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Methotrexate Injection

Q: Is there any benefit to receiving methotrexate by injection as opposed to taking it orally? Is it metabolized differently? Are the side effects of methotrexate injection different?

A: Methotrexate is a disease-modifying antirheumatic drug (DMARD) used to slow the disease process and treat the pain and swelling of rheumatoid arthritis. The body's absorption of the drug, and therefore its effectiveness, varies among individual patients when the drug is taken orally. To improve methotrexate's effectiveness, physicians may increase the oral dosages or try intramuscular methotrexate injection.

Although the injections may help improve the medication's effectiveness, the potential side effects and benefits of methotrexate are virtually the same whether it is given orally or by injection. Liver damage remains the main concern, and is monitored by frequent blood tests. Taking 1 mg of folic acid per day can help reduce other side effects related to methotrexate use, such as mouth sores or gastrointestinal irritation.

David Pisetsky, MD, PhD, Rheumatologist

Ramona

03 Mar 2010, 07:20

Hi, when i take oral Methotrexate, I got Horrible headaches almost migraine like, never went to injection, does anyone who went from Pill form to injection,and had bad headaches, will the injection be better?

Pincky Mount

19 Feb 2010, 11:09

Hi!! I'm one of those people that has tried everything. I have been living with RA for 18 years. At this time I am doing injections once a week for the last 2 months. Started with .60; then .80; now 1.0. Also on folic acid and pred. When I was on Humira it really worked. But now that I'm on medicare I can't afford my good drugs. My doctor is talking about orencia. That's a monthly infusion. He said my ins would most likly pay for that. But I have to say the injections have worked better than the pills. Forgot to tell ya'll I am a cancer surviver. One year out. When I was on chemo my RA never was a problem. Funny!!! But I know I will get better. I will not give up.

mandy

17 Feb 2010, 18:40

hi my 6year old son has JIA and has been taking meth for almost two years now, in the beginning he was on the oral dose but would have continues flare ups resulting in into joint injections every 3 to 5 months, he is now on a higher dose and injection form which as worked wounders for him, the only down side is his tummy cramps and he seems to have diarrhea all the time.

Kerry

12 Feb 2010, 04:46

Hi Everyone, I am 29 and was diagnosed with serio negative arthritus when I was 15. I have it in my neck, elbow, both knees and hips, ankles and my shoulders are starting to ache. I have been on methotrexate for 5yrs and have been on 25mg of the injection form for about 10 months, the benefits have been amazing, however I am wanting to start a family and am really scared of coming off the medication. I have read I have to come off for 3-6 months before we can start trying, this seems such a long time and I am petrified of the pain I will be in, but am desperate to have a baby and fear the longer I leave it the worse it will be, does anyone have any advice for how to make this less painful?!? Thank you in advance.

Shadia

28 Jan 2010, 16:36

I Have Neurosarcoid and have tried several of the chemo drugs and so far the Methetrexate is helped the most.
I was on the pill form for 3 months and than it stoped working. so my dr just gave me the injectable. this week will be the first shot and i am hoping it helps much more than the pills. I did lose all of my hair with the pill form but hoping with this my hair loss will be less.
Good luck to you all

Deborah R

17 Jan 2010, 10:57

Thank you all for your statements on RA and MTX, I was switched from the pill to the injections. I don't like needles. I panic. I appreciate the insight on using the thin needles. Its so great to be able to communicate with people that truly know what you are going through. I know its on me for not asking questions about my medications. After reading your comments, I will! Folic acid. I was given it anf had no idea as to what it was. I was and still do depend on my daughter for reseaching my medicatios-and its my neglect for not intaking the things she explains to me. I will do better, I love you all. Its so heart-warming to read your articles and obtain info. I stay home because there have been many times-it seems like an attack on my joints. The pain is unexplainable and I be so embarrassed. Some don't understand/ you do. Thanks so much with lots of LOVE.

