How to overcome the nausea related to Methotrexate?

Methotrexate is a wonderful drug for Rheumatoid arthritis. However, the nausea associated with the same can be quite a disturbing problem. At times, it is so severe that one has to discontinue methotrexate despite the relief provided by it.

Can you overcome the nausea related to Methotrexate?

Yes! here are a few tips—

1) Spread out the Methotrexate dose- The total dose of Methotrexate can be divided & taken over 2 days every week. For eg. You may take 1 tablet of methotrexate (5mg) after lunch & dinner on Saturday & Sunday instead of the entire dose once on Sunday.

2) You may take the dose at bedtime if the dose after lunch is causing nausea.

3) Take the dose after food instead of taking it before food.

4) You may take an antiemetic medicine along with Methotrexate.

5) Take folic acid on the all days except the day of methotrexate.

6) Acupressure:
According to traditional chinese medicine, a point called as Pericardium 6 helps relieve nausea.
It is located on the inside of the wrist, about 3 fingerwidths up from the center of the 1st wrist crease.
A person can press on the point using the index finger of the opposite hand.
Acupressure wrist bands with a bead/ button to press on this point are available.

7) If nothing works, you can shift over to injection Methotrexate. A Family Physician can administer it to you (intramuscular) or you can take it yourself subcutaneously (just like insulin shots). Even this could be impossible as in the case of one of my patients who used to get nausea even by looking at the Methotrexate vial. Her relatives never believed her story & considered the same ‘all in the head’! After months of struggling with the injections, she has found a way out. The injections are now kept by her relatives in the Family Physician’s refrigerator & he administers it to her without showing her the vial! Believe me, the trick worked.

If you have any such tricks/ experiences feel free to share the same here.

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81 Responses to How to overcome the nausea related to Methotrexate?

  1. Rajesh says:

    i’ve been suffering from RA since last 3 years.
    Struggled with methotrexate. In fact, struglled to such an extent that I changed my Doctor; shifted to ayurvedic. In poor state now, persistent pain, already lost my job.
    May be I should go back to my Rheumatologist, retry methotrexate. Thanks for the tips.

  2. madhukar11 says:

    Methotrexate is a nasty drug indeed. I have so much of nausea that my weekend is spolied.
    I’ve been taking 10 mg tablet twice a day on sunday.
    I’ll speak to my doctor & try splitting the dose.

  3. sarla says:

    I seem to be lucky. Hav been taking methotrexate for 3 years without any problems. I’ve been taking 5 tablets every week.

  4. Kelly says:

    These are very good points. I appreciate your communicating with us RA patients online in this way it will help a lot of people to better understand their RA treatment decisions.

    As a patient, I have written several pages on Methotrexate on my blog here: http://rawarrior.com/methotrexate-and-rheumatoid-arthritis/
    However, even though some of the advice is the same, it is read differently when I comes from a “doctor.” Keep blogging, doc! ;D

  5. rachel says:

    same happens with me…..the tablet makes me feel nauseated even before having it…….
    bt still i hv to swallow……so i do…
    bcoz injection is worst option as i fear needles…

    • Dear Rachel,

      This does happen. Methotrexate induced nausea can be a difficult thing to handle.

      You can try a similar trick. Ask someone else to open the packet & give you the tablets . Ask him to mix the tablets with other meds. Take an anti emetic med (to prevent nausea- something like ondansetron) on the day of methotrexate.

      Dr. Akerkar.

  6. RA SB says:

    Hey,

    I just found your blog, and I LOVE it!!! So informative- so easily understood! I have a blog, not sure if you have seen it. I get a lot of great response. I take a very honest approach to the subject of living with R.A. People seem to think it is refreshing. I’ve even been contacted by two wonderful RA authors telling me how much they like the site.

    But anyway, my point was lost somewhere. LOL. I wanted to ask…I used to have VERY thick hair, and I have lost most of it due to mtx. I take the injectable, and I take only 5.5 on the needle. I also take leukovorin (sp?), but I just read that you should take it 12 hours after the injection, and I thought you could take it within 8 hours of the shot. I know the RA is serious, but as I fall into the 20% not responding, and as I am only 34 and have had the disease and subsequent hair loss for 5 years, I am just really tired of being bald on top of being miserable. Is there ANY way to stop this hair loss???

