Side effect of methotrexate?

[JanW]

For those of you who take mtx, what, if any, side effects have you noticed. How soon to the start after you take your weekly dose and how long do they last? My first dose will be tomorrow -- not on pred or any other WG drugs. Am starting with 10 mg. Already have folic acid on board for nausea.

[Sangye]

I was only on mtx a couple months so my experience is probably not useful.

Taking folic acid is necessary because mtx depletes it. I don't think it has anything to do with nausea, but could certainly be wrong about that!

[JanW]

Dr. Yee said that it was definitely to stop nausea, which is apparently quite prevalent with mtx, and my search on the internet revealed a meta study from Britian that showed it was actually as effective as expensive anti-emetics. Funny, he never mentioned that folate was depleted with mtx!

[Sangye]

That's great info to know.

Yes, the mechanism of action for mtx is that it interrupts folic acid activation. Without that activation, cells can't multiply. This is why it's used for chemo.

[snooz23]

I started at 10mg and slowly made my way to 25mg which I will stay at for quite some time. I may have it a bit different because I am also on pred. and tapering from that now (currently at 9mg). There is no doubt my body goes into sort of a hibernation yet hyper sensitive mode for 1-3 days after I take it. That's why I always take it over the weekend, so I am prepared to go back to work each week. The first few weeks I described it as being flattened out (almost like) ran over by a car. Now I am really tired and need several naps just after taking it. Nausea hits me every now and again (probably every other weekend). I am also taking the folic acid daily but have not noticed that to take away the sick feeling. I also just feel a lot more achy and uncomfortable for 1-3 days. By Wed. or Thurs. I am usually feeling pretty good again, but then I just have to strip the body down again on Friday. My husband always comments how unfortunate it is that this disease actually needs you to break your body down so far that regular ailments feel much, much worse. I am definitely no long in pain but I do have lots of discomfort on a daily basis (which I am hoping will disappear when remission and possibly treatment is complete).

[Brooke]

I have been on methotrexate for a couple of months now. I too started off on 10 mg the first week ( I did not notice any side effects), then the following week I was on 15 mg ( I did not notice any side effects), then the following week I started the 25 mg ( I threw up a few times that night, after that I felt fine.) I still feel fine after taking methotrexate. I take my pills every Monday around 3 pm About to take them now.

[JanW]

Thanks, snooz that was helpful. My doctor, who doesn't prohibit light social drinking when taking mtx, suggests that patients take it midweek, since, presumeably more people like to enjoy a drink or two on the weekends, vs. midweek. I guess we'll see when I take the pills -- I don't have much on my schedule for tomorrow. Do you break it up on take them all at once.

[JanW]

Do you take folic acid as well, Brooke?

[Brooke]

Jan ~ Yes I am on folic acid and also 20 mg of prednisone, bactrim, and zoloft.

[JanW]

I think, like Sangye said in a different thread, 60 mg pred and cytoxin is "standard of care" in cases of lifethreatening Wegs, and every other situation is likely what about what the doctor wants to do/try. My doc was very clear that there is a possibility that mtx may not work or might not be tolerated by me, and that we would have to try something (likely rtx). If my condition stays as is, no plans for steroids, however.