg if possible for my knee op 🤞

[Japsquar in reply to Topcar]

you are doing well, good luck with it all

[Topcar in reply to Japsquar]

Yes I seem to be ticking along quite well at last after a few ups and downs along the way , the trouble has been pinpointing which of my inflammatory conditions were to blame during a flare! Good luck yourself with this topsy-turvy condition 🙃

[Japsquar in reply to Topcar]

yes, it's baffling. have a happy christmas!

[Frewen1]

Hi, I've been on Methotrexate for GCA at the same time as Prednisolone for 2 and a half years... just 10 mg once a week. Can't honestly say I've had any digestive issues. I've now been given permission to remove it as of this week - I'm nearly halfway through a year's TCZ, and currently down to 7mg Pred. So for good or ill, I'm quite glad to be removing the MTX... it all seems a bit like overkill, but what do I know? Still feeling like a toxic alien. Good luck!

[Japsquar in reply to Frewen1]

Interesting that you are on TCZ as well. Toxic alien indeed, I know what you mean! But it's obviously working. Thank you

[Janetknit]

I also was switched to injections once a week. I have had tremendous success with no side effects using the injection method.

I highly recommend this as the efficiency is so much better with injections. It is very easy to give yourself the shot, no worries there! Hope you are successful with it helping you reduce your pred.

[Japsquar in reply to Janetknit]

Thank you, that's very encouraging.

[JuneWalker]

I am on my 3rd weekly injection of Methotrexate and no digestive/ stomach issues. My rheumatologist recommended the self injections instead of the tablets.