Hi all
I probably just haven't found the right thread and there may be answers I've not seen so please excuse if this is the case.
I have read many comments and posts in general (thank you) about the switch from MTX tabs. to injecting MTX.
I have been on tabs since this time last year (and prior to that 8 tables of SASP for Rheumatoid and Osteo since onset late 1995) but as they recently increased my MTX dose (not enough improvement happening at lower dose at the hospital, from 15 to 25mgs) I noticed, inevitably, my side effects coming stronger. I could get by with a little disorientation the day after the dose of tabs (splitting 25mgs over the evening and first thing next morning at the Rhemy's suggestion) but now I find after being on 25mgs for a month or so that my nausea is quite troublesome and I feel washed out totally. Because of this I am stitching to the i/js (today!! I'm just off to the clinic, but it will probably be a nuse who can't answer my questions and my Rheumy appointment is not till next week. Can't ask my GP as he only says "You know more than I do!!!". Hence,I am here! Asking you).
I also noticed I the last week or so my hair shedding .. in general but it is similar to when I was on Beta Blockers for a few months (Propranonol) two years ago at the onset of over active thyroid. My pillow has a light, but obvious, general scattering of hairs which look like they've come out easily).
So, after the explanation, what I wondered if any of you could tell me (I understand Grandma Skittles is well experienced in MTX!!) - but anyone, please, with experience - does injectable MTX lessen or worsen any side effects? I know we are all different and on a combi of drugs which can also give us many confusing s/e's, but am I likely to experience less of my s/e's (I know by i/j MTX should reduce fatigue and nausea) but what about the hair thinning? I will drop to 15mg for the first i/j then up to a higher dose, but does anyone know if I will be able to take less dosage if I take the injection method?
BTW I recently made my decision to try the injectable MTX instead of taking Enbrel. A hard decsion and thanks to those who helped with comments, but I may be ready to take Enbrel if MTX injectable fails me. However, let's hope it works.
Anyhow, thanks for your help in advance and good luck everyone with their "trials and tribulations"!
Joolie
Hi Joolie,
I've been using injectable MTX for 14 months, and have found that my mouth sores and nausea are gone, and my fatigue and my hair loss are much improved. Also I was able to drop to a slightly lower dose than I was taking with the tablets. My RD is a great believer in the injections, and he feels that most people can't fully absorb the pills. It was certainly true in my case.
My RA is now well-controlled with Mtx and Mobic.
Good Luck to you.
Ellie
I also made the switch from pill form to injectable after my liver enzyme test escalated. I haven't had a problem since.Hi Ellie and Owiedeb. I saw I didn't post my reply here - but i know I posted it somewhere! so I will say thanks again.
Sorry for my delay - been on holiday and before that four visits in one week to the hospital ... it got crazy with everything going on at once - all came at same time, my appointments for varying things.
I went back to the MTX tabs. (15mgs) whilst away for a week on hol. no side effects of nausea on that lower dose split over the evening and next morning (had been taking 25 mgs before switching to injectable a coupleof weeks before my hols).
My hair shedding hasn't got any worse/better and I don't usually shed much so it would seem odd to me to see more hair than normal on my brush or dark clothes.
I have my first bloodwork result from the MTX injectable on Wednesday when I resume MTX clinic, so I will know then what it's up to since the couple of weeks starting on the injections. I feel sure if it had been out of synch they would have phoned me on the mobile. They are good at chasing you up. I m just a little anaemic but I know that and it's getting better with Ferrus Gluconate tabs.
hope you guys are doing well and thaks for your replies.
Joolie
Joolie, Are you taking folic acid along with the mtx? If not, you should be. It helps with all the side effects. Good luck and let us know how it goes. The inj. mtx is usually easier on your system because it does not go into your stomach first to be digested.My RD suggested that I switch to injectable when I saw him Monday. That's because I've had 3 flares in the last two months and I'm already taking 20 mg MTX by mouth. He said I could try adding a pill and see if that helps, but usually your body won't absorb more than that in pill form. I'm giving that a try before I switch just cause MTX doesn't come in the clicky pen like my Enbrel. The MTX shot looks to scary. I mean, I guess I'll get used to it if I have to , but I just want to avoid another shot if I can. Yeah, I'm a baby. I'll admit it.
The first issue you need to address with your rheumy is the obvious, large increase of MXT from 15 mg to 25 mg in one dose. That's an extraordinary increase of 10 mg. and you'd have to be superwoman not to have some side effects. Usually the increase is in much smaller increments. You want the MXT to work, but only in it's lowest dosage. You might get great results from 17.5 mg. but you'll never know because they hiked you to 25 mg. and that's taking a great risk with your liver. So please ask your doctor about this and ask WHY such a large increase versus small increases over time. Right now this is more important than the side effects.
If you don't take Folic Acid, again talk to your rheumy. It's a given that Folic Acid is prescribed at the same time as MXT. Folic Acid is depleted by MXT and is needed to build cells. It also helps with the side effects.
