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
































I was diagnosed with RA at the age of 3 and am now 25. I started taking Meth at about age 7 and still take it. 2 years ago I contracted mono and for some reason it put my RA into remission for about a year, but then came back even worse. Doctor suggested a larger dose of 8 pills and I asked about injections after that. I have been on the injection for about 5 weeks and have been having dizzy spells and episodes where I feel faint and sweaty. I see here that other have had that effect too. Does anyone know why this happens, if it's just the injection form or the dose maybe? It also seems to make me more liekely to feel faint when working out. Thanks for any suggestions!
Mandy
I was diagnosed with systemic lupus and RA 14 years ago. I am 45 years old now and I feel like I am 85. Different meds throughout the years including steriods, plaquinine, pain meds, and 6 months ago I started 80 units of methotrexate injections. The first 6 weeks were terrible...nausea, chills, stomach pains, ect. Then those side effects left. However, I am still having alot of swelling in all of my joints so my doctor wants me to consider Orencea along with the methotrexate. Unfortunately, my immune system will decrease and since I am a teacher, I am always in contact with different viruses, colds, and flu. So I don't think that will be a good choice for me. I can not take the folic acid because it makes me very sick. I am always tired or weak. Is there anything that can give me a boost of energy? I can deal with the pain more than I can deal with having no energy. Let me know what there is please.
I try to solider on and not complain but it's really helpful to hear you all have similar experiences. I have never met anyone with RA of the same age as me, people thinks it's something you get in older age. It's been really helpful ready this page.
How long i have to take? What are the side effects ?
I crawled into the Doc's office and begged for help. He said are you done having children and I said if it means you will give me help , YES! If I cannot take the cap off of a baby bottle or run with my 2 year old or risk passing it on to someone else! I'm done , give me help.
7 years of methotrexate (15mg week), 5 years of plaquenil, folic acid and predinsone every now and again. I work out 5 days a week, mountain bike ride when I can, play with my very active boys and love life !
Yes I get down but I have to WARRIOR UP!I am glad to hear your stories for I feel like no one can understand the pain but people whom have experienced it. My darkest days were soon after my second son but get help and keep your head up. You have to keep moving .
I tried the injections after my tummy aches hit 12 hrs just like clockwork from my methotrexate pills and I called them meth headaches. The injections I did not do a good job on and had too many flare ups and yes they seemed to be out a good bit of the liquid methotrexate, so I went back to oral and dropped hydroxychlorquine in year 5.
Warrior Up and yes much prayer to all of you RA sufferers!
to all r.a hope your conditoin inprove,
andy
Hallelujah. I can do a freaking cartwheel.
I hate the injection. My mouth produces an awful taste when I even think about it. It's is so strange. So, Jane, I totally feel your pain. But we do it, because it's working.
We do it, because we want to run in the park with our kids (I have three-- 5, 7, 9). We do it, because we've tried fish oil and gluten free and candida detox and every other natural thing out there, and the reality is... If there was ever a time to get RA, it's now. Because they're getting better at fighting it, and were reaping the benefits.
Stay strong. Eat right. Exercise. And don't miss an injection or a lab check. Ever. And one more thing...
Pray.
I am a 33 yr old gentlemen who was diasgnosed with a spondylo arthropathy in March 2010
The dr thought it may be sporiatic arthritis, but is now not too sure
My dad had ankylosing spondylitis and sadly passed away in Jan 2011
Dad had been taking long term indomethacin which ultimately we fear led to a thining of his bowell and he suffered faecal peritonitis
have been taking methotrexate 25mg tabs weekly for 4 months and am feeling the benefits
considering the injection instead , but am not a fan of needles :-(
My question is, is there any clinical benefit to the injection?
I am tolerating the tabs, occassional upset tummy but nothing major so retisent to change unless there is a significant benefit
I also take prednisolone 10 - 15mg a day, etoricoxib 90mg , folic acid and a ppi
my dr doesn't advise that diet is that important, but i feel orange juice, grapefruit and steak is best avoided?
I also want to do a bit of travelling, so figure that a tablet form would be easier than injections
Not being able to drink on methotrexate is a bit of a bummer as this was a big part of my social scene - but if it means i can carry on and live a relatively active life, then i will stay on it and not drink
not sure if other meds for our Arthritis stop you from being able to drink too?
My dad never let the the condition 'have him'
he always would say that he had the condition
I know how important mind set is with this condition - we all want a cure I am sure
Any thoughts / advice jamesculley@yahoo.co.uk
Having second shot next monday so hopefully i will not get the side effects back,
Could any one tell me how long do the shot stay in your system.or will it build up in your body every week?????
Good Luck to all with their R/A and please god we will get through this pain and feel a bit better,
I am just about 2 start met injections today after reading all the comments i feel better about it. I could not tolerate the tablets at all so i am hoping the injections will work for me.
Hope every one on here the best of luck.
Will pray for every one that has r/a and in pain.
I have very bad pain so i am hopeing the injections help me .
I'm up to 20mg (8 pills) and she just switched me to the injected form because my nausea has been *horrible*. I have to take zofran every day, sometimes it's so bad I cry--I know, sounds crazy but it's 100 times worse than the "morning sickness" I had with my kids. Plus it makes my chronic headaches/migraines worse--so those two side effects make me miserable.