DHS-Deborah

carol scherrer

14 Jan 2010, 06:56

my question is that i am taking the methotrexate 25mg in injections per week, I take 1mg of folic acid each day and also on prednisone daily, the thing I am concerned on is my doctor doesn't do the blood test every month, I thought this was one of the main things to have done monthly while on this medication. I started the shots this week and she gave me 2 refills of it and then when I need to refill, then she wants to see me, that will be over 2 months on the shots, is this right?
thanks
carolc

megan swink

03 Jan 2010, 21:52

i have been on the methotrexate shot for about 1 and a half now and im using it to improve my eyesight which hasnt worked very well... im 16 years old and want to loose weight that was caused by the methotrexate, and want to take diet pills but dont know if its safe... if anyone knows the answer to my question please contact me at megan_lovesyou1993@hotmail.com please and thankyou...

Megan Swink.

sam

03 Dec 2009, 16:28

Hi,my nearly four year old son has been on metho trexate injections for 18 months now.He has JRA in 5 joints and since being on methotrexate his condition has greatley improved.He suffered with the sickness for 1st few weeks but it setteled down.He only takes folic acid once a week but this seems to work for him.To any one worried about having injections it really isn't that bad,i injected heperin through both my pregnancys and it is easy and if a four year old can handle it im sure most adults can.One last thing,please make sure that if you have any immunisations to really keep checking there not live(because of immuno suppression) as i asked twice at the doctors and they still injected my little boy with mmr!thanx.

Gina

02 Dec 2009, 14:38

I have been on the MTX for about 6 month now for the treatment of Lupus. I could not handle the pills and went to the shot. The once a week shot has been a lot better. I have had high inflammation in my blood and can't seem to get it under control. Two weeks ago we went up on the dosage because my inflammation went up instead of down. Is there something else to try?

Steven

26 Nov 2009, 04:10

When on Methotrexate you need to be aware of being tired - anemia can be a side-effect -- even for men ! Speak with your doctor if you are overly tired.

The injections are very easy in the thigh - if you feel the needle go in - it is probably dull ;-] - use an ultra-fine needle and you will be fine.

The issue I had is with the 2ml vials of Methotrexate - it is very difficult to draw the remaining 1ml from the vial - and the vials are so small - with hand issues comes more difficulty - try to get the larger vials from your doc.

Alan

24 Nov 2009, 21:58

Hi, I'm new to this site and now I know that I am not going mad, I've experianced most of the side effects myself. I have been taking 8 Meth tabs a week on a Saturady night for the last year and the the stomach pains the next day are hell and I bleed when I poo. I have be told to go on injections next month and I hate needles. I take folic acid 6 days a week but they don't seem to help. Will I still get the rashes and fatigue with injections? I know the meth helps as I am a bass player and before it, I could not play for 2 year, now I play for 15 minutes a day, not great but better than some.

Connie

18 Nov 2009, 08:16

I am 68 years young and was diagnosed 7 years ago. I started with the Meth pills as I didn't think I could give myself a shot in the stomach but my wonderful Dr. encouraged me to try and I did and really there is nothing to it. The thought is worse than actually doing it. I have much better results with the injections. I take a couple of milligrams of folic acid a day to keep hair from thinning. I am so happy to be on metho as without it I would not be walking, I am sure. I feel great and no complaints. Good luck to all of you with this disease. I don't have to look very far to find myself thinking "there but for the Grace of God go I". One has to be thankful for good Docs and a good attitude. lol

Karen in Iowa

13 Nov 2009, 15:20

I have pretty severe mixed autoimmune diseases including RA and have been taking methotrexate injections 18 mg for about 10 years now. It has helped tremendously and is relatively pain free. I still am gradually getting more and more affected with RA but feel I truely would not be walking or doing many of the things I do if I weren't on MTX. I take about 800-1000 mg of folic acid 6 days of the week to keep side effects under control and really notice mouth sores and abdominal discomfort when I skip a dose. The real benefit seems to be the sparing effect on my liver. So far, so good. I'm on several other meds, like prednisone (boy, I'd like to get off that) and Plaquenil (great help)and pain meds too.
If you need the MTX, the injections seem the way to go to reduce side effects and get "more bang for your buck" towards the RA.

Steve

09 Nov 2009, 04:52

When I started taking Methotrexate for Psoriatic Arthritis - the doctor started me on pills to determine my tolerance - then switched to liquid injections - 1ml/weekly. He stated the reason for the injections was liver damage - that in pill format, 100% is processed by the liver - in the liquid injectable format, 20% is processed by the liver.

