What’s It Worth?: The Pros and Cons of Methotrexate

We are living in an age of ever-increasing medical options. While it is wonderful to have options, the process of finding which medicine regimen works best can be daunting, and even sickening, literally.

I have been on a number of biologic drugs over the years, and I am currently taking Orencia via subcutaneous injections. I’ve been on Orencia for eight months, and while it helps, I continue to have more swelling and pain than my doctor or I would like. Therefore, a few weeks ago my doctor suggested I add Methotrexate. I have only been seeing this rheumatologist for about a year, so he asked me about my history with Methotrexate. I told him that I took it for a year or two shortly after my RA diagnosis in 2000, and that it made me nauseated and tired. However, I honestly can’t remember whether it was the side effects or a lack of efficacy that led my former rheumatologist to discontinue the medication. My new doctor stated that studies have shown that Orencia is far more effective when taken in conjunction with Methotrexate than when taken alone, so he suggested that I go back on the drug but start with half of the standard dose to minimize the risk of side effects.

I was willing to give it a try. It’s amazing how much I’d forgotten about the medication in the twelve years since I’d taken it. The first “oh yeah” moment came when I took my pill bottle out of the paper bag and saw the “Do Not Drink Alcohol While Taking This Medication” sticker my pharmacist had placed on the cap. While I have congratulated myself for the year I spent abstaining from alcohol early in the millennium, by memory had morphed the reason for the abstention to an effort to improve my RA, not because of the increased risk for liver damage that combining alcohol and Methotrexate use causes. Somehow I had forgotten all about both the risks for the liver and the subsequent need for regular blood tests to test liver function. I was disappointed in having my memory refreshed by that pharmacy label. While I’m not a heavy drinker, I love having a glass (or two) of wine after a long day of working in a public school and keeping up with my 2 and 4-year olds. I called my doctor, and he said it would be okay for me to have a daily glass of wine, but not to have more than that. However, knowing that I might be damaging my liver has definitely taken away some of the relaxation benefits of wine, and I’m experimenting with seeing if increased exercise can replace the desire for that evening glass of Pinot.

The next issue to contend with has been the side effects. My rheumatologist had hoped that taking a half dose of the medication would leave me free of any side effects, but that has not proven to be the case. Every week I spend 8-12 hours feeling nauseated and exhausted. I have tried to time taking the pills so that my side effects would occur on Saturday nights (in hopes that I would sleep through them with the help of Zofran or Phenergan, the latter of which really knocks me out). However, one week the nausea will set in 24 hours after I take the drug, another week it will have a 30 hour delay, and last week the nausea developed only 12 hours after I took my medication. My husband sees how rotten I feel on my “Methotrexate weekends,” and has questioned whether it’s worth it. Of course I keep asking myself the same question.

At this point, my evaluation is that I have to allow time to find out whether the one-two punch of the Orencia and Methotrexate combo will make a huge difference in my RA. If it does, I have to think about the long game. Those of us with rheumatoid arthritis don’t just have our current symptoms to think about, but also the potential long-term deterioration of our joints. I hate feeling nauseated and lethargic each week, however I’ll also hate it if I have to have surgeries down the road. Living with RA is a constant balancing act, and it will take a little more time to see whether Methotrexate ends up with pros that outweigh the cons, or vice versa.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (23)
  • Early Girl
    2 years ago

    I am taking the low dose of Methotrexate at 4, 2.5mg tabs once a week. I was also having nausea problems. My doctor suggested taking one half the dose in the morning and the other half in the evening. That has greatly improved the problem. He also said it could be spread out over 2 days if needed. you could ask your doctor if this is an option.
    Good luck.

  • Tamara Haag moderator author
    2 years ago

    I’m so glad you found something that works for you! Thanks for the suggestion, and for being part of our online community.

  • Pamela Gilbert
    3 years ago

    I took methotrexate for about 2 years but had to stop it along with Humira injections as I was diagnosed with cancer . When I had radio therapy and only one course of chemo as it gave me a massive saddle PE. I nearly died .
    Once finished treatment and remission my RA had been dreadfully but on morphine, planaquil,and warfrin and couple of other meds. I asked to have methotrexate again as I found before it worked well and was I a lot of pain . But I was told that due to the type of drug it is . (Chemo) in low doses. It was to big a risk of it bring my cancer back . I have been on a couple of other infusions and am now on Toxilimib? Self inject due to collapsed veins so no more infusions. But it does not last long now . I inject Thursday so ok for weekend by Monday I am shattered the fatigue knocks me for six. Need something else but not sure what if cannot have methotrexate.

  • Patricia Katz
    3 years ago

    I was on methotrexate injections a few times and after about 2 months I became confused and unabke to get words out, which were things I knew. I recently saw a naturpath physician who tested me to see if I was genetically predisposed to toxicity with methotrexate. I teated positive and stopped taking immediately. I found it very scarey that no one else ran that blood test. I am following a very strict diet and trying to work on repairing my damaged cells. I am off most of meds and feel quite a bit better.