    Thanks again for such an informative blog.

    -RA SB

    • Dear RA SB,

      True…hair loss is a feature associated with methotrexate. Biotin is a vitamin that takes care of this problem. Speak to your Rheumatologist regarding the same.

      I’ve seen your blog; in fact seen it when you replied to my interview on rawarrior. I know that you have seen lots of ups & downs with your RA. Hope you get into remission soon. I’ll be happy to be of any help to you & others with RA.

      Dr. S. Akerkar.

  7. Hehe am I honestly the only reply to your great post?!

  8. If only more than 76 people could hear about this..

    • Dear Tracy,

      Thanks for visiting. This blog is a humble effort on my part to increase awareness about RA & its treatment.

      A lot of misconceptions exist about RA & its treatment; methotrexate in particular. Nausea is a common problem faced by many patients & I’ve provided tips to overcome the same.

      Dr. Akerkar.

  9. rachel says:

    do methylpredisolone[medrol] has anything to do with prevention of nausea?

  10. seo boston says:

    Good point that I had never thought of before.

  11. Bill says:

    I read your comments on Methotrexate. I just found out I have Psoritic Arthritis. I always thought it was a skin thing. So I am put on 10 mg going to 15 mg of this drug. I took it last week around 12 noon and in 2 hours I was nassaus and not feeling like eating etc. I take folic acid also every day. SO I was told to take it before bedtime. Is it better if I have oatmeal with it? Also what is a anti nassau medicine.My wrist and right hand has had flre ups. Does a Medrol Dose pack help. I know it helps me feel better but I have heard Psoritic Arthritis comes back worse after? ALso If Iget it by injection will that help not getting quesy? Last is there a laser treament out there as I did it for my 14 year old dog andhelp alot? Where are you located.You sound like a Super DR. Thanks and awaiting your reply.

    • Dear Bill,

      Methotrexate is one of the best medicines for psoriasis as well as psoriatic arthritis. And yes, it does cause nausea in a few. Please go through the tips I’ve mentioned to overcome the nausea.
      You may have oatmeal with methotrexate.
      Ondansetron is one of the nausea medications you can use to take care of nausea. You can take 1 tablet thrice a day on the day of methotrexate after consulting your Rheumatologist.
      You may try methotrexate injection instead of the tablet. It does take care of nausea in quite a few patients.
      There is no proven LASER therapy for psoriasis. Speak to your Rheumatologist & stick to DMARDs (disease modifying anti rheumatic drugs).

      All the best!

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  14. Cindy Lou says:

    This site has been very helpful to me. I am 56 and suffer from RA like issues in my wrist but do not test that I have RA. I have gone from 5 pills a day to 6 then 8 now 10. Nausea did not occur until 10 pills. I was just switched to injectable Friday. Still sick and had my first headache in years last night. Taking a pro botic helped with for a while with the nausea. Now I know I am not alone with the changes in my hair and feeling so sick just looking at those pills. Hoping the shot will help but time will tell. I get the whole 25 mg at once this way. That seems like it would be worse on me.

    • Yes Cindy; nausea with methotrexate is a common problem; specially at a high dose. I hope you overcome it with the tips mentioned here. Changing over from oral tablet to injectable would help. Just in case it does not help, you may have to settle down with a lower dose & take a higher dose of other DMARD.
      Wish you all the best & may you conquer your RA.

      You may also like to read about ‘how to take care of methotrexate induced hair loss

  15. Jeramie Dreyfuss says:

    I have had lupus since age 20 and now at 62 have also had RA for 7 years. Thanks to shots of methotrexate and Humira I still have a life, but lately the nausea is impossible. Last week I was sick for 4 days. Just the thought of the shots makes me sick. It is not in my head. A true physical reaction. I am on a high dose of methotrexate 20 mg. Thank you for this blog.

  16. greek says:

    i have the same problem with methotrexate. I have RA for 11 years and now i take again meth.. 5 tables on saturday. i hate saturdays because of nausea.. Im just sitting on my bed and waiting until it goes away. i trieed many things but nothuing helps..
    is the injection expensive? and can i do it by myself without a nurse?