I've never had a problem except fatigue from MXT. Nausea shouldn't be present with the injections (there's always the exception). Hair loss is iffy. Inj. may or may not help with the thinning. It doesn't matter how it's delivered, fatigue will be present if you're so inclined. I had fatigue with both pills and inj. Since you're anemic and on MXT, they should be keeping a close watch on your blood count.
I much prefer the inj. because it bypasses the stomach and also because there's a very small increase in the potentcy of MXT inj. vs. pill form. I figure if I have to be on MXT I want to make sure that every little bit of it counts. Hope this helps and keep us posted about what your RD says about the 10mg increase. Lindy
Since injectable bypasses the stomach the entire dose of MTX metabolizes, you lose some dosage as the tablets pass through the stomach. So many people actually can take a LOWER dose of the injectable to get the same results.
Hi guys - thanks for your comments. I confused you Lindy, sorry as I put my ) in the wrong place onmy first post! DOH! My apologies.
What I meant to communicate was that there was not enough happening for me at a lower dose of tablets and also at 15mgs it still wasn't doing enough. When I wrote my MTX tabs were increased from 15 to 25mgs I meant in 2.5mgs increments. Sorry I didn't say that. I had to slowly increase to try lessen side effects. Then that was the problem - the nausea and tiredness on 25mgs. After 20mgs I really noticed the side effects getting worse so they changed me to injectable.
Since the injections (had three now) I have noticed I don't have any nausea and I don't feel knocked out like I did the day after with the high dose of tabs I took. So that's great.
Fatigue is certainly something I have always had with the R.A.(my GP says I have unprovoked exhaustion! However, with an overactive thyorid there's another spanner to throw into the works so to speak!) I feel not as tired on the injectable MTX. Also anemia could have been making me tired too but my red blood count is up a bit now to 11.2 from 10.5 so that's not too bad and I am taking Folic Acid and Ferrus Gluconate, both as prescribed by the Rheumy. I'm on full blood tests evey two weeks until they are sure the injectable MTX is fine for me. I haven't really ever had any adverse effects from blood tests apart from anaemia.
As for the hair thinning. Had my hair cut on Friday and my hairdresser says that the hair has been forced into a "relaxing stage" from the drugs but it is not panic stations. He says I don't usually shed much at all,so any shedidng is obvious. I have always had finer hair so its his job to give me a good cut! He didn't think there was any reason to panic but he will keep reviewing the situation every 6 weeks. I have been with him for over 20 years so trust him. He said it is a shedding of hair rather than hair loss of any large amount. I saw on the web that Aloe Vera shampoo, and Aloe gel massaged on the scalp is supposed to be good for hair that is shedding. I didn't know that. As all hair health really has to come from within I can just continue with my healthy diet and not worrying too much about it. I am due my latest bloodwork results on Wednesday so I will see how the anemia is then.
My Rheumy nurse said about the injectable being more effective - that by injection it can be up to three times more effective as tabs. I think they intend to increase my injection by 2.5 increments (currently on 17.5mgs having had two shots at 15mgs and then a week away on holiday meant I had to go back to tabs. As I am new to the injections I could not do it myself on holiday so was told to take the tabs. for that one week). Thank you lindy - I will let you know how I go on. Hope you are doing alright.
Owiedeb - Hi! Yes i am taking the Folic Acid tab each day (except MTX day) and also Ferrus Gluconate tabs . I asked last Rheumy visit if it was alright to take the two together and my Consultant said yes. I am feeling no nausea with the injections of MTX. Thank goodness!
Linncn - I hope all goes well for you if you change to injectable MTX. I am sure they will eventually do a sureclick type pen for the MTX. ( I understand from my Rheumy nurse that in the UK there isn't a click pen for Enbrel as yet - just the Humira pen. ) To me the MTX shot I have looks small and because I am having my shots at the Rheumy clinic at the hospital as i am new to thisway of taking MTX, they do it in my upper arm and it doesn't hurt at all - just a cool strange sensation as it works it way in but that doesn't last more than a few minutes. If my bloodwork stays Ok and no adverse effects then I will attend a clinic with the Rheumy nurse who will show me how to inject myself and do it for me at first in my leg or tummy and then watch me do it for a few vists before I am allowed to do it myself at home. No you are certainly not a baby and I understand well how you will feel when your clickpen is much simpler to administer. None of us are babies with the problems our conditions bring us if we feel apprehensive about a new way of doing things. Good luck anyhow.
Buckeye - I am hoping that I will be able to settle at a lower dose of the injectable eventually but I was told I will be put up to either 20 or 22.5mgs to start, and if it goes well brought back down to a lower dose. Let's hope so.
Thanks lovely people. Hope you are all doing well. Sorry not to respond sooner but I have had problems logging on to the Net.
Joolie