Decided to start methotrexate

My rheumatologist recommended that I begin taking methotrexate. I told her I needed some time to think about it, because methotrexate is such a powerful and potentially toxic drug. But after three weeks of research and weighing all the pros and cons, I called the doctor's office and said I wanted to go ahead and try it.

My plan is to take the first dose during the upcoming three-day weekend (due to the Labor Day holiday), so if the drug makes me sick, at least I won't miss work.

Anybody have advice on what I can expect when I first start taking it, and anything I can do to minimize the side effects? Thanks.

Congrats on taking control of your disease. I had no effects, most don't. I recommend after supper and hour or so before bed. There are tons of posts about it here so poke around.

Depending on how many pills you are starting with some take half in the morning and half later that night. check with your doc or pharmacist about splitting though....

More important star a pain /motion journal and keep close track of any changes its good info for your doc and tracking for you. as you gain motion in some joints take advantage of it and stretch or exercise those areas to regain strrength and more importantly stability. Good Luck!!!!

I take all 6 of mine just before bed time so that side effects hit me whilst I’m asleep. Saying that, I was nervous about mtx and resisted taking it for ages. Ironically I have NO side effects whatsoever (am on 15mg - nit sure that that is in US imperial). it’s taken a while to kick in but now it has (5 months) I feel good - the best in about 2 years!

I take the injectable mtx, which helps a bit to reduce side effects. It still tends to make me tired and loose my appetite a day or two each week, but making sure that I remember to take my Folic Acid really seems to help :) Good luck with it- hope it works for you.

I had the same kind of fears, so you are not alone. I have now been on it for a couple of months and I take mine half with breakfast and half with dinner. The next day I need a nap in the middle of the day, but other than that - no side effects so far. Good luck! :)

Hi I have stuck to a routine with my Methotrexate. I take the it on Saturday morning and remain standing for at least half an hour to allow the tablets time to travel down. Drink plenty of water that day and I have had no drastic side effects. I just get a little tired at the end of the afternoon but nothing too bad. I now have an increased dose and my Rheumy said to take that dose on the Sunday if I wanted to split the dose and it works great for me. Remember to take your folic acid I take mine on the Tuesday morning now which leaves a gap from taking the MTX. The main thing is to give it a go and not to look out for side effects as you may not get any like me. Good luck and hope it helps you as it does me. X

most reported side effects are due to large dosing by chemo patients.. where the dosing is usually 3-5 times higher then for PsA patients. for those poor souls, the relief provided is often well worth the potential side effects

I had the same fears and it actually took me a few months to make the decision. I am almost at 3 months. The only side effects I have had is a loss of appetite the next day (it’s not a bad thing I would love to loose a little weight lol!) a little tired, maybe slight headache. Nothing that’s unmanageable. I did try to increase my dosage and did get a few mouth sores. I increased my folic acid And am going to try to increase again this week. I really feel fine on it. I take all my tablets at bedtime. I have noticed slight improvements in my joint swelling. The one thing I have noticed is that even with slight side effects I think I feel better overall. Good luck!

I too, put off trying any drug for almost a year after my replacement surgeries. I cleaned up my diet considerably, and still feel that diet is an important factor, but was still experiencing some pain and swelling. After finding a rheumatologist I liked and came to trust, I started Methotrexate about 3 months ago. No side effects for me, I take it at night before bed. I am still on a low dose of prednisone, as Methotrexate alone didn't seem to alleviate the swelling. I guess it can take several months to really kick in. I do feel that it will work for me. I just went from 6 tabs. to 9 this month and am feeling much better. Back out hiking, kayaking and bike riding this summer and feeling much more like me! Good luck. Hope it works for you as well. Deb

Hi there,

  1. I have a hint that should stop or at least cut down on the severity of nausia with methotrexate. I had pretty close two days of nausia after injecting mtx so I asked rheumy if there was any thing I could do and he exclaimed " didn't I tell you about sucrets with DM or cough syrup with DM?". So here is the deal, suck two sucrets with DM or take two teaspoons of cough syrup with DM 24hrs before and then again one hr before your injection or pills. The secret ingrediant is the DM.It does work I hope this helps every one. I am also on an Amgen drug study for a new biologic specific to psa and hurrah! It seems to be helping. I have much less pain and am much happier.

I've been using MTX for three months now with no noticable side effects. I started with six and now take eight, once a week and just toss them all down on Sunday afternoon. I was instructed to take a folic acid pill every day, no more, no less.

The MTX has helped my PSA and made it managable. I am still taking a 5 mg. Pred everyday but am

not sure it's necessary anymore and I think my doc will be reducing the dose even more.

Good luck with your treatment.


Silver Spring, Maryland

I had active psoraisis when I finally started methotrexate, and found out I had psoriatic arthristis also. I resisted for a very long time before finally starting it. It took about 6 months for all my psorasis to go away and had no side effects except some sores on my tongue. Make sure you take folic acid, that will take care of that. After a while the metho pills was’nt taking care of my pain as well so he switched me to liquid form which is a injection you give yourself once a week. I have had no problems.

All these medications that they want us to take are in fact quite scarry, and we have to do the research, and decide what we are comfortable with. I always do my injections sunday evening. When i was taking the pills I took 12 (max dose), always take all together.

I will keep my fingers crossed for a great outcome for you. I work with kids in the schools and I have to say it is so nice to not have to answer questions regarding my large breakout on my leg and elbows. Good Luck!

I just started methotrexate 5 months ago. Taking it when you know that you have down time is a good plan. I wanted to not have trouble on the weekends, and I work from home, so opted for Sunday evenings. The response to it seems to be highly variable. The one constant is that your doctor should be prescribing folic acid along with it. . . This helps avoid the common side effects.

I started with 10mg/wk and am now on 15mg/wk. I will admit, I'm still struggling with nausea, and will be discussing this further on my next visit. It has lessened since the beginning, but is still a problem. That said, I know a few people who started around the same time as I did, with no stomach upset. I wish you luck with it.

Hello, I started Methotrexate this past friday and had some nausea on/off for three days, and felt tired. It was mild nausea with no vomiting. My problem was my pain was alot worse because I could no longer take my motrin. Talked with the rheumatologist on monday and they increased my folic acid to 2 pills a day, gave me phenergan tablets from nausea as needed, and started me on a prescription anti inflammatory medication. I have felt the best today than in a long time. She also said if the nausea reoccurs each time I take the methotrexate, then she will decrease my dose some. She explained everyone is different and sometimes it takes awhile to adjust to the medication and/or get on the right dose. I was nervous about starting it too, but am glad i did.

I haven't had any problems at all with MTX I take 8 pills a week same day with a meal and I am good to go. No issues and they keep my blood cells under control!!

I have been on mtx for about 4 months now i take 8 at a time and no side effects but i may also add no relief either still have a lot of pain and flare ups which only steroid injections can help. My consultant is thinking of trying something else that works along side mtx so i will find out next time i go xx