  17. Joyce Greene says:

    I have RA and Psoriatic Arthritis. Was taking Methotrexate until I had to have ACDF surgery in September. Glad that I had to go off MTX due to severe nausea and fatigue but pain and all symptoms came back with a vengence. Have been on Arava since October and it has helped some but not completely. Rheumy has just prescribed low dosage Methotrexate along with Arava. Does anyone have experience with the combination of these two meds.

    • Arava & methotrexate is a commonly used combination. When combined, the doses of both the medications are kept on a slightly lower side as they have similar side effects.

      It is a good combination & does work wonders in many patients.

  18. Penny Tucker says:

    I spoke to my Rheumatologist about the nausea I am experiencing on a daily basis since I have upped my dosage to 6 tablets a week of MXT. She does not believe this is a side affect of the medication because it is rather constant. I would appreciate your opinion. I am trying to decide if I need to go to primary care doctor to see what else could be going on.

    Thank you.

    • Nausea is a known side effect of methotrexate. One can try antiemetics/ other methods as explained in the post here.

      If the nausea does not settle, one may have to change the DMARD.

  19. amy says:

    How can a drug make you feel so much better and so much worse at the same time? I am up to 8 pills a week and am so sick that I just don’t know if I can do it anymore. My joints feel so much better but the sick feeling is unbearable. I am going to try some of these ideas and see if they help. I kinda thought I was crazy because I know other people on Methotrexate and I am the only one that is this sick. Everyone looks at me like I’m a wimp and just can’t handle pain.

    • Methotrexate is a wonderful drug but does cause nausea & the ‘sick’ feeling in quite a few. Try these remedies & keep us posted about the progress.
      I’m sure these simple tips would help you overcome the sick feeling.

  20. Han says:

    I’ve been taking the injection Methotrexate (for Takayasu’s Disease) since I was diagnosed and came out of the hospital 6 months ago and I started to feel nauseous in the past 3 months. Now when I look at the vial/needle I feel sick too… but the nausea that actually comes from the Methotrexate happens about 5-6 hours after I take the injection; therefore, I avoid doing it at night before bed because I get nauseous while in class the next day. I’m not sure what to do since I already take folic acid once a day (plus twice a day on the day before and after my injection) and I doubt having someone else do it for me will help since I I don’t feel nauseous until (I assume) the medication kicks in. Even though I only feel nauseous for the day of, it’s not fun at all. I really hope I can get off this medication, since I’m only 18 and would not really enjoy having to take the injections for the rest of my life.

    • Dear Han,

      Methotrexate does cause this type of nausea in quite a few. You can try taking the injection in the afternoon/ early evening so that you would be sleeping when the nausea effect is at its peak. Take sufficient dose of anti-emetic medications twice a day.

      Try these tips & keep us posted.

      • Stephanie Cabrera says:

        I was just prescribed Methetraxte for Lupus and Sjogrens Syndrome. My first week side effects were bearable. This week another story. Took on Sat. And on sun I vomited about four times. Today I havent vomited but still very nauseated. Have hard time taking my other meds. I called my dr and left a message. Hope this week will be better.

  21. Lin says:

    I am a newly diagnosed, just under a year, with RA and I am stuck on the methetrexate nausea cycle. I am going to try the tricks you have suggested. I was wondering if you could tell me if RA comes with muscle spasms. The spams started in the right forearm and now they are happening all over (feet, legs, back) they can strike any time and during any and all activities including sleep.

  22. Jean Finch says:

    For a month liquid Methotrexate has not been available. Pharmacist says company was shut down. Do you have any information regarding this. I have no nausea with the infusion once a week – but pills make me nauseous.

  23. VMV says:

    I have been taking methotrexate for ten months. I take 8 pills (20mg) every Saturday. I also take 1mg of folic acid on a daily basis. Over the past two to three months I have often forgotten to take my folic acid. About six weeks ago I woke up feeling nauseous and it just wont go away. It sounds like most people who have nausea as a result of methotrexate have it for a day or two after taking the pills. Has anyone else experienced constant nausea? Could the lack of folic acid be contributing to the nausea?

