Advice for nausea from methotrexate

Hey all. Wondering what things people do to get rid of the nausea caused by methotrexate? I take it on a Friday night as advised my by doc, but Saturday is usually awful with headaches and nausea until around 3pm. I feel pretty bad for the majority of Saturday. Sunday is better but still some residual nausea. Have tried natural things like ginger tea with not much difference.

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Just confirming you are taking folate? If so what dose when?

I think others will know more than I, as my nausea was usually cleared by lunchtime next day (after taking it in the evening), so I just ignored it till it went away (it does over time for most people). Will need to hear about your folate though to be most helpful :grin:

Yes I take the folate on all the other days. I used to take the methotrexate in morning but nausea was much worse. Dr suggested to rake it at night. Nausea as mentioned above.

Hi there @LoganJ, just wondering if you have tried drinking heaps of water when you take your Mtx and the next day? That seems to help too… I had a few minor SE’s when I first started Mtx and remember needing to reduce the dose for a few weeks (on doctors advice) then when we increased the dose again the SE’s weren’t an issue… might be something to discuss with your doc if the nausea doesn’t settle for you… it might prove to be worth hanging in there with it if you can, I have definitely had improvement with it (although it is not enough on it’s own for me, it might prove to be for you).

All the best with getting it sorted out, there is enough to contend with just from the PsA without having SE’s to cope with too.

Thanks for that clarification - yes, at least you have a doc on the ball, night does seem to be better for those of us who get nausea.

Janson has a good point - with MTX the side-effects seem to be directly related to dose for most of us, but also reduce over time, so one option is to reduce the dose (say by half) then slowly titrate up.

Another option is to take by injection - I haven’t tried this because MTX hasn’t been so troublesome for me, but others have said this helps them.

Still another option would be anti-nausea meds. I personally wouldn’t go down this road unless the MTX was working really well on every other score - not a fan of taking meds to deal with the side effects of meds… but it’s up to you to decide this with your doc if you want to talk about it. I had Maxolon in my medical kit for other reasons, and when it was bad at the very start (I commenced on 20mg MTX in the morning, on a day I had to go to work), I used the Maxolon and it worked.

Like you, I didn’t find ginger did much, nor peppermint, despite it having sometimes previously worked for IBS type nausea.

I do think it’s important that you tell your Rheumy and/or GP what’s going on. If it’s debilitating and stays that way, it is really worth talking about other medication options.

Thanks heaps for the responses. I am currently on 20mg methotrexate. I commenced Simponi last month about to have my second injection on Saturday. Maybe I might not have to stay on methotrexate long term. Seems as if Simponi has made an impact. Swelling reduces and fatigue not as severe.

Dropping the MTX to 10mg, in combination with a biologic, meant I didn’t notice the side effects mech at all the next day, but I could still take it.

Switch to injections…

I’m a big fan of the anti-nausea med zofran (generic ondansetron). It was originally developed to help off set nausea from chemo meds so it has very little interaction with other meds. It comes in tabs and melt tabs and it’s pretty cheap.

I’m usually not a fan of taking one med to offset the side effects of another med unless it’s nausea. Usually nausea is a short term issue, you should adjust out of it, until then, anti-nausea meds are a huge help.


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I was given Ondansetron tablets for nausea/vomiting. I take ginger lozenges as well and have found accupressure points really effective. Accupressure (I googled accupressure for Psoriatic Arthr., and mentioned what it was for, i.e pain etc,), is great at night when nausea wakes you up and you don’t want to drink water and take pills. Hope you find some relief-nausea has to be the thing I hate more than the pain.

Zofran worked great for me but also try sniffing an alcohol pad when the nausea starts.

Switch to injections.

Oh my goodness. I hope they do not have you on MTX without Folic Acid. I cannot imagine what the nausea level would be without it.

I was on a high level of folic acid and still got extremely sick with it, as well. Unfortunately I am not sure what to recommend. It did more damage than assist and I got off of it pretty quickly. :persevere: Have you tried a bit of raw, organic honey on your tongue? This seems to help me when Ginger-ale and other things don’t. I sure hope you can find relief soon.

I just noticed what @DrunkenBear wrote, and remembered this. The alcohol pad my sound weird, but apparently there are some good recent studies showing it’s almost as effective as Zofran and other medications used in ER - a nurse friend of mine shared them with me.

Many ERs now use alcohol pads for nausea before going for Zofran.
EMTs have known about it for quite a while.

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Thanks everyone. I will chat with specialist when I see her to discuss my options. I’d love not to take methotrexate anymore.

Yes, I think it’s worth a chat. I had a quick read of the Simponi info and note that they did not trial it with MTX, so it’s impossible to tell if the MTX is likely to have an effect on its usefulness. If states it can be used either alone or in combination.

MTX did drop the likelihood of developing anti-Simponi antibodies from 7% to 2%

A couple other things that I’ve used for nausea THC and/or CBD.
I’ve talked with my Rhumatologist about both, he’s not exactly an advocate, but he’s never said anything negative about them either.
For myself I’ve found help with other symptoms as well.
Since being diagnosed and on MTX, then Enbrel and now Remicade, I’ve been having very bad, almost debilitating anxiety. I switched from Sativas to Indica strains and it helps my anxiety.
Indica also helps me to sleep better.
Also helps my joint and tendon pain.

I’m fortunate that I live in Oregon and Cannabis is legal here.
I have a dispensary right across the street and I can usually get whatever I need.
I’m hoping to be moving to a larger place where I can grow my own soon.