Methotrexate

General
1

Does anyone have trouble functioning the day after taking methotrexate?

I had problems taking the methotrexate pills, so my doctor switched me to 1 ml of methotrexate which I inject subcutaneously every Friday. I find now that Saturdays are very difficult. I'm completely wiped out and all I want to do is sleep. I also suffer from chronic migraines, and it seems that my headaches are worse the day after mx.

I take my Enbrel on sundays, and I don't have the same fatigue after that injection. I'd love to hear how you all do with mx. It's just so frustrating to lose part of my weekend every week, but I found that if I take it during the week, it completely messes me up for work.

2

I hate to say it, but I think its kind of par for the course with Methotrexate, although it does affect people differently. I know for me, I get a bad headache, and pretty much feel like I have been run over by a truck, and all I wanna do is sleep for a day or two. ALTHOUGH, I have to say that the longer I take Methotrexate, the side effects to seem to be slowly improving, so I guess there is still hope.

3

You are right Dani it does seem to be par for the course with MTX. I take mine on Sat night and all day Sun is pretty much a waste, the truck hit is a good description. I also say that I have the flu one day every week. I can feel like I want to sleep all day, have a low grade temp and upset stomach. I don't have the headache but everything else gives those to me. Go figure.

Ibeth: Taking them at night has helped with my nausea though. I guess I sleep through that part and now by Mon I am ok. Just a thought if you are taking them in the am.

4

Hi
I have to say my first month of MTX I felt a little tired, slight headache and no appetite. I am one who totally feared MTX. I could have had every fide effect just because I read about them. But I really did ok. I font feel like I loosing a day. That being said I did try to increase my dose from 10mg to 12.5 and did get the sores in my mouth and kind of feeling think swollen glands. I went back to 10 mg and increased my folic acid. I now on week 9 and feel ok. Maybe still loss of appetite for a day. I have fatigue with PsA so I don’t think I am more tired. I know I am on a low dosage and hoping I see some improvement soon. My hands are pretty swollen and painful. I know I will have to try and increase again. But I don’t fear MTX like I did before. If I can get some relief on this dosage life will be good :). So I would say also the side effects go lessen as time goes on. Just hoping I start seeing some benefits. Just curious what dosage you are on?

5

I am on 20 mg. Started there and my Rheumatologist has not changed it at all.

6

So thinking my 10 mg isn’t much. I can see how 20 may make you feel worse. 10 is tolerable for me. Hoping I see some relief on 10. Wishful thinking maybe :slight_smile:

7

In the beginning the MTX made me feel completely worthless for the following 24-48 hours. After almost year I tolerate it better but don't sleep well the night i take it, and feel out of sorts the following day. I also take my Enbrel injection on Monday's which as I mentioned before has made me feel oodles better. But sadly the last few weeks i feel horrible...I feel like I have the flu and ache everywhere. My joints (knees, hands, hips, elbows) just burn and ache. non-stop. take advil and Celebrex to ease the ache, but nothing is helping. I am hoping this passes.I am so tired i can just sleep but does not make me feel any better. Seems my pain ebbs and flows, so hope this shall too. Is this what it is like? Is this normal? Are the meds working or is it time to call the Rheumy? thoughts?

8

I have been on MTX for almost a year, and I used to say that I had no effects of any kind from it, good or bad. But lately, I've noticed that I am tiiiiiired for a day or so after my weekly dose. I think it's because I'm on a new anti-depressant, which is doing good things for me, and these days, instead of being dead tired 7 days a week, I'm only exhausted 1 or 2. And it's always right after MTX. This, apparently is one of the more common side effects of the drug.

PS, I'm on 25 mg, injectable

9

I don’t sleep well the night I take it either. Thought it was anxiety…maybe not? I assumed I was tired because I didn’t sleep well.

10

Well here are my MTX lessons learned: the side affects do get better over time. I used to be totally incapacitated- now not too bad at all

  • I take the shot too 25mg! The pills are horrid for me.
  • take it about 6-7 pm on a full stomach
  • drink 7 seas worth of water all week ( I am not kidding). If you aren’t in the bathroom at least every 2 hours drink more!
  • 1 mg of folic acid and a multivitamin every evening
  • the following day eat really good food; lots of proteins and plan an easy morning
  • lukewarm green tea if you get mouth ulcers
  • no sun- wear hats, bathe in sunscreen- if you get too much sun it makes the tired feeling worse because u sunburn so easily ( I live in San Diego)

I will still feel a bit sluggish the next day unit noon, but this routine has meant it doesn’t drag for 2 days!
I have migraine disease too and I take a daily preventative- makes a big difference.