I really hope the IM form works because I know the MTX is working--my skin has cleared up and while I still have pain, it's better. I still can't walk or stand for more than 5-10 mins at a time (sad, I'm only going to be 41 this month) but the constant pain is better. I don't wake up in horrible pain anymore.
I figure I've had this for probably 8-10 years. I kept going until I found a doc who would listen. Thank god for my regular doc who trusted me and referred me. I already have hip/back damage. Scary to think if I had kept going without treatment!
Take care everyone.
to the guy who's meds are not covering him for the week, go back to the consultant and get assistance , try a higher dose for a while and then gradually drop back down. my experience is that this drug needs regular review and i see my consultant ever three months and have done for the last ten years. we tend to suffer in silence, hiding our pain, i have for 26yrs, its good to be able to speak to others that share this disease.
Recently been told I have to take Methotrexate - 15mg per week. Is there anything I need to watch out for specifically and how sick can it make me?
Thank you
I was diagnosed with arthritis at the age of nine. i was on all sorts of medication that just made me have no energy. when i was put on methotrexate first orally it made me so ill i had some really bad side affects then when i was 12 i got put on the injection. It really worked for me. i had more energy and could walk without having to have someone with me. i am now seventeen and am on 25mg a week. it really does work it changed my life.
best of luck
xx
First time i can relate to a group of people -strangers that somehow become close- because of a disease for which a cure is not really available. I've been gradually on Naproxin then hydoroxychloroquine then methotrexate at the high dose of 8 pills a week, plus folic acid. Many side effects that even my wife doesn't know about, so we sort of live this condition alone. I'm switching to the methotrexate injetion upon my doctor's recommendation with a view to get on DMRAD drugs in 3 month-time... Hang in there guys and don't stay still; enrol in a gym or take yoga classes but get on the move. Inactivity just affects your morale.
Take care!
I was diagnosed 2 years ago with Carpal tunnel syndrome. they wanted to operate but I refused as chances of recovery were too slim. Then they did more extensive blood test which found the RA spike. By then i was bed ridden and in agony. I was injected in every joint with steriod which was like a miracle cure for a while. I now take Sulfasalazeine and Methotrexate by injection. Life is miserable for three days following the injection and just as I feel OK its time to have another dose!.
Im thinking of going back to tablet form MTX as the sickness has remained constant.
Is there no alternative to this foul stuff?
I was diagnosed with RA twenty one years ago and I have been through a lot. I was 29 when it happened. I was bed riden when I got it.
Sometimes, I feel like a burden to my family. My children and my husband are my reason to keep fighting.
It is very important to have a close friend or family member to be there for you.
My family has been tremendously supportive and that mades me want to keep going.
I have been in ten different kinds of treatments and they didn't help me much, so my doctor gave up on me. So, I begged her not to and she put me on Arava and it was a great blessing. I didn't get any side effects. After ten years of taking Arava, it stop working and they put me on Embrel; it almost killed me, so they put me on methotrexate and it gave me horrible headaches and fatigue. I felt spaced out and exhausted and had nausea. The folic acid improved my nausea. After 5 months, my doctor switched me to Methotrexate shots which gave me stomachache, nausea, and sometimes I feel weak and it's like I have an on and off switch; I change from one minute to the next. The headaches are gone after stopping the pill. Sometimes I feel very weak and like I am going to faint and I get very dizzy and I cold sweat.
It is so comforting for me to read your comments because I know I am not alone, I know I am not hypocondriac, these side effects are real.
I keep busy and positive but sometimes I give in to this horrible disease but I am grateful that I can see, talk and walk and I know there are people worse off.
It is really hard to live with this but I want to tell you all to keep your faith going and never give up. The most important thing in life is not how many time we fall down but how many times we get up and keep going.
I will keep you in my prayers. Best wishes!
I have been diagnosed with Rheumatoid Arthritus and Lupus (otherwise know as Rupus) for 2 years now. I started taking 2x Plaquenil per day along with Methotrexate on a Sunday (and also folic acid to counteract any side effects) I must say the folic acid did seem to work, especially if I have suffered with mouth ulcers (if I start to feel like I am getting one, then I take my folic acid and it doesn't seem to be a 'fiery' as previous ones). It has been a constant struggle to come to terms with me being sore, other people not understanding as it's not a disease that can be seen, but the worst thing I have had to contend with is my fatigue from my Lupus. Being quite a bubbly kinda girl, and always on the move, it has hit me hard. I have gone up to 10 tabs of metho per week and have recently been told that it is not being absorbed properly into my body so I will have to go onto injections. It's quite daunting, but reading these about it have answered some questions and given me some more to ponder.
Keep your chin up with it all guys, we are here to be sounding boards for fellow RA and Lupus fellows (I wont say sufferers as I don't ever think that I suffer from it, I'm not dying from it!!!) I refuse to let it run my life, I am in control of my body not my Rupus!!! Be strong guys xx
i am 16 years old and on methrexate injections but i have put on weight and i cant seem to shift it are there any suggestions let me know on x-anika-x@live.co.uk
plzzzzzzz help me
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
DHS-Deborah
thanks
carolc
Megan Swink.
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.
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.
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.
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
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
is there a delay period when you change from tabs to injections?
has anyone else had a similar adverse reaction?
Andy
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 liverpool.. if you would like to email me i can send you some info on natural therapy products..
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.
I can't find any information about Euflexxa in your website. Please let me know the detail of this new product. Thnak you.
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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