I'll be starting MTX soon and am wondering what will be my best strategy as to when and how to take it.
I've read a lot of posts on various forums and frequently see these suggestions:
take it in the morning
take it before going to bed
take it with food
take it on an empty stomach
always drink lots of water
So, I'd like to hear from you MTX users what works best for you and why. Thanks ahead of time ya'll.
In terms of scheduling, some people find that they are really beat for a certain period of time after, which is the only reason why timing matters. So for some people who only get sick for the few hours right after taking it, taking it before bedtime is best.
I only used MTX for 6 months, and wound up taking it in the morning, with food, and drank lots of water. I wound up switching over to leflunomide, which worked better for me, without the nausea.
It may take a few weeks for you to get this evened out for you, in terms of how best to take it. Are you being started on a low dose and increasing?
Hi, it was suggested to me by my Rheumatologist to take the MTX in the evening when I would have at least 1 but best 2 days before I had to work. My work schedule was changed to set days so that I would get Sunday and Monday off, and so took the MTX on Saturday evening. I found the Sunday afternoon really difficult as I felt completely floored with fatigue, sick dizzy and would spend all afternoon and evening either on the sofa or in bed. Monday wasn’t too bad but often I would be back on the sofa by 4 in the afternoon.
A few weeks ago I must have had a brainstorm because I completely forgot to take my MTX on the Saturday evening. I had the injection Sunday morning instead and felt fine all day, but went to bed about 9.30pm. Slept really well and was ok on the Monday too 
So my dosing has changed to the Sunday mornings.
Originally I was on tablets but on the high doses I found nausea was a real problem for me to the point of just putting the tablets in my mouth would make me gag. The subcutaneous injections are just so much easier and side effects are reduced enormously.
Good luck with the meds
Thanks Stoney, that's helpful.
I don't know yet how the dosing schedule will go but I'm hoping for starting at a low dose.
Stoney said:
In terms of scheduling, some people find that they are really beat for a certain period of time after, which is the only reason why timing matters. So for some people who only get sick for the few hours right after taking it, taking it before bedtime is best.
I only used MTX for 6 months, and wound up taking it in the morning, with food, and drank lots of water. I wound up switching over to leflunomide, which worked better for me, without the nausea.
It may take a few weeks for you to get this evened out for you, in terms of how best to take it. Are you being started on a low dose and increasing?
I take mine on Mondays, but my doc has me do 4 tablets in am and 3 at supper. Plus I also take 2 folic acid pills a day. Not a lot of side effects except for an occasional headache on Tuesday and feeling tired. I just don't plan much for Monday evenings.
I take mine Tuesday night after dinner. I started with pills in April and switched to injections (25mg). Not everyone has side effects...unfortunately I do.
The night of and the next day are usually tough, especially when increasing the dose. Like you mention above, drink lots of water, drink ginger tea, hydrate...hydrate...hydrate. I take folic acid every day, but not on MTX days. We increased the folic acid to two pills to help with side effects.
I've started getting migraines, it has progressed from a strange eye sensation to migraines now, nausea and dizzy spells. My rheumy added sulfasalazine in September as I was still having daily pain and flares. I'm seeing my doctor tomorrow as this combo isn't working (currently having a horrible flare in my lower back :-( ) .
I started put with injections. After reading about all of the GI side effects, I asked my doc to begin me with injections and folic acid. I started 3 mg of folic acid a day one week before I started the MTX ( no one suggested this, I just thought I could have a healthy level of it in my system before starting the MTX) I started out on Saturdays, but for me it doesn’t really matter. I don’t have a whole lot of side effects aside from some fatigue. That doesn’t happen each time either. I’ve been really lucky with the MTX.
THe injections are a breeze too. The needles are so fine that I barely feel that part, and the medication doesn’t sting.