What to Expect: Methotrexate
Last updated: September 2023
As a newbie to the rheumatoid arthritis (RA) community (although not a newbie to the chronic illness community), I truly had no idea about the treatment options when it came to RA.
I was a little late to start methotrexate due to pregnancy and breastfeeding, although it's one of the first lines of treatment. The side effects made me even more hesitant when the time finally came to give it a try.
However, pain has a funny way of making you willing to try anything. So when I began methotrexate, I was determined to be open-minded. Here’s what I found during my experience with this popular RA treatment choice.
What is methotrexate?
Methotrexate is a disease-modifying anti-rheumatic drug (DMARD) approved for the treatment of adults with rheumatoid arthritis (RA). In low doses, methotrexate helps control swelling, pain, and stiffness that results from inflammation. It can be taken in both oral (pill) and injectable forms.1-3
I have to admit that once-a-week treatment was a big selling point for me! I felt like I could manage that better than a daily pill or the every 2-week injection I received in the past. At the moment, I take my 4 methotrexate pills on Saturday night, and it’s worked out routine-wise for me.
Managing the side effects of methotrexate
My hesitation surrounding methotrexate was caused by the unfortunate side effects I saw other people with RA experience after starting the medicine. Though they weren’t any more threatening than the biologic I was on at the time, I was spooked.
Common side effects of methotrexate include:1-3
- Dizziness
- Drowsiness
- Headache
- Hair loss
- Redness in eyes
- Reduced appetite
- Mouth sores and swelling and/or tenderness of gums
- Sun sensitivity
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View all responsesTruthfully, hair loss was the big one for me. Although admittedly a bit vain, I was really worried my already thin hair would become even thinner. As a young mom in her 30s, that felt a little scary and like a total bummer. So far, I have noticed minimal hair loss, and I hope that continues as I take methotrexate.
Staying safe while taking methotrexate
As you begin taking methotrexate, your doctor may remind you of some things to ensure you stay safe and healthy in the process.
Serious side effects, including in pregnancy
Methotrexate has a boxed warning from the US Food and Drug Administration (FDA) because it can cause serious side effects, including anaphylaxis and death.1
Methotrexate can also cause serious birth defects in people who are pregnant. If you are considering becoming pregnant, make sure to talk to your doctor. Methotrexate should be stopped at least 1 to 3 months prior to becoming pregnant.4
People who are currently pregnant or breastfeeding should avoid taking methotrexate unless their doctor has determined that the benefits outweigh the chance of harm.5
Folic acid supplements
Folic acid is commonly added to a methotrexate prescription to help reduce side effects. Be sure to talk to your doctor about any other medicines or supplements you are taking, and be sure to take all medicines and supplements as prescribed.4
Gastric and liver impacts
Since methotrexate is processed in the gut wall, it can cause gastrointestinal intolerance (diarrhea). It can also cause elevated levels of liver enzymes to show up in blood tests. Adverse events experienced by some people include cirrhosis of the liver, so people with liver disease should avoid taking methotrexate. Ask your doctor about whether consuming alcohol is safe according to your methotrexate dose.4,6
Have you taken methotrexate before? How was your experience? Share with us in the comments below!
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