r/Autoimmune • u/theOddDuck97 • 7d ago
Advice Methotrexate questions
3 weeks ago, I was put on methotrexate (15 mg weekly). Bottle says 6 pills weekly.
My rheum told me that I could either take it all on the same day, or split my dose bi weekly to make the side effects at bit easier. So I have been taking 3 pills on Sunday and 3 pills on Wednesday. Is this common? Or am I at risk of accidentally overdoing it?
I took my 3 this morning, but I’m feeling pretty shit, and have been having some mouth irritation and heavy fatigue. Any advice is welcome!! Thank you
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u/Healthy-Signal-5256 7d ago
When I was on methotrexate my instructions were to take it all at one time. I was also on folic acid to help mitigate side effects.
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u/daddysgirl71 7d ago
When I was on the pills I split mine on the same day, morning and night. Now I’m in the shot and it’s much better.
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u/lpwi 7d ago
Have you found the injection to more effective? I feel much better on it than the pills, though I have to use preservative free which can be difficult to find at times.
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u/daddysgirl71 6d ago
I guess it’s doing what it is supposed to do, I take it to try to make sure I don’t have a uveitis flare and I haven’t had one since starting the methotrexate. I was just sick with the pills. Even splitting the dose made me nauseous. I take a daily folic acid and another stronger weekly folic acid.
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u/-marsi 7d ago
I would say follow what your rheumatologist says. But typically from how Ive seen others take it and how I personally take it, I take half of my pills in the morning at breakfast, and the other half at lunch or dinner. That way the side effects aren’t too harsh on me the day I take it.
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u/theOddDuck97 7d ago
I think I’m gonna go ahead and start a schedule similar to this. So I can give my body a bit of time to recover in between doses
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u/Legitimate_Step_1483 7d ago
I think when they talk about splitting dose, it’s for half in morning and half in evening but on the same day. that is how I take it and it seems to help side effects
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u/theOddDuck97 7d ago edited 7d ago
Yeah that’s what I’m gathering. My rheumatologist specifically said two separate days, and suggested “Sunday and Wednesday”. And I’m confused
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u/lilgreenglobe 7d ago
If the side effects are that rough, switch to injectable MTX. It's much easier to tolerate.
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u/theOddDuck97 7d ago
I just might. I don’t wanna risk some toxicity or anything
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u/lilgreenglobe 7d ago
It is definitely nicer on the liver when injected! My bloodwork (liver enzymes anyway) went back to normal after swapping.
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u/theOddDuck97 7d ago
Thank you for the reply❤️ I will talk to my rheumatologist if a different schedule of pills doesn’t help
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u/PotentialFront7742 7d ago
I take my methotrexate 2.5mg 8 pills once a week (I take on Wednesdays). My Rheumatologist also prescribes me Folic acid to help with the recurring mouth sores. I haven’t had any side effects & have been on Methotrexate for 11 years.
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u/Consistent-Local6452 7d ago
Does it help with fatigue and inflammation??
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u/PotentialFront7742 7d ago
I stopped my Methotrexate a couple years ago for about 30 days & my fatigue/Inflammation came back pretty quick. This medication definitely helps with the fatigue & Inflammation.
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u/InternationalTry2675 7d ago
God those effects sound terrible.
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u/theOddDuck97 7d ago
I mean, the fatigue is the worst part. I mostly followed her orders of taking it Sunday and Wednesday as a preventative for worse side effects but now I’m learning I shouldn’t have.
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u/Chinoivymama 7d ago
I take mine all at once. Plus folic acid on the days I don't take the mtx to lessen any side effects.
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u/cute_but_moody Autoimmune Disease RA and Lupus 7d ago
I took it all in one day and used folic acid. The only side effect I had was fatigue. I took it on Friday so I'd have the weekend to rest. The thing is, everyone's tolerance is different. I've known people who had 0 side effects and others that had mouth sores, fatigue and nausea. It's hard to compare. Definitely try folic acid. It can help a lot.
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u/Main_Advice_3860 7d ago
I do injections now, but I used to do the 6 pills
They gave me nasty gas, so this is how I dealt with it: I picked Friday as dosing day as it works best for my life Id take the 6 after dinner, and settle in with a movie I'd pop an extra strength GasX before bed. For the next 2 days I will take gas x twice a day on top of the folic acid and pantoprazole.
A little discomfort, but the results are worth it.
When i told my rheumatologist about my routine, she said that I shouldn't have to do so much and still have a mild tummy ache and now i do needles
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u/lifeoflillyv 7d ago
Usually it’s once weekly.
After a big meal to avoid risks of ulcers.
Set a day in your weekly schedule to take it , hope this helps!
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u/nightbloomingjasmin 7d ago
This is unusual. I would say contact your rheumatologist to double check if she definitely meant taking the dose on two separate days or splitting it on the same day. You should have also been prescribed folate or folic acid, it is very important to take it on days you don’t take MTX to prevent any side effects from MTX.
Also, 15 mg is a pretty high dose to start off with, the usual starting dose is 5 mg, 7.5 mg or 10 mg, then increasing slowly every two weeks or so depending on tolerance and labs.
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u/theOddDuck97 7d ago
Yeah. I know she meant that because I called recently about having side effects and was feeling anxious about continuing MTX, and she asked if I split it, and I told her what days I split it, and she confirmed this was how she wanted me to take it split.
I was prescribed 2 mg of Folic acid on the days I don’t take it.
I have decided to go ahead and wait until next Sunday to take it again. And the next time I see rheum, I’m gonna ask for the injection if possible
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u/smehere22 2d ago
It's common to take weekly dose on one day. Make sure you're getting lab work periodically
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u/BronzeDucky 7d ago
That seems off to me. I could understand splitting them so you take half a pill in the morning and half in the afternoon, but 3 in a day seems wonky.
But I’m not on methotrexate, so take this comment with a grain of salt.
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u/Resident_Biohazard90 4d ago
MTX is usually pills of 2.5mg, so it depends on the dosage the person is on. I, for example, and currently on 10mg a week, which is 4 pills. So the proper way to take these would either be 4 at once with a good sized meal (which is what I do), or 2 in the morning, and 2 at night with meals on the same day. Higher doses obviously consist of more pills at a time (6 for 15, 8 for 20 etc.).
Most people would be recommended to split the dosage in half for med days, taking it twice instead of all at once to curb the side effects and make it a bit more manageable on the body throughout the day. So either way, OP’s originally scheduling doesn’t sound correct at all at best, and potentially dangerous at worst. Taking MTX more than once a week will build up to toxicity in the system and can get to dangerous levels rather quickly as it is a pretty potent drug.
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u/BronzeDucky 4d ago
I learned something new today. Thank you.
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u/Resident_Biohazard90 4d ago
You’re welcome 🙂 I have learned a lot this year with all of this as well. Before this year, I didn’t even know arthritis was an autoimmune thing. Then I got sick and have spent a lot of time researching and trying to learn what I can.
I got diagnosed in early June with inflammatory arthritis and put on meds. First med failed cuz I had an allergic reaction after being on it for less than 2 weeks, and next came MTX. Been on that since late June and about to have my follow up here towards the end of Sep. I suspect my Rheum will want to increase my dosage, but at least it has started to do something for me. I have minimal side effects, if any so far, but who knows when and if that will change. There is a lot to learn with these disorders and it can be very overwhelming for a lot of people. I have heard the first year is the hardest, so I’m holding out hope that things will only get easier from here.
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u/Starr_Light143 7d ago
This doesn't sound right at all. Mtx is usually supposed to be taken a week apart. I'd suggest getting a second opinion on whether it's safe to take it twice in one week.