    • A few, but not many patients experience nausea with Methotrexate.
      Folic acid does help reduce this nausea.
      Try the various techniques described here to take care of the nausea.

  24. Markus says:

    I suffer from psoriasis arthritis and have be taking pills as well as vials over the last 3 years. I moved from 10 mg pill to 10 mg vial weekly and now went down to 15mg vial every two weeks. The nausea has gotten worse over time. It is typically strongest 36 hours after the injection. Interestingly, the scent of the isopropanol pads caused nausea as well, as resolution I just did not use the pads any more. In my case, nausea is strongest when I get hungry.

    • Just in case, the nausea is intolerable, may be you can speak to your Rheumie & ask about leflunomide.
      It is equally effective & does not cause that much of nausea.

  25. Kristy Birdsong says:

    I have been on methotrexate for about 3 months. I get small waves of nausea within the two days of taking my dose which usually subside no problem and I take my dose on Saturdays. I’m now wondering if because it has built up in my system somewhat, can it also cause nausea on other days throughout the week? It is now Wednesday morning and I have had nausea since 4:30 this morning. Or could this just be some little stomach bug and the nausea only comes on/around the days you take the dose? Thank you for any assistance and for the website.

  26. TRISH says:

    can i take biotin on the day i take
    Methotrexate

  27. heather says:

    Thank you for your wonderful tips.
    I have psoriasis and have been on methotrexate (15mg once a week), it has done wonders for my psoriasis but am left nauseated, ‘gagging’ and feverish for 2 days each week. I have been on the medication on and off for +/- 6 years, yet the serious nausea has only shown itself in the past month.
    Does the folic acid daily instead of once a week (on a differenct day to the methotrexate) really help prevent the nausea?
    Thanks again, its nice to know there are others out there suffering the same sort of side effects!

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  29. Mariam says:

    Good tips. Helped me overcome the nausea.

  30. Fran says:

    I have been on Methotexate for nine months (treating Lupus) and also experience nausea. Usually it begins 24-36 hours after administering my injection. (I started out with pills, but was even more nauseas with those) It can last for a day or two or stretch out longer. Sometimes nausea is intermittent all week long. I do take folic acid, and my rheumatologist prescribed Zofran to help fight the nausea. I find Zofran helpful, but will be the first to admit that battling nausea gets really tiresome. Sometimes I delay the weekly dose of MTX just to get a few days of relief from side effects, but it doesn’t take long before the Lupus pain increases. I know it’s important to stay on top of the disease. Also take Celebrex daily and a low dose aspirin. Did not have good experience with plaquenil.

  31. Mike says:

    I’ve been on methotrexate since September for my stubborn crohns disease (along with an ever increasing dosage of Remicade). I inject 25mg Tuesday night, and I’m wrecked for two days, sometimes longer. I feel like I have poison running through my veins. Marijuana helps short term, zofran sort of helps. It’s a real drag, but it has helped my condition, so I deal with it for now.

  32. Barbara says:

    I am beginning to hate the weekends. I take methotrexate on Saturdays, tried moving taing the medication to evening so that I slept through the nausea. Worked for a month or so and now I’m back to feeling yucky all weekend. I also take Humira every other week by injection. Damned psoriatic arthritis. How on earth do you overcome the tiredness that these drugs bring? I’ll be sleeping my life away at this rate!

    • Have you tried the suggestions mentioned in this Post? Nausea with methotrexate is real & quite troublesome for many.
      If nothing works, stopping methotrexate may be the only solution.

  33. Gail says:

    Yukkkkk….I am so tiered of feeling nauseous. I was diagnosed with RA over 1 year ago. I take Humira injections along with methotrexate (8 pills every Friday). Most times I feel O.K. through the weekend but by Monday I experience extreme nausea. It is like a delayed reaction (72 hours). I can’t eat for about 2-3 days. No appetite. Usually by Wednesday, I am feeling better and my appetite comes back. It is awful feeling like you want to call in sick EVERY Monday. I will try a few of the “tricks” I’ve seen posted. Splitting the dose, etc. Hope it helps. Really don’t want to take another injection.

