Getting Ready to Start MTX - Tips?

Since my biologic isn't helping all the way, my rheumy prescribed MTX to help it along a little more. I start this weekend and was wondering if any one has any tips. So far, from looking on here and elsewhere on the internet, I've compiled the following list:

-Take Folic acid every day, except the day of

-Drink lots of water the day before, day of, and day after (I drink lots of water anyway)

-Take anti-nausea meds about an hour before the MTX

- Instead of breaking it up into three separate doses, take it all at bedtime and try to sleep it off (I'll be taking 6 pills)

- Drink lots of gingerale and green tea w/ ginger to help with the nausea

- Try vitamin B complete to counteract the fatigue

Am I missing anything? Does anyone else have other tips to help? Anything that will help with the possible dizziness? I've read that nausea, dizziness, fatigue and headache the next day are the most common side effects.


Both Rheumatologists that I've seen tell me they don't prescribe taking Folic Acid anymore. I do take B Complex and it has Folic Acid in it but I don't take it for that reason. You should be fine with 6 pills at night. I started at 8, went up to 10 and now back to 8. I also take Prilosec everyday because the Prednisone gives me heartburn but it may also be helping with the MTX - who knows? I have had no side effects the next day.

Maybe you'll be like me, CJCB and you won't have any significant side effects. The first while I was a bit tired and I had a bad taste in my mouth. But not enough to complain about. When I told my rheumy, she said that most people don't have horrible side effects.

So don't get yourself too wound up about it, or you may just be talking yourself into trouble! Fingers crossed, here's hoping it goes well for you.



My rheumy prescribed folic acid to help with side FX, but said not to take it the day I take MTX. Only take it on the other six days. Folic acid is a MTX antagonist, she said, and if you take it the day you take MTX, it actually works against it. She told me to take MTX all in one dose at night...just like you said, so you can sleep it off. Staying hydrated really seems to help me, and some recommend a high-carb meal the evening you take it. Always eat something when you take it...even if it's just a couple of crackers. Had some GI symptoms when I first started using it, but after a few weeks, those seemed to subside. I've been using it since late summer and the only thing I notice now is some fatigue the day after my dose. It's really not as big a deal as I anticipated. I was scared of the hair loss thing because I don't have that much hair to begin with. lol But that hasn't happened. I hope it works great for you and that your side FX are few! Keep us posted!

I agree with all of the above tips you have, taking it all at one time right before bedtime is the best tip of all! but the other tip is to eat a somewhat healthy full meal, I have noticed that it I eat anything greasy I feel worse the next day so I try and eat something light fut filling and healthy. good luck!

Thanks for all the helpful tips. I'll keep my fingers crossed that I'm worrying for nothing and I won't have any issues.

Yuck, yeah that made me soooooo sick at first. But looks like you've got a great plan to combat it. ^__^ Best of luck!

It's not making me sick yet. The biggest thing so far was feeling exhausted on Sunday and sleeping all day. That and being incredibly thirsty. Every time I woke up I was dying of thirst. Today was a little better, still a little tired and once in a while a little lightheaded, but nothing major; I was at least able to make it through a full day of work. The biggest thing I noticed is that I have almost no pain - just a little in my left hand and a tiny twinge off and on in my right shoulder - oh, and I feel horribly bloated all over (maybe from all the extra water?)


Glad to hear you are having few side effects with the MTX. I still get that feeling of tiredness the day after taking MTX, but I think that is getting better with time. Hope things continue to go well for you. Keep us updated!

Definitely will keep you updated. I'm over the moon cause I've actually had a couple of almost pain free days! Enjoying it while it lasts! Of course, makes me think of the Joan Crawford twilight zone, where she's blind and can see for just a second.