Methotrexate oral versus injection

I saw my rheumy yesterday and, after some discussion of my stomach/bowel issues, he suggested I may want to try injections of Methotrexate rather than oral. I generally have one to two "yucky" days the day after my dose and most of it is related to stomach issues, nausea, diarrhea, cramping, although I also get fatigue and dizziness. Some weeks I'm okay but some weeks are just not good. He felt that the fatigue and dizziness will not be helped but the gastrointestinal issues might be since injection would bypass the GI tract. Any experience with this that will help me make a decision? Thank you in advance...


Lots of us on injectable MTX have found that it helps greatly with the GI issues. The injection is really easy and painless.

This is becoming the new "standard" in treatment. Yup, few side effects and more efficacey. The "injection" is an insulin needle. I feel nothing and my granddaughter does her own. Much easier than trying to swallow a handful of horse pills. From what I can tell most here as of late inject If needles do bother you (My son was and NFL defensive end and passes out at the sight of one) there is an injector pen available now.

Thank you, Lamb and Seenie... Needles don't bother me, but when he first suggested it, I said no... Today is a BAD day and I am rethinking that, LOL!

Don’t even think twice about it…the injections are 100 times better (citation needed, lol) than the pills. The injection is a breeze- no pain, and very little side effects. I did have a little tummy trouble later on the day of the injection, but that was IT. No nausea, just a vague sort of stomach unrest. It was always gone the next day. I finally figured out to do them just before bedtime, and then I didn’t get the weird tummy thing.

Thanks... I think I will do them at night as well.

I have now done one injection. Easy...much more expensive though. I did not have any stomach issues this week, but time will tell. I had weeks on the oral that were okay too, but most weren't. They only gave me two doses (two weeks) worth. Is that normal? Going to talk to the pharmacist. Perhaps it doesn't last longer once opened??? Thanks for any info.

More expensive?????? I get 2 vials (4 doses of 1ml) for $ 28.00 there is a 5 and 10 ml bottle available too

I learned a while back to shop for MTX if you are paying out of pocket. BTW Humira folks will buy it for you on their copay program

Thanks, Lamb. I think I need to talk to the doctor about how he prescribed it so I can get a bigger bottle. I was paying $20 for three months of Metho on our insurance. This was $10 for two doses.

Thanks people, great discussion. Do you all actually experience it as being more effective? And were you told it was going to be more effective ahead of time, or did you just discover that from using it?

It may have been a year or two ago, but we had a shortage of MTX pill form. Its a real cheap drug and manufactures had huge back stocks quite a few quit making it. and suddenly there wasn't enough to go around and prices exploded. Folks started using it and it wasn't long before the reports started circulating about how much better it was. Sooner or later they started doing studies like this one:

They also learned there were fewer side effects (stomach wise anyway) Docs are doing it a couple of different ways for patients. They are starting with lower doses of the injectable and working their way up, they are starting on pills and switching to injectable, if there is problem. The docs here are using a full dose from the get go of the injectable believing it has more efficacey quicker because the blood levels build faster.

The effect has been so dramatic in fact that the FDA recently approved a new drug called Otrexup late last year and just last month another one called Rasuvo that has more dosing options. They are basically MTX autoinjectors. I didn't realize what a fantastic thing this was until this last weekend. Until I saw Dr Peggy working with a group of 7 - 10 year olds and had them autoinject as a group (it was saline) Its been a bit of a battle with my grandaughter as she has learned to inject her self, but I have to draw it up. Seeing these kids take one more step for being independent and taking control of their disease was great.

There is an advantage to drawing your own meds especially for kids in that there is less preservative therefore less sting. The littler ones in particular have a different skin pH than us so all these things sting them a bit more. Sorry That was more than you asked for.

That was actually incredibly helpful. I had read some dumb literature review study recently that suggested very little had been done in showing effectiveness of any DMARDs for treating PsA. Now I think those authors either didn't look very hard or were being paid by biologic drug manufacturers to make DMARDs look bad. Medical literature is very very biased by money.

Ah, the real question comes back to the issue of symptom control vs disease control. There are some studies that suggest that MTX (and other DMARDs) is better at treating symptoms than it is at preventing damage. I take MTX along with Enbrel.

There was a 2012 British study researchers concluded that, despite some symptomatic and cutaneous benefits, their finding of a lack of effect for synovitis meant methotrexate can't be considered to have "a true disease-modifying effect" in psoriatic arthritis patients. The went on to further document their findings with a beautiful flat graph of ESR and CRP scores that didn't change.

This pretty much some is why one has to be VERY careful doing their own research and reading studies. I'm by no means saying one shouldn't but anyone who has been around here awhile an find three things wrong with that statement (and if they they read the study several things more) Actually there is nothing right with the statement. some symptomatic and cutaneous benefits Whats the problem with a medication that reduces pain and makes your psoriasis go away? lack of effect for synovitis When did synovitis become a problem for psoriatic arthritis? The LACK of synovitis is one of the things that distinguishes PsA from other forms of arthritis. WHY didn't they study its effect on enthesitis? Thats the problem we have. Or maybe dactylitis, sponylitis and a few other itises. Then there was the issue of flat CRP scores and ESR scores. Unless you want to make your brain hurt don't go there A few of us have have elevated inflammation scores BUT most of us have not. Normal ESR and CRP are also normal for PsA. Yet that study has developed a life of its own. Rarely do you come across a site where somebody isn't saying MTX doesn't work and there are studies to prove it

MTX is also thought to stretch out the time it takes for you to develop antibodies to a biologic, so many continue it even when on a biologic that works.

For me, mtx completely cleared my skin. Wasn't quick- maybe four months or so- and my skin problems are quite mild, but boy, has it been nice to be rid of the flaking, bleeding patches.

As far as price goes, I've paid anywhere from $22 to $75 for a 10 ml. vial (a vile vial, that is!) of the lovely poison-yellow stuff.

LOL, Louise, a vile vial! I’ll remember that.

I have heard that the MTX stretching out the time that biologics work has now been validated, but I have not seen the study firsthand and it may be an error.

I know this is an old conversation, but I wanted to add my own experience. About eight or nine years ago I took the pill form of methotrexate for 6 months. It was awful. Basically from the moment that I started taking it I had nausea and it didn’t let up at all until after I stopped taking it. In reading in here I knew that if there was ever any reason for me to go back on methotrexate that I would go direct to injections. I went back on it just over a week ago. Last week I definitely had a bit of a hangover feeling, but I may not have been adequately hydrated to begin with. This time I made sure to drink more water during the day, then I injected early evening. Woke up with just a bit of extra dryness. I’m a believer!

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