  34. Rodger Mcarthur says:

    I feel for everyone posting here about methotrexate….my thoughts are with you all.
    I have had Plaque psoriasis for 20 yrs and tried everything, creams of all shapes and sizes, but orally (or by needle) administered drugs work so much better and save the hassle of constantly lubing up! cyclosporine was the best but the tiredness and headaches were unbearable (along with the horse sized tablets). Methotrexate tablets made me very nauseous so I switched to injections after about 6 months. I tried injections for another 3 months until I had to give up… Having 2+ days a week feeling ill and feeling like I wanted to eat 24/7 just took its toll. I actually found that if possible exercise and hyrdrating made me feel better, along with lots of what I’d refer to as snacking on bird food during the day. Agree with the post and laughed when I saw that someone was feeling sick even looking at the drug … Same here I started to feel sick on my Sunday night routine, I might go back to it and ask my wife to inject me without me looking (by the way for those who don’t like injections… Neither do I but doing the task is not the worst part so try to overcome your fear as you might be better off than I have been switching from tablets to injections… They are very very small needles and sometimes I don’t even feel it, others just a small pinch). My other option is biologics (humira) but the uk nhs seem to want you to have to be crawling in the door to prescribe it due to cost. (and have what they call a PASI score of 10) Keep your heads up and stay persistent…. Now I’m off to throw after writing about MTX ;-) x

  35. Gillian says:

    I also struggle with methotrexate but have found if I take it with fizzy juice I don’t feel as bad…random i know….but after trying all sorts of things it’s been a last attempt before moving onto injections!

  36. Donna says:

    I was on 6 pills once a week then moved to 8 for a long time doc increasing again I guess I grew a tolerance and has to increase but he is switching ti injections I can give self hope this works as well as pill

  37. Ann says:

    I’ve been diagnosed with RA for about 5 yrs, but now know I was suffering within for the past 12. Take Enbrel and inject metho once weekly. Past 8 months are a living he– as not oly is my RA in gin gear, but I get very sick with the drugs. I stopped for a month and tried some Naturopathy, but pain was so severe I went back to Enbrel, and followed with the methotrexate 2 weeks after that. It IS the methotrexate that is making me sick. I jus look at the med in its vial and feel like vomiting. I went to the injections because I had such terrible cramps with the M pills. Quite frankly I’m sick of this,but I guess we don’t have any choice do we….one thing tha helps me somewhat is to take my drugs in the early evening, so by the time I go to bed, the word part is not noticed asim sleeping.i still have some trouble the next day or so, but the first Davis the worst. Any ideas anybody?

  38. Shadi says:

    I have polyndromic RA and I start taking Methotrexat ebwe 10mg weekly + FA “since a month”, my doctor describe me Diclofenac 75mg once daily; but before I will start taking it I need to know if it is safe to have Diclo along with Methoroxite?

    • Problems associated with co administration of Diclofenac & methotrexate have been described in literature. However, these are extremely rare & these meds are commonly co-prescribed.

      However, the aim of treating Rheumatoid Arthritis (RA) is to control RA activity with Methotrexate & other DMARDs. In that case, you should be requiring diclofenac only on a ‘as & when basis’ down the line.

  39. Samantha Lawrence says:

    I am 15 years old and have been taking methotexate since I was 11 for juvenile idiopathic arthritis in my knees and jaw. I was originally taking tablets but now I have to have injections as tablets did not work. I am sick for the whole weekend after taking methotrexate and usually bed ridden with nausea. I am desperate for any solutions to this problems, as I am taking folic acid tablets but they do not seem to work. Any help is much appreciated.

  40. Cari says:

    I’ve had RA since 1997 & been on methotrexate for most of that time. the last 3 years the nausea, poisoned feeling, bad taste in mouth & very strange head have got worse & are constantly there to differeing degrees. Persevered as it works for the RA for me. Now just started injecting & was so happy doing the first one successfully & very hopeful it would stop the side effects…but 6 hours later….all back as bad as ever. Disappointing & physically feel so horrid. Doc said to try another drug if injection doesn’t help, but concerned that perhaps the RA won’t be targeted so well. But – can’t wait to feel better from the methotrexate. Try all the tricks that others have mentioned, but nothing eases it. Thanks for the forum.

