Methotrexate Timing

Posted , 9 users are following.

Hi all,

Having taken advice from the fantastic folk in the forum, I had an urgent Rheumy nurse review ON Friday and have been prescribed Methotrexate. I have been advised to wait until Monday before taking it and that I should take it at tea time. I didn't think to ask why at tea time....... Can anyone advise why it would be at tea time and whether I should take it before, with or after food?

Thanks

Anthony

1 like, 15 replies

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15 Replies

  • Posted

    To soften the blow Anthony! 

    It can be tough on the digestion, take with food. As with many of these things, everyone may react differently. I persevered with oral for a number of months, then switched to injections. I have adapted to injections better than I did to the tablets, and it seems to have been more effective against my symptoms. 

    Hang in there, good luck and be patient... but not too patient... :-S 

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    • Posted

      Hi Blair,

      Thanks for the reply, advice and benefit of your experience. I'll take with food at tea time tomorrow and see how I go. I kept hoping I'd get away with methotrexate but given that my heels haven't stopped giving me pain all day and my hips being not much better, I can't get away with it. Think I just need to accept I have RA, suck it up and get on with it 😂. With any luck the effects of codeine might be balanced out by the methotrexate and bring some balance...... I can live in hope 🤣😂.

      I'll post how it goes.....

      Thanks again,

      Anthony

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    • Posted

      Hi there George. I was not initially offered a choice, although from my own research (a desperately intensive period prior to and immediately following my diagnosis) I was aware some people used them. After I had got up to about 25mg on tablets, my symptoms were still not great. The rheumatologist asked if I would prefer to try injections in the hope of a better response, or up the dose. I was really keen to give my guts a break, so I opted for injections. 

      In some countries there is a self administering spring loaded pen device.

      I’m in New Zealand, and the pens are not offered. However I get pre-filled syringes and self-administer. It is very easy. Grab a pinch of skin, stick it in and inject. I follow a 4 week rotation - right side of stomach, left side of stomach, left thigh, right thigh... then back to stomach. 

      The first time was the teeth-clenching moment. It’s a pretty healthy fear I expect, against sticking something into oneself, and I had to take a few breaths and get to grips with my aversion to what I had to do. Then I did it, the silly tiny fine short needle was seriously not painful, and I felt a little foolish at my fear. So now it is easy. Monday morning each week I get on with it. I had a sharps container on the dresser for the used syringes. Fills up over about 3 months. I still have 5mg folic acid each Friday. 

      So in short, more direct, easier on the guts. I’m happy with it.

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    • Posted

      Hi Blair,

      I'm hopeful to sticking with oral meds but open to whatever happens and turns out to be effective...... If injection turns out to be the way then I'll have to get used to it......itll add to this 'interesting' ride😂🤣

      Thanks again,

      Anthony

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    • Posted

      Hi Anthony,

      I started with Methotrexate tablets along with folic acid tablets the day after. My prescription was the same dose of methotrexate as folic acid. By the time I was taking 25mgs Meth and 25mgs Folic acid weekly I was getting the only side effect I ever had which  was nausea. The anti nausea meds  meant I only had 2 bad days.

      After 3 years of this I thankfully moved address and the first thing my new Consultant said was why are you not on injections. Started them and not a side effect since.

      Not sure where you live but in UK I think anti nausea meds are standard. When you start the methotrexate I would certainly ask for something for nausea as early as possible if you start with it. I kept going as I thought things would get better. It's a great treatment and I can tell when I haven't taken it. I also have a blood test every month to check liver and kidney as well as inflammatory rate.

      Sorry this is such a rambling reply but I have been living with RA for around 15 years. I wish you all the best with your new treatment.

      Elspeth 

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  • Posted

    I'm on methotrexate injections I take mine before bed. Take a me couple days for side affects to wear off xx

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    • Posted

      Hi Sarah,

      Oh dear....... My Rheumy nurses suggestion of Monday may need to change then, I don't work Mondays so Tuesday is my Monday and probably the height of the side effects (I'll know by this evening I guess).

      Thanks for the reply, it's really helpful info.

