Average dose of MTX

[NicShaf]

Just wondering, what is the average dose of MTX? My rheumy is starting me on 2.5mg per week, is this high or low? should I expect it to go up from here, or will I be at this dose for a while?

Thanks,
Nicole

[Chris G]

2.5mg per week sounds, pardon me for saying this, but ridiculously low. Yes, they usually taper us up to a maintenance dose, be even so, they usually start at 10mg per week. When I was started on it.......week 1 was 10 mg, week 2 was 15mg, and week 3 was 20mg (which was to be my maintenance dose). After that we increased it to 25, and then 30 because we were not seeing results.

Average maint dose is usally 20-30mg per week.

[Lightwarrior]

Just wondering, what is the average dose of MTX? My rheumy is starting me on 2.5mg per week, is this high or low? should I expect it to go up from here, or will I be at this dose for a while?

Thanks,
Nicole

I started on 25mg a week and have had to drop to 15mg (six 2.5mg tablets) due to dropping my WBC)

[NicShaf]

I'm a dork! I misread my doctors email...I haven't picked up my prescription yet, so don't worry, I didn't do anything wrong yet:) I'm sure the pharmacist would have straightened me out.

It says 2.5mg tablets x 3 tablets once a week....does 7.5mg sound better?

[NicShaf]

Not sure if this also makes a difference...I haven't shown sypmtoms of Wegs for a long time, been on CTX for a year...been on 25mg CTX for about 10 weeks now.

[Chris G]

7.5mg mtx sounds like a more reasonable starting point. What does it say about increasing weekly? What will be your maintenance dose?

[NicShaf]

That is why I was asking, he didn't mention increasing my dose in his email, and so I didn't know what his plan was...I'm trying to read his mind a little. I see him in two weeks, so it seems that maybe he would like to see how I'm doing and discuss it in person at my next appointment. Thanks for all the input, now I know what questions I'm asking when I do see him.

[Chris G]

If you're seeing him in 2 weeks, he'll tell you what to do next in person. That's way better than via email :smile1:

I suspect he'll put you on a maintenance dose of 20ish. That seems to be where they like to start. Good luck with it!!

[Dryhill]

I am on 1.2g CTX infusion every three weeks which is not working and whilst waiting for funding to be agreed so I can have RTX, I have also been having 20mg of MTX every week.

Jim

[Thakator]

Hi Nicole,
Chris has it right (per my experience and study); start low like 7.5mg for a few weeks and move up steadily to the 20's then hold there. Ron

[mishb]

I'm the same,

I started on 10mg and then the next month when I saw my rheumy I went up to 15mg and held there for about three months and then went up to 20mg and have been there for a few months and will probably stay there.

My rheumy said that the max is about 50mg and therefore most like to keep their patients at the half way point of around 20 if possible, like Ron said.

I hope you take well to it

[maria garcia]

A year on CTX ! I have heard is a very powerful drug but more side effect than MTX? Did you have alot of side effects?

[JanW]

Started at 10 mg, next week 15 mg, went up from there to 17.5 mg, and backed down slowly over the course of six months after having been in remission at 17.5 for close to a year. Now at 5 mg. No pred.

[gunnyl]

Off CTX for two weeks now. On 20mg MTX and 5mg Pred. Been flaring in my ears a lot since stopping the CTX and yesterday had awful pain in my knees. I hope the MTX takes hold soon, I don't want to go backwards anymore!! Is it common to flare during the transition? My labs looked good last week but I'm not feeling as good as the labs looked!
GL

[Sangye]

When I transitioned to mtx I was kept on ctx. As we lowered the ctx dose we increased the mtx dose. I don't think it's typical to be off the ctx completely, especially since the mtx takes a few weeks to kick in.

[JanW]

I was told when starting mtx it would take at least 4-6 weeks to notice any difference. It ended up putting me into remission pretty quickly.

[Lightwarrior]

When I transitioned to mtx I was kept on ctx. As we lowered the ctx dose we increased the mtx dose. I don't think it's typical to be off the ctx completely, especially since the mtx takes a few weeks to kick in.

That is exactly how I transitioned from ctx to mtx

[NicShaf]

I was already on a pretty low dose of CTX before starting MTX, 25mg. I've heard of people doing it both ways. Just curious, if it takes a couple weeks to kick in, could the CTX also take a couple weeks to be out of your system?
Either way, I'm feeling pretty good. I have a little nausea on the first day and the day after I take it, then it gets better, is that to be expected?

I thought a year of CTX was pretty standard? Especially since I had lung involvement? I know some people are lucky enough to be on it for 6 months, and the "old school" way is about 2 years, so I thought a year was pretty even ground...

[Lightwarrior]

Nicole,
I was on ctx @ 250mg a day for 15 months. I heard that ctx always stays in your system??

[JanW]

When I was at the Symposium a couple of years ago they said standard of care should be no longer than six months.

[pberggren1]

My doc told me no longer that 3 months for ctx unless absolutely neccessary.

[NicShaf]

Well, what's done is done now, all I can do is move forward.

Wow, 250mg of Cytoxan? I can't imagine that. I was at 150mg at my max dose and that was pretty tough to get through.

[Kami]

I was started on 15 mg MTX weekly (tapering pred from 60 to 0) , was on it for about a year and I flared, March of 2011. Increased my MTX to 20 mg MTX did 4 Rituxan in May and started 20 mg Pred.

Now just on 20 MTX, hoping I don't flare.

I read that the maintenance dose for MTX is around 18 - 20 mg weekly for WG.

[HopeinTN]

I have been on Cytoxan since October and they say I should plan on 1 year, and I only have lung involvement (both lungs). I will have my first post Cytoxan CT scan at the end of March. Not sure what my next drug of choice will be but are most of the maintenance drugs taken orally?

Thanks

[Sangye]

Hope, they should not automatically be keeping you on ctx for a year. That is outdated thinking. Ctx should induce remission within 6 months. If it doesn't, it might not be the right drug for you.

[HopeinTN]

Thanks Sangye. We'll know more next month. I posted this in a new thread to get input as well. Hopefully we'll know more then.

[pberggren1]

Ctx any longer than 3 months is quite dangerous and wreckless.

[JanW]

Phil is right. The comments I heard (almost two years ago now at the VF forum) was ctx no more than three months and then stepping into AZA, MTX or cellcept. Increasingly docs are using rtx as well.

[me2]

I was on ctx for almost two years starting 1979. Things change. I developed a bleeding bladder. No one told me to drink extra water - at least not that I remember.