Best alternative to Methotrexate?

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Hi there, I'm coming up to my fifth week on methotrexate after my RA diagnosis. The plan is to start me on hydroxychloroquine at end of this month as well (staging the drugs in order to identify side effects).

But I'm struggling a fair bit with the methotrexate. Extreme fatigue which is leading to some nasty depressive thoughts and an uncomfortable nausia. At the end of the day, I could probably live with these side effects if I really had to (I.e introduce more rest time into routine etc), but it's not nice and I could be on this for a long time.

I'm guessing all the DMARDS have unpleasant side effects but I'd love to hear from people as to what they've got on with the best? (My consultant said we have options and I can try different drugs).

I know people react differently to things, but it would be interesting to hear if there's a drug that seems to be the most popular / the most preferred by RA patients.

Thanks in advance!

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9 Replies

  • Posted

    Hi Sarah, sorry to hear you are having a lot of side effects taking Methotrexate. As you said everyone has different ones.

    I have RA. Also started with Methotrexate and I have to say I had all the symptoms you have mentioned. I tried for 6 months and my joints didn't improve, so tried the Hydrox as well. Unfortunately I couldn't tolerate it. Also Sulphasalazine, the same.

    I had decided the side effects outweighed the benefits and asked for advice from the Rheumatologist, he then prescribed Benepali, which has helped a lot. Everyone reacts differently Sarah and you have to try it all to see what suits your body the most.

    Maybe if the side effects dont improve, then you may need to get more advice. I'm sure that the Rheumatologist or Nurse can help, it is hard to cope with, physically and mentally. There are a lot of people on this Forum who can advise, plus taking the same drugs as you and know what you are going through. Also R.A. Causes fatigue, plus the drugs, so please don't get despondent, we all feel like this at some point and felt better for advice on here. Good luck. 😊

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  • Posted

    Hi Sarah,

    I was diagnosed with RA 9 yrs ago and put on Methotrexate straight away. The nausea was quite bad so I switched to injections. There was an improvement in the nausea but I just felt so unwell I asked to try something else. I was offered 3 options and chose Hydroxychloroquine which has worked very well for me.Approx 8 yrs on I have been told I'm in remission and have been off my medication now for over 6 mths. No telling if things will stay this way but I'm hopeful. Good luck.

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  • Posted

    Hi Sarah. As u mentioned its ur 5th week on methotrexate. From my experience u need more time to feel some relief. In the beginning I started with 12.5mg once a week and after 15 months my physician has reduced it to 10 mg and then 7.5mg a week. So In my opinion continue this medicine under consultation with ur doctor. Plaquenil 200 mg 1 or two tabs.a day will also b very helpful in keeping ur joints from inflammation and severe pain. So wish u the very best and speedy recovery
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    • Posted

      Thanks syedq51 - will definitely give it a few more months on Methotrexate. The pain & swelling is already reducing so that's good! Wish you all the best too :-)

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  • Posted

    Hi Sarah

    I am quite a newcomer and I see it's been a little while since your question and the thoughtful responses. I hope things settled down for you.

    Methotrexate took several months to be effective for me. As well as Hydroxychloroquine, I started on oral 20mg mtx a week for some months, and then up to 30mg, then switched to subcutaneous injection, which made a big difference. Fatigue has been a varying problem. I can't clearly put the cause down to the mtx or still the RA, but it does fluctuate and I will feel it from time to time every week so far.

    I have not associated nausea with mtx, but when also on Sulfasalazine for a few weeks, nausea was bad, then I also developed a rash and it was stopped. 

    I originally took diclofenac as well and it makes me nauseaous too, so my rheumatologist changed me to Naproxen, which seems fine, when I take it, which is now not often. 

    The mtx seems to have a slow, cumulative effect. I think you need to be quite patient, and I know that is really hard. 

    Let us know how you're going. Hopefully a bit better.


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