The self injections were easy - be sure to use a thin needle - the thing I did not like were the monthly blood tests.

Best to Everyone.

sharon turner

09 Nov 2009, 02:59

hi all, i have been on methotrexate for my psoriatic arthritis for 1o months orally. changed to injection form 4 weeks ago but i still have the nausea and fatigue. i take folic acid 6 days out of 7 but do not think it makes any difference. get joint injections to help relieve swelling and pain, going tomorrow for one into my ankle. not looking forward to it.

Brenda

06 Nov 2009, 11:52

I started injection of the methotrexate instead of 6 pills what a difference it has made. I no longer hate for sunday to come and the 3-4 days that follow with the side effects.I was at first scared as I do not like needles but its very easy and pain free. I highly suggest to talk with your doctor about changing if you have side effects with the pills. good luck

kristy

05 Nov 2009, 18:53

My experience with methotrexate is good its a miracle drug in my book but im not so keen on the idea of the needle , I also have a hard time remembering to take my folic acid , how dangerous is this ?

Linda

29 Oct 2009, 13:47

I have been on Methotrexate for about 3 months. The shot once a week. I have been walking with a cane for about 7 years because of my mobility. since I have I been on the shot I had not to use my cane, for that I am greatful. But I notice my appetite has change and losing weight, I take a bite of two and can't eat any more. I am finding that I am Nausea, and some stomach cramping. Is this a side affect. I was told that this medicine was use with Cancer patient. How true is this.

Lisa McCulloch

21 Oct 2009, 14:18

Hi Everyone,
I've been taking Methotrexate ( 10 tablets) for about 12 years. A few months ago I started to get really really bad stomach pains and headaches. Taking them on Saturday really wiped out the weekend which at 26 is not the greatest thing. (Or any age :) I asked if it would be possible for me to try the injection. I'm going for my first one tomorrow morning. It gonna mess up my 'tablet' day but hey ho it's worth a go. Reading this i'm starting to feel a bit nervous now. :S I'll write back soon and compare stories.
Take care everyone,
Lisa.xx

Kevin Southall

13 Oct 2009, 03:42

Hello, I have been on injection form for only a few weeks but have noticed more hair loss when washing than normal also my hair on top seems to becoming realy fine and I am worried about losing my hair anyway, is this normal ? will it stop or should I stop the injections can anyone advise me. Thanks.

Carol

30 Sep 2009, 16:42

I have taken MTX injections for 10 yrs. I was unable to tolerate the folic acid. I tried everything but would end up with heartburn & indigestion. ( This is what I experienced when I was pregnant, also. So, I don't take folic acid)

Cynthia

25 Sep 2009, 14:12

My doctor has not officially said I have RA but some type of Arthritis. She currently has me on 8 tab of methotrexate and I am so far lucky not to experience any side effects but I am not experiencing any relief either. She has also added a daily does of Plaquinel and I have not noticed any improvement. She has mentioned switching me to the injection. I am wondering if I can expect better results.... Is it possible to respond to injection form and not the tablet form?

chris bardy

20 Sep 2009, 13:31

Hi
In reply to a question i have been put on injection from tabs cos of tummy pain nd headaches on my second week now nd still the same So wot do you do
Chris

Linda Sercombe

01 Sep 2009, 07:16

I have just recently been changed from tabs to injections because of the need to increase the doseage and associated side effects i suffer but after the third weekly injection my imflamation levels have gone up and my joints, feet and hands have becombe swollen and painful as if i had stop taken methotexate completely.
is there a delay period when you change from tabs to injections?
has anyone else had a similar adverse reaction?

lidia

22 Aug 2009, 11:57

is there anyone else also taking placquenil for the fatigue from RA i am injecting once a week of methotrexate, and always nauseous and am taking folic acid everyday. humira and enbrel were to painful for me

Georgette

04 Aug 2009, 13:01

Hi ive been taking injection methotrexate for 8 weeks now, but every timei have an injection i get around red rash almost like a heat rash approximately 1 week after havingthe injection. Has any one else experienced this,if so will the rash ease off. i am still waitingnfor the injection to start workingalthough i hardly get any sicky feelings at all.