      Anthony

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    • Posted

      Don’t get too stressed about potential side effects, take things as they come. We all respond our own way. For example I didn’t notice a great deal of weight change taking prednisone, you are responding in a different way. I couldn’t tolerate sulfasalazine, others on here take it for years. You just have to go through a bit of a process to see how things work out for you. If you get worried use your health professionals.
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    • Posted

      Sarah,  ask your doctor but do you not think that taking methotrexate before bed would be hard on your system.    I take my eight pills on a Friday prior to our main meal, dinner, ( tea time in UK ). I have absolutely no side effects possibly because of being taken with food !
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  • Posted

    MTX, ONCE a Week, and then remember your Folic acid on the two days following, as the MTX does a lot of damage to B group vitamins in your body, and you need to replace, therefore the folic acid.

    For me I was taking my MTX on Friday, that gave me the weekend to get over any side effects, if any.

    How big a dose has she started you on, I was started on 10mg, am now on 35mg weekly.

    After my dose was upped month after month, and my inflammation levels stayed the same, I was asked to have a blood test the day after I had taken the tablets, to see how much MTX was in my bloodstream, nowhere near the doseI had taken, apparently I was not taking it up via my stomach, so that's why I was changed over to injections, I just inject into the front of my upper leg, easiest to reach for me when I am seated.

    Should work, but are you going to be one of unlucky ones whose liver does not like the MTX, and or you cannot tolerate side effects.

    From experience I have gone through the chemists shop of medicines, in 15 years, some give me rashes, others have spiked my blood pressure so high dangerous, others make me itch like crazy.

    Between specialist and myself we have worked out what works and what doesn't, my GP watches my bloods monthly, and I know what my levels are, and if its new GP, I ask what my ESR and CRP levels are, they are my indicator if I am on the right track with meds, I only see the specialist every six months now, and she usually asks if I think my bloods are high or low, I can usually tell her, this time I think they are up a little, seeing her in the next couple of weeks, so we will see, as they were very low 6 months ago. but she changed my meds, dropped dosage of some.

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    • Posted

      Hi Lynn,

      I'm starting on 15mg and they're expecting to increase it in a month. I've got the folic acid and I'm working to change my diet (I needed to in any case but the steroids have increased my weight by a kilo in just 3 weeks). Sounds like my blood pressure will need monitoring closely.... I already have meds for that. I cut out alcohol about 3 weeks ago in anticipation of methotrexate in the knowledge that it can exacerbate any impact the methotrexate may have.

      I have blood cards for just under 2 weeks from now and then 4 weeks from now so they're planning on reasonably close monitoring.

      You sound like you have built up a fantastic knowledge and awareness of what RA and methotrexate is doing to you and for you...... I aim to get there so I control it, not it controlling me.

      Thanks for your help and advice, it's much appreciated 😀

      Anthony

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    • Posted

      Try cutting  out all wheat for a day, and see if you feel better, ridiculous I know, only took me 15 years to figure out I am sensitive to wheat products, a big part of my arthiritis, but come back not sensitive or celiac in Dr's tests.

      I noticed about 6 hours after no toast for breakfast that my shoulders that had been very sore in the weeks running up to my experiement were not as sore and painful, as I nearly went mad trying to find something to eat instead of anything with wheat in it, so have been eating far more fruit than is good for me, but the lack of wheat has helped.

      Is it worth a try in your case, what harm can it do, find something else to eat, rice, oats (although apparently some are still sensitive to part of oats so treat with caution), I have a cook up of rice in the morning, so rice with some kind of sauce for lunch, or salads, or a fried rice, again for dinner, and a rice type pudding for breakfast the following morning.

      Hope this some help for you let me know as I find it fascinating that lack of wheat has worked for me, I have reintroduced wheat, and I feel the worse for it, have reported this to my rheumo, and her reaction a shrug of shoulders, but other than that my ESR & CRP have never been lower.

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    • Posted

      Hi Lynn,

      That's really helpful thanks. I have been trying to eat more omega 3 foods over recent days (I have to start at some point and Fridays Rheumy nurse appointment was the starting point for change). I have also bought in more whole foods, nuts and seeds and veg that are good for anti oxidents. I'll build in about wheat reduction and see how it goes.

      I figure drugs and exercise can't be the only areas of attack to keep the worst of this at bay.

      Thanks again,

      Anthony

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    • Posted

      I used to have injections, 25mg but had to stop as my liver function became elevated. Now take 7.5mg tablets, but was always told to take one folic acid every day EXCEPT Methotrexate day.
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