  • Tamara Haag moderator author
    3 years ago

    Hi Pamela, Thanks so much for sharing your experience! The two conditions certainly make things far more problematic. As the prescription medications for RA do target the immune system, I can see how complicated that makes your treatment. Arava is often prescribed for those who can’t tolerate Methotrexate (I ended up being switched to it after increased side effects from Methotrexate), but it may share the same concerns as Methotrexate for a person in remission. I wish you all the best as you contend with these challenges, and hope the cancer is gone for good!

  • Kelsybug
    3 years ago

    I’ve been on methotrexate for a little over a year. I started at a low dose & had no issues with side effects until my doctor kept increasing the dosage. I would get nauseous too. Finally I agreed to self injecting it. I’m not having any side effects from it at all. This along with Humira & Plaquenil have definitely made me feel better than I did before. Although I’m not 100% well, I’m headed in the right direction.

  • Tamara Haag moderator author
    3 years ago

    Thanks so much for sharing! I’m so glad you found something that works for you, and I hope you keep getting ever closer to that 100%!

  • fumblyfingers
    3 years ago

    I have been on methotrexate for 3 years now and have found that it enables me to function. Currently I am on the max dosage and starting with injections next week. I am not sure if the constant tiredness is a result of the disease or the medication, but it has made the pain tolerable. Male, age 64.

  • Tamara Haag moderator author
    3 years ago

    Thanks so much for sharing your experience, Russell! I hope the injections go well!

  • elisee55
    4 years ago

    Hello. I have been taking methotrexate for a bit, and I was prescribed a drug called leucovorin and it really helps with the nausea and flu-like tiredness. I take it 10-12 hours after the shot….

  • Tamara Haag moderator author
    4 years ago

    Thanks for sharing! I was not aware of that drug, so this tip could be very helpful to many people like myself whose doctors did not discuss this option.

  • Carly
    4 years ago

    I take the injections too, but still deal with hair loss and exhaustion. Since my doctor split my total dosage amount into two shots it does help with lasting longer. I still have “Methotrexate weekends” where I don’t have a lot of energy and sleep a lot, but no nausea!

  • Tamara Haag moderator author
    4 years ago

    Thanks! Yes, 2 mg of folic acid and also 8,000 ICU of vitamin A daily. We’ll see . . .

  • Carly
    4 years ago

    Also, make sure they are having you take enough Folic Acid with the methotrexate!

  • Elizabeth Riggs
    4 years ago

    I’m in Lawrenceville – just a few miles SW of you. I’m on the injections – and my Medicare Advantage covers them. I can’t imagine an insurance program that wouldn’t. But what do I know! Obviously yours won’t cover them. I will say, however, that when I didn’t have medication coverage a few years ago, I found the Methotrexate injection and syringes were not expensive.

    Hoping you will find a way to switch, soon.

  • Gayla
    4 years ago

    I had to switch to the injections because of the severe upset tummy. My doc wanted to increase my dosage and I knew my stomach would not tolerate any additional pills. I also have a bleeding disorder and two benign tumors on my liver. I did my research and discovered that the MTX injections do not process through your liver! So I talked with my doc and we switched me to the injections. I take it right after I take my Orencia injection. Some times I get a little sick to my stomach within a few minutes of the injection, mostly because of what I had eaten earlier in the day. But now it doesn’t seem to bother me as much. My doc said I can have a drink or two 48 hours after my injection. So I know my limits. I don’t drink often or much but I love the freedom to choose. So much has been taken from us all as a result of this disease, it is nice to get something back!

  • Tamara Haag moderator author
    4 years ago

    Thanks for sharing your experiences! I’m currently battling with insurance to cover injections, and I’m hoping I get the opportunity to try them and that I have a positive experience with them, as you have had.

  • Robin K. Blum
    4 years ago

    Take the self-injections! I am prone to nausea and dizziness and all those other unfortunate side effects of methotrexate. But I started with the injections (never took the pills) when I was diagnosed almost three years ago, and apart from the first week or two when I was a scaredy-cat about sticking myself with a needle, I am successfully taking methotrexate without any side effects except perhaps some hair loss.

  • Tamara Haag moderator author
    4 years ago

    Thanks for sharing your experience Robin! I am actually in the middle of a battle with my insurance company, who don’t want to cover the injections. So I’m hoping I’ll have the opportunity to at least try them.

  • Kellie
    4 years ago

    I quit taking methotrexate due to what my Rheumatologist called the “methotrexate flu”. I was nauseous all the time. I now take leflunomide in its place. I am also on a biologic. The leflunomide seems way easier on the stomach.

    I am still going with yes, it’s worth it if it helps. No, if it doesn’t give significant relief.

  • Tamara Haag moderator author
    4 years ago

    Thanks for sharing your experiences and for your advice!

  • Susan St. Amour
    4 years ago

    Great article. The side effects vs. benefits are so important. I had to stop Methotrexate when Arava was added because the combination knocked me out for 3 – 4 days. Now I’m on Humira, Arava and Sulfasalazine and am considering going back to Methotrexate and discontinuing the Arava and Sulfasalazine because the side effects of the Arava have resulted in 3 more meds. It’s so hard to think of the future damage, when the side effects are so .. NOW!
    It’s always a juggling circus to find the right balance of meds/side effects.

  • Tamara Haag moderator author
    4 years ago

    Hi Susan, yes, it is a juggling circus! Thanks for sharing your experiences with us.

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