    • Ann says:

      Cari, I responded already to someone else, but I. Case you didn’t see it… Similar situation to yours. Injections worked well for 41/2 yrs but then nausea, which turned into throwing up, which got worse until I just lay in bed for days afterwards. The Zofran helped for a few ours, but I’d have to take it again as it wore off, and then I was hourly constipated. Tried all the tricks I read about, dr. finally took me off and using Plaquenil in place of metho. I continue the Enbrel. Of course the Plaquenil is not as effective, but I am holding off on gong back to metho….just can’t wrap my mind around it! Good luck, try the Zofran.

      • Yes indeed, Ann.

        Methotrexate induced nausea can be quite bad & one may have to stop it altogether.

        But then, the other DMARDs like leflunomide (Arava), Hydroxychloroquine (Plaquenil) & of course, the biologics are useful to control the RA.

  41. Tamara Macleod says:

    I have switched from oral methotrexate to injection… and began to feel the nausea after injections… lasting 2-3 days. Something about the smell and now even thinking about it, looking at it… I feel nauseous… but the relief in joint pain is incredible!
    Would it be okay to spread the injections out over the course of the day? As you suggested for oral? I usually take it on Sunday so I can deal with it while the children are at school…
    So could I divide the injection in 1/2, doing 1/2 in the am and 1/2 at night?

  42. Dan Marsengill says:

    My wife has contended with psoriasis and associative arthritis for years. I’m always looking for anything that will help her. She recently began taking methotrexate and, of course, the nausea that comes with it. You mentioned acupuncture in your article. I am very prone to sea sickness and found a wristband type of product that incorporates a small battery that produces a small amount of current to stimulate that wrist point that you mentioned. I know that it is voodoo but by golly it helps me. It comes with several comments suggesting that it also helps with other types of nausea such as nausea caused by pregnancy and chemo treatments. You seem to welcome any suggestions that might or might not help so here’s one for whatever reason. The product is “ReliefBand”.

  43. Sarah says:

    Thank you for your information and your replies. I have rheumatoid arthritis as well. Methotrexate didn’t cause any side effects for me and my pain went away completely after a couple of months. The only issue I have is that the smell of my alchohol swabs makes me feel extremely sick. I started using peroxide for my injection site and I stopped feeling sick. I think a lot of that must have been in my head.

    I felt so good I tried taking a breaks from the meds (without asking my doctor what she thought) and sure enough the pain is back. I just took my methotrexate last night and today I feel so tired and nausous. I hope my break didn’t cause my body to react differently.

  44. helene olson-reed says:

    This is a very interesting blog. I am presently taking celebrex, plaquenil and 2 650mg extended release acteminophen in the am and pm. I had been on oral methotrexate for about a year but became too nauseous so began injectable methotrexate. Again after a year I became nauseous for 2-3 days per week. My doctor next tried me on Arrava. It gave me relief although I did have many loose BMs per day plus after being on it for 6 months my tryclicerides went sky high. The next med the doctor put me on was zulfazine. I never made it to the full dosage due to nausea, headache and major diarrhea!

    The doctor reccommends going back to methodrexate! and yes, my stomach did a queasy turn just hearing the word.

    I am giving aloe vera a try……..if my pain was at 1.25 on a scale of 1 – 10 after the arrava it is now about a 2 on aloe vera maybe 2.25. I will give myself about 2 weeks to see how it goes.

    It is nice to know that other people have the same reaction to methodrexate……….I thought I was just a wimp.

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  46. sharon says:

    My daughter was recently diagnosed with RA. She also has ulcerative colitis. She is on 6 pills of methotrexate and the nausea is awful for her. She is a PreK teacher and is quite miserable the day after trying to keep up with the little ones. Please give me some advice on how I can help her get through this. She is very depressed

  47. LondonS says:

    Hello, My husband has been diagnosed with Psoritic Arthritis recently. He was given NSAIDs for 2 months and then prescribed Methotrexate 15mg weekly for 6 months. He is 29 years old. I had a few questions regarding the treatment –
    1. Does Methotrexate cure Psoritic Arthritis in sometime or does it have to be taken life long?
    2. If methotrexate is discontinued, do the side effects wear off with no long term damage?
    3. On discontinuation do symptoms for Psoritic Arthritis come back worse?
    4. Are there alternative treatments for Psoritic Arthritis?

