Adding Methotrexate for the First Time

Hello all and Happy New Year!!
I saw my rheumatologist today and I am starting on a 10 mg dose of methotrexate each week. Though I am familiar with the medication and some of the side effects I would appreciate any recommendations.

I am currently on cosentyx 300 mg and doing well but it only lasts three weeks leaving me in pain the week before my injection. My rheumatologist adding the methotrexate will help cover that gap.

Other than that, things are going very well! I hope the it’s the same for all of you and I’d love to hear how you’re doing. :heart:

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sounds like you have been given what I have somewhat, also have 10mg mtxt plus cosentyx, and so far together w sugar and gluten free am functional. A good combination! Things in Rome as usual, beautiful country and enjoying the house. So glad to hear you are fine, buon anno a tutti

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How long have you been taking Cosentyx @amielynn38? It does an horrible dip after the loading doses and for me didn’t get back up to full coverage till around calendar month 8 of taking it? Prior to that I felt like it was only working for 2 weeks out of the 4 weeks. Now it’s certainly working all the way through from dose to dose. Mxt hated me so there wasn’t ever any question of it being added in when I complained loudly Cosentyx wasn’t making the full 4 weeks. So it might be a question of just waiting it out a little longer.

Thank you @letizia. I am glad to hear the additional methotrexate is working for you as well. I could do with a trip to Rome. I am just imagining the food.

@Poo_therapy hello! I’ve been on Cosentyx for 5 months now. The 4th week, right before the next injection, is unbearable. It feels like all the good work that was done in weeks 1 to 3 is undone. It works well for my skin but Rheumy feels its not enough for the arthritis but we both agreed not to jump to a bigger injection biologic drug since Cosentyx is working so well weeks 1 to 3. I really like it, better than the other biologics I have been on in the past.
I am still thinking about the MTX. I know most of the risks and side effects. I don’t smoke, I am ok with cutting out alcohol, and we are not having more children. General health is good. I am ready to push past this small hurdle to have a better life. Feel better. We all know 2020 has been a you know what and I am not allowing myself to feel that awful again when there is something I can do about it. hugs

Hi Amielynn,

I’d just suggest what you’ve probably already read - if you take it in tablet form, it’s better to start lower (like 10mg) and work your way up, as your body does progressively get more used to it.

Then I take it at bedtime, to sleep through the worst of the side effects, if you get them. If you get fatigue and brain fog the next day, which many of us do, it is good to schedule that day as quieter if possible. Drink bucketloads of water before you take it and in the next 24 hours - keep yourself well hydrated to minimise any headaches. And take 5mg of Folic acids (prescribed by your Rheumy) every day except the day you take the MTX.

Now days, I’m not terribly religious about any of the above. I started straight on 20mg and got noticeable side effects (including nausea, headache etc both that night and the next morning), but just muscled through them as MTX was my only option, and they weren’t completely debilitating. Within a few months the side effects of nausea etc were just that night, so I pretty much slept through them then had brain fatigue and fog the next day. Within a few years, I have no side effects, except a slightly better nights sleep.

Hope it is the boost your Costenyx needs :grin:


Thanks @Jen75 . Loads of advice for sure. I was planning on taking it at night and I also read about the water intake. With food, etc. I have the folic acid ready to go.

I found out that my family has a history of having a fatty liver. My grandmother and mother both have it. I plan on calling my rheumys office on Monday to see if they want a base line liver reading before I start taking it. If not, then I will start a day next week that isn’t so busy and where I can rest the next day. That’s the hardest part!! Finding a day to rest, lol. I dont expect there to be any issue but I figured I would ask.

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liver function blood tests to be taken regularly , as in every few months or so, to monitor liver function. I also started w fatty liver, am going to have an echograph to monitor extent following low carb 2 years,

Just remember for me when I got to calendar month 8 of taking 300mg Cosentyx, it then started to give a whole month’s coverage instead of around two weeks. Now on calendar month 14 nearly 15, it’s still doing the same thankfully. I do believe it’s a real slow burner to get itself up to speed and we get awfully seduced by how wonderful the loading doses are, hence feeling the ‘dip’ is quite stark. I certainly felt that.

As regards the potential of your liver issues with mxt, I would insist on baseline blood tests and here when starting mxt (even again) you get blood initially every two weeks working up to once a month after 3 months and I believe you stay on once a month thereafter. Best of luck.

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Thank you @Poo_therapy I will do that. I may wait on the MTX and see how another 2 months of Cosentyx does. I would hate to start MTX but not need it.

@letizia You did, that is good to know. He wanted a liver panel at the 12 week mark. I will call back tomorrow.


I have been taking 15mg of methotrexate since April of 2020 and so far I have not had any side effects. I take folic acid everyday and Embrel once a week.

I cant described how much better I feel today. My only issue now is that my hands hurt more but I think that is because I feel so much better I am doing too much physical activities.

Good luck and I hope you feel better soon.


I really appreciate this question. I have PSA but now my son who is disabled ( he is 40 years old but functions at a 5 year old level) has also been diagnosed. The Dr started him on Hydroxychloraquine which helped some but wants to add Methotrexate. My son is on so many seizure meds, heart meds, tremor meds, psych meds and the list goes on. I am so worried that he will have side affects. Good luck and hope it goes smoothly for you.

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Wow, thank you!! This is very encouraging!

@cindybme I am sorry to hear that your son is now diagnosed and I would also fear side effects. I know you are working closely with his doctors and I assume they are aware of his list of medications? You are a very strong person to support yourself as well as your son who needs you so much.

I talked with my rheumy today about my family’s history of fatty liver and he said from past liver tests I do not have a fatty liver! I pan on waiting another month before starting MTX to allow the cosentyx some more time.

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Friends, try vitamin d supplements daily under dr.coimbra treatment protocol under your local country representative. It gave me good energy levels and able to give support for my psa and ps. I am also on enbrel and methotrexate as well.


Thank you. I recently added it.

I started MTX last night. Today I feel yucky. I’m happy to start it though and i hope it helps.


I hope it does too :crossed_fingers:

Thank you. Its been a rough few days but nothing I cant handle.

Injecting it will lower the side effects, such as the associated lethargy, but the biggest thing thing is being proactive on the folic acid. Since your son seems to have other health issues a Thiamine test may be something to consider. Best Wishes

Update on methotrexate:
Things are going well. Only on 10mg once a week, tablet form. It’s been about 3 months. The IG side effects aren’t too bad. Brain fog and tiredness ok to deal with. I have seen improvement. My cosentyx still doesnt cover the 4th week, so having the MTX allows to keep going before my next injection. BUT it’s not covering 100% and I am not inclined to go to a higher dose. Maybe a new biologic is in order.

I have missed wine! I havent had a drink in 3 months and though I am sleeping better, I do miss a glass here or there. It’s too hard for me to measure and keep track. Just easier to avoid.

@Keith what is a Thiamine test?

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