11

I take 20mg of pills at about 8pm, makes for a great nights sleep, as long as I don’t wake up (with a piercing headache - then tramadol is about the only thing that will get me back to sleep, or at least all they’ll prescribe for me!), though it still feels like I’ve only had 5 hours. Like having a hangover the next day - make sure you drink heaps of water, it really does make a difference.

The MTX though, does have different side effects to Enbrel.

There are many wise souls on here, including 2trees (fear the disease, not the meds - hopefully the reason she hasn’t been so active lately is because she’s in remission!), and tntlamb, or just Lamb, who is a statistician ( so he says - and I believe), and is very good at reminding us of the relative side effects of each med (worst NSAID, next MTX, then other DMARDS, lowest side effects, biologics).

I take MTX, because I don’t yet have access to any of the biologics (though that will change next week), and MTX is the only thing (apart from steroids, which I also take lots of - and they aren’t even on the list because they are so bad) to touch it so far.

Anyway, this is a very long way of saying, don’t be more frightened of MTX than the disease, but really, if you are already getting good success with the Enbrel, maybe it’s time to drop the MTX and see what happens?

I’ve had some very major concerns about MTX, but haven’t found a great article that summarized them in somewhat meaningful terms without resorting to gobbledygook, but still had a reasonable scientific basis until just recently. Finally I’ve found it, so here’s the web location;

http://m.rheumatology.oxfordjournals.org/content/47/7/939.full

I still take MTX, but I think it’s very important to have an understanding of your own choices.

If Enbrel works for me, I’ll be dropping MTX like a hot potato!

12

Thanks, everyone, for your great replies. Nice to know that I'm not alone.

I'm a teacher and I've been on summer break for the past 8 weeks. It's been so nice to be able to nap when I want to, and just be home to relax. I am already stressing about going back to work on Monday. Not a good sign. I have a very physically demanding job: I teach orchestra at 10 elementary schools, travel to two every day. I teach about 8 classes a day. It's not the kind of job that lets me just take it a little easy if I'm having a rough day...I have to be "on" all the time. When I was diagnosed in 2010, I ended up taking a year off to get things under control. I went back last year, full time, and ended up asking my rheumy for a note to let me work for only 4 days a week. When I ran out of days, and had to go back, I ended up taking lots of sick days for which I was docked. I just don't want to have another year like that again. My colleauges kind of understand, but I don't think they truly get how exhausting this disease can be and what a toll it can take on one's body. They think that once the meds work, I will be fine. I don't EVER feel FINE. So depressing. I've been teaching for 24 years and love what I do; the thought of not being able to do it again is heartbreaking. And, to make it worse, my husband is currently unemployed, so I can't just leave my job right now. So much stress, which I feel doesn't help any. It's so nice to be able to talk to a group who is going through the same thing that I am. Thank you all for being there for me!

13

That is a good point about the MTX - you may you need it for a short period of time too just to get things under control - I think that is why in part my doc hit me with everything - in hopes of pushing back on the disease hard, I get my blood drawn every month to check my liver. I also take anti- seizure meds because I have a type of migraine called a BAM. Without the anti- seizure meds I don’t function. It is really bad for liver. My hope is to lose the MTX soon. I know the Enbrel is for life unless a miracle occurs!

So an option might be to take it for a defined period of time with blood monitoring and then stop.

Agree the steroid are,the worst- I feel so good on them but they are so bad for your body on the long term.

14

I am on oral mtx and that alone but you are describing me to a T. I take my meds on Friday afternoon and Saturday and most of Sunday are a loss. Being wipedout is exactly how I describe it to my family and friends when they ask me to do something. I don't take it during the week precisely because of what you said. I never had headaches but have them after my dosage. My joint pain is even worse the first few days. How about yours? Will your rheumy let you take Enbrel alone? Hang in there!