Methotextrate dosage - timing for efficacy | Arthritis Information

Ok .. I give up. I've been on prednisone and plaquenil since I was diagnosed last september ... but it looks like my symptoms aren't getting any better ... still have morning stiffness and my knees seem to flare every three days ... I take a mobic and it goes away, I feel good, but my RA seems to still be active.

I want to try and kick it into remission. I think I will start methotextrate this saturday. The bottle says to take it on an empty or full stomach. Which do you guys prefer? Is taking it on a full or empty stomach a better choice for the methotextrate to work best? Also, is it better to take it in the morning or night?

I will be taking 8 pills of 2.5 mg every week.

Thanks for any advice,

Cindy

Cindy742008-05-22 13:29:07I take mine after I eat. Some prefer to take it in the evening so they sleep through any side effects they may have. I've been lucky, I've never had any problems.

Good luck!

I take mine a while after dinner....but my stomach certainly isn't empty.

I started taking mine years ago on Saturday nights so I would have Sunday to veg out if need be. It's been a good system for me. In the beginning I could pretty much cancel Sunday's off my calendar all together. I was tired more than anything; but often just felt "icky" all day. It's been about 5 years now and I still often take a nap on Sunday's.

I wouldn't advise taking it on a day you had anything you HAD to do the next day....just in case. A down day never hurts any of us, right?

Good Luck. Hope it works as good for you as it has for me.

I started taking methotrexate pills in 1986, along with naprosyn and trilisate. About 2003 I started to have problems with my stomach (ulcer-like) and acid reflux like symptons, so I discontinued naprosyn and trilisate and switched to injectable mtx. From my experience, I would suggest taking mtx with some food. Also should you have stomach problems, you could split the dose, take 4 in the morning and 4 in the evening or 4 one day and 4 the next day. Discuss this first with you doctor though. Good luck, I hope you get good control with the mtx. Take care.I always took it on a full stomach since I had heard some have stomach issues. I never did but I did feel crummy at first the day after, but that passed. I'm concerned that you're taking all eight pills the very first time. My RD had me start with 4 for two weeks then 6, then 8. That may be why I had minimal problems. I'm just telling you this so if you do have any issues, you won't give up on it too soon, thinking it's always going to be that way. Also, if you find that the MTX isn't working for you after several months, I have found that I'm getting more bang for my buck with the injections. It's also supposed to be better for side effects. And don't forget, you need to take folic acid faithfully with the MTX. Good luck. I hope it works wonders for you. I forgot to say, I used to split up the dose too: 2 at each meal and 2 at bedtime. I found I could eliminate all side effects that way. The times I felt worse was when I took all 8 pills at once, but that might have stopped eventually too if I didn't split the dose instead. I got the great idea (my RD OK'd it) to split the dose from the lovely people here. I believe it saved me hours of grief.

8 pills right off the bat? I'm surprised they aren't starting you off with 3 or 4 pills and slowly moving you up.

Let me just say this...with food definitely, lots of water day of and day after to flush the system. I take on Friday nights immediately after dinner. That gives me 2 down days. All in all I have faired very well. I usually crash about an hour after taking. For the first 2 months I just felt bleh for the next 2 days, now my system must be used to it. I still crash the night of, but no more "yuckies".

MTX freaks people out, but it is an awesome medication. I feel near 100 PERCENT. And I meet more and more people who say the same. Good luck.Adding...Yeah I didn't want to come on too strong...

Glad to see Jesse picked up on this as well.

If you have major side effects I think it will come from starting off with such a large dose. You might want to discuss that with your RD. At least you will be informed and understand that possibly bad side effects come from the dose more than the script.

Hi Cindy

I've taken mtx for about a year now, sometimes on empty stomach, sometimes not and I don't see any difference. I started taking it after work so I would sleep thru side effects as others suggested, but recently switched to mornings as I'm more tired about 12-15 hours after taking. Before if I took it at 5:00 pm, I'd start fading about noon the next day. Now, I take it at 6:00 am and can hold off until the next evening and then go to bed early.

As others said - drink lots of water, don't forget your folic acid and if you do happen to have a doctor that allows some alcohol, avoid it day before, of and after. If you find you have too many side effects, ask about injections - that can lessen the side effects. Hope it works well for you.

Cathy

I too was surprised you would start out on 8 pills. My doctor started me on 4 and built me up to 6 over a period of a month.

I have always taken mine in the morning after I eat. I take prilosec and folic acid. To prevent side effects. Never had stomach issues.

I take mine on Monday. I figure I am fresh for a week of work. I do get tired for 2 days after but nothing I haven't been able to push myself through.

I also drink alot of water that day and try to avoid having my infrequent alcohol near my MTX day.

I feel it has been a succesful treatment for me too but I am still on 8 mgs. prednisone each day.

I've never had alcohol since I started MTX in October. Just don't want any complications that I can't deal with.

I drink loads and loads of water the day of and day after MTX. IF you haven't been taking folic acid yet.. I would dose with that a few days before starting MTx.. 1.mg a day is the recommendation from my RD.. but you need to build some up to ward off the Yecchies..

If you don't drink the water.. as I said above.. You may have what feels like a "hangover headache" feels like y our brain is smashing on the sides of your skull!!

The dr said if I got that... then the next time, take a dose of cough meds w/ dextramethorphan 2 hours before dosing.... and then again the next day as needed.

I've had NO issues at all since I began doing that..

and I always take it with food.. sandwich style... little food.. MTX... little food again... around 8 pm on Saturday night.. then I sleep 10 hours and feel pretty good the next day.. may want a nap.. but otherwise not so bad..

I'm wondering about the dose of MTX too.. I also started off w/ 4 2.5's a week.

I wish you luck!!

I take mine in the morning with food to help the stomach. It take it in the morning so i know i can move better when i need to.

I did like less pain at night, but it wasn't worth having worse days.

I take prilosec in the mornings along with 150 zantac for my stomach, i take this every day as requested by my doctor. I don't have problems while i take this.

But, when i first started pred i had horrible stomach ulcers. I can take it now, 3yrs later without food, but still prefer to just in case.

If you don't want a whole meal, eat a couple crackers, an apple etc.

Looks like the side effects have been covered very well, and special precautions, just wanted to say my Rd started me off on 6 pills, then increased to 8 about 3 months after. good luck with it. My side effects were hangover feeling at first, now not to bad just get fatigued easier.I have been taking MTX for 1.5-2 years (I really do lose track of time) I started off with 3 and progressed to 4 pills. I take 2 in the morning and 2 in the evening. I never worry about whether or not I take it with food. I did not start taking folic acid until the past 4 months.

For the most part I have not had any side effects. I would be concerned about taking 8 pills all together for the first time.

I started with 3 pills and moved up to 10 in about a 6-8 mos period. I tried everything, but what works for me; eat 3 good meals that day, lots of water and I swallow the pills before going to bed. If I don't, i feel dizzy, queezy, etc., however this way I sleep right through it. I had thought that having less food would make me skip the queezies, but that did just the opposite. Unfortunately it's a trial and error to see what works for you.

I take mine on Thursdays since I have Friday's off. I function on Fridays, but I am a little more tired. I also have occasional glasses of wine. My rheumie said as long as you don't overdue, you're fine.