    Nobody in my husband’s family has had Psoritic Arthritis and we are finding it difficult to adjust with. Any tips on helpful lifestyle changes will be appreciated.

    Regards.

    • 1) Methotrexate does not cure psoriatic arthritis. However, it can definitely control the psoriasis as well as arthritis. Controlling the disease activity would mean preventing the damage to the joints in the long run.

      2) Methotrexate needs to be taken on a long term basis; may even be life long. But it is a good drug & controls psoriasis & the psoriatic arthritis in many patients.

      3) You can have a look at the blogpost about safety of methotrexate (http://doctorakerkar.wordpress.com/2011/02/20/are-dmards-really-toxic-focus-on-methotrexate/) to understand the safety & side effect profile better.

      4) Talk to your Rheumatologist about TNF alpha blockers. They are potent medicines & can effectively control the psoriatic arthritis.

      5) Psoriatic arthritis is not necessarily hereditary & one need not have a family history.

      Please consult a Rheumatologist. Psoriatic arthritis can be effectively controlled & one can lead a normal life.

      • LondonS says:

        Thank you Doctor for your reply.
        My husband’s Rheumatologist has prescribed methotrexate for 6 months. We were not told if methotrexate will be a life long medication. We intend to start family in about a year’s time. But I am concerned if we will stop methotrexate then will my husband’s condition worsen?

        Thanks & Regards.

      • He will have to stop methotrexate for at least a month before planning to father a child.

        Please speak to your Rheumatologist reg this concern.

        However, it would be better to give priority to control of Psoriatic arthritis. Once it is well controlled, methotrexate can be tapered slowly, stopped & you can go ahead with the pregnancy plan.

  48. Hi I have psoriatic arthritus think I’ve had it a long time but my gp was useless so finally demanded an X-ray and things then moved very quickly, was put on Celebrex 100mg twice a day and methotrexate the Celebrex helps a lot but the methotrexate caused nausea that lasted all week so yesterday at 10am I took a 15mg injection of methotrexate felt fine went back to work but by 2pm felt very sick and had to leave by the time I got home I was cold sick and had joint pain and a banging headache ,have taken today off and mostly slept its now afternoon and still have a little nausea even though I’ve been taking diclofenac since it started, my rhuemattologist said its very important we stop the damage to my joints but don’t know if I can cope with this two days a week ,has anyone else had these symptoms ?

    • Dear Annette,

      Nausea with methotrexate is quite common. Please try the suggestions listed here.
      Let us know about your experience with the suggestions here.

      It would help the other readers as well.

      • Ann says:

        My sis told me she splits up her methotrexate over 2 days, which I did. It helped, but then the Dr. asked me to stop dividing it because it wasn’t as effective. So I began using the injections, wich worked great! For 4 1/2 yrs. then came the time when my nausea began and would last days. I finally was taken off the methotrexate. I tried all different things, nothing worked. Good luck.

  49. Kenny says:

    Interesting thread Dr. I initially found MTX quite unpleasant, couldn’t sleep after it and nauseous. I was on 20mgs per week by 2.5mg tablets. It did improve for a while but after about 9 months it worsened again. I only had to think of the colour of the tablets and it set me off. Very odd, some sort of associative response it seems. I was talking to my rheumy nurse and she said they did a test with some kids on mtx. The put a pale yellow coloured folder on the desk while talking to them about mtx and they all started to feel ill. The colour association was so strong. I am now on 25mgs by injection and its much better. Not pleasant but tolerable. I can get through a working day now as long as I nibble stuff through the day and keep my mind off it. I do find now though that the smell of the alcohol wipes used with the injection does make me feel slightly nauseous now though not as bad as the yellow colour. As for what it does for me. Its put my psoriasis away though it was trivial anyway and didn’t justify mtx but I think it does nothing for my PsA

  50. Anjsters says:

    I am amazed that I am not the only one who becomes nauseous at the sheer mention of the dreaded word Methotrexate.

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