andy whiteside

24 Jul 2009, 08:23

Hi. I have recently been diagnosed with disorder and was put on methotrexate, 8 tabs once a week due to side effects which included upset tummy feeling sick and horrible headaches which would last for nearly 2 days, i have now been taken off the tabs and about to start on injection and am worried that i am going to suffer the same reactions. Can anyone who has been through this ease my mind as to whether the injection is better than tabs.
Andy

Pam

20 Jun 2009, 19:22

I've been on methotrexate now for about 8 months. I was taking 5 pills then increased it to 7 a week. Still too much pain in joints and stomach pain was pretty bad. Now I on injections once a week now for the last 2 weeks. I haven't noticed and change yet but my RA doctor said it would take about 4 weeks to notice the difference. Still get flares in my feet, hands and wrists but nothing like it was before taking methotrexate. I was unable to function before the medication.

barbara

13 Jun 2009, 23:41

I'm fairly new to this illness called rheumatoid arthritis, and I can't say I really like it much. I'm embarrassed to ask others to open a jar of pickles or my coffee creamer. I take methotrexate (15 grams) every week, and it really helps. I'm having shoulder surgery soon, and i had to stop taking it - this week is BAD. And once I stop my work for the day, I just want to fall asleep! Is that normal? Thanks so much for listening. Bless everyone suffering with this miserable disease.

Jane

12 Jun 2009, 11:17

I've been taking METH for several years now -currently 6 tabs per week. It's the highest dose I can take without awful side effects (headache, tired, sick, nauseated) that go on for two days. My rheumatologist finally said to break up the dose so now I take 3 pills before bed, then 3 pills again before bed the following night (all in 24 hours). This has helped quite a bit.

ALSO, he gave me folic acid Rx, but that didn't help at all. Another doctor said 40% of people in US don't have the gene allowing our bodies to process prescription folic acid. This doctor put me on a methylated or water soluable folic acid. BINGO. Life has gotten much better the last several weeks.

julie

07 Jun 2009, 14:27

hi christa, in reply to your concern about the side effects of methetrexate, do you have you regular blood monitoring? it is very important, and not to take any over the counter medicines without the advice of your r nurse or doc..

julie liverpool.. if you would like to email me i can send you some info on natural therapy products..

julie

07 Jun 2009, 14:21

i take meth orally every time i take it once a week the day after i get very giddy, and just feel awful. also my rhymatoligist just said take one follic acid once a week, some people i see take it every day. is this right?

Christa

12 May 2009, 04:54

I'm taking Methotrexate oral pill. I'm taking 2.5 mg (4 tab) weekly. After I take it I seem to feel fatique and a little achy. Is this normal?
I'm also concern about the side affect of this medication. I heard it can affect your liver and immune system. I did take Prednisone and it upset my stomach I just stop and gosh I felt miserable. Now I'm on Methotrexate seem to help with the swelling and pain. I just concern about the side effect of this medication. Anyone else who is condern about this medication.

Denise Huang

16 Apr 2009, 15:11

My rheumotologist gave me Euflexxa injections for my OA in both knees. He said this new medication just like to add a new "cushion" between bones in my joints. Since I am allergic to many medications and had a history of ulcer in my stomach, this new treatment may prevent from further health problems.

I can't find any information about Euflexxa in your website. Please let me know the detail of this new product. Thnak you.

Nan in Waco

13 Apr 2009, 12:32

Now that I inject methotrexate rather than take it orally, I experience no stomach irritation. It was getting so that my stomach would hurt for a day or two after taking the oral dose. Keep in mind, I'm referring to actual stomach pain rather than nausea. Daily folic acid, keeping well rested, staying hydrated and not letting your stomach get empty are ways to help reduce nausea.

Janice Sweat

31 Mar 2009, 18:15

My experience with methotrexate pills vs injections bears out the truth of this article. I experience extremely better results when I inject methotrexate once a week versus taking the pills.
Doctors should be more forthcoming with their patients re this. My doctor didn't tell me anything about the difference.
Maybe he didn't know.

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Methotrexate Injection

Methotrexate Injection

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