Starting Methotrexate

Hi, I am starting methotrexate next week. Any words of wisdom on what to expect and helpful hints

Starting it tonight. A little scared, but hoping this is the answer to help my swelling and pain in my hands and feet

Just to let you know, that no nausea this morning, but I am a little dizzy. Like a bad hangover LOL

I am on 4 pills right now, and in 2 weeks i up it to 6. I am on 1mg folic acid a day.

One piece of advice is to give it chance to work, the side effects can be very unpleasant at first but these do reduce with time and it's usually worth it.

If you find that it is beneficial in terms of lowering disease activity, but the side effects (esp. bad stomach) are not tolerable, you can switch to subcutaneous injections which generally speaking result in reduced severity of side-effects.

I took MTX for about 2 years, 6 months oral and then for a while injecting, but stopped after a few months of Anti-TNF (Enbrel) treatment as I didn't feel it worth carrying on.

Regarding Alcohol and MTX (if this is relavent to you), every region has a different piece of advice and it's best to come to your own conclusions on this. Some docs suggest total abstinence, but my rheumatologists (3 or 4 of them) say it's generally not a problem. There is confusion on both sides and no-one really knows how bad the combination is for the liver. My opinion is that although MTX can cause liver toxicity, alcohol is unlikely to increase this risk unless it's consumed in excess.

Remember not to take the folic acid on the day you take the MTX, I was terrible at keeping up with it, but its advisable!

Also remember to have regular blood work - your doc may or may not chase you to do this after a few months, but it is very important that you keep an eye on everything.

I hope you find some relief from it, good luck!


James

Oh really? There's a lot of variation in what is considered standard procedure it seems - every pharmacist who has ever given it to me has insisted upon this this, and any doctor I've seen has made a point of telling me not to take folic acid on the day I take MTX.

The following information is from the British Society of Gastroenterology:

Folic acid treatment : Folic acid reduces the toxicity of methotrexate treatment and
improves continuation of therapy and compliance. Folic acid should be taken ONCE
weekly, but SHOULD NOT be taken on the same day as the methotrexate.

(Note I was actually told to take Folic Acid 6 times per week, the trend seems to be that newer documents suggest larger doses of folic acid, but this would be potentially detrimental at the same time as the MTX)

and Arthritis Research UK fail to clarify how important (if at all?) this is:

Most doctors prescribe folic acid tablets to patients who are taking methotrexate as this can reduce the likelihood of side-effects. It is often recommended that folic acid should be taken once a week only; some doctors advise that it should not be taken on the same day as methotrexate.

- so basically it depends on the pedigree of the prescribing physician from what I've gathered...

Biologically speaking, it would make sense not to take folic acid and methotrexate together as it will inhibit the treatments effectiveness for no extra benefit.

That said, I'm not a physician - so do exactly what the docs told you to do - but it's something you could ask him/her about.

james