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Community > Expert Q & A > Medications > Methotrexate Injection
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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


Keith
28 Aug 2010, 05:37
Hi
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?
Deborah
06 Aug 2010, 00:31
I'm not new to the pain but was just diag a few days ago. I was put on prednisone for the next 20 days and will start the injections shortly after. Not worried about giving myself a shot but rather will i get pain relief. I'm 47 yrs old with 5 kids still home and cant move most days...just praying this works! I will pray for you all!
gill wilson
03 Aug 2010, 12:51
I have been injecting Methotrexate for the past 4 months after 10yrs taking the dreaded yellow pill form ...I cant tell you the difference to the quality of my life, ok I still get tired, headache, but the heaving stomach and dread of having to take them has disappeared..push for the injection form.
Laura B
26 Jul 2010, 00:26
Bless you all. I feel for you because I understand your pain. I try to look at the positive side of being sick and having RA. It has taught me how to have love and compassion toward others.
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!
Lynn D
19 Jul 2010, 10:46
I have had both my hips replaced (2009 and 2010) I had stage 1 lung cancer, remove the upper right lobe in(2009) also have atrilbribulation of the heart and take 6 mg per day of coumadin and also take lanoxin 0.125 mg per day. Now my doctor (specialist) thinks I have RA because my fingers are getting crooked and I am in pain. The RA flared up because it was a shock to my system due to these operations, My RA doctor wants to try 2 tablets of 2.5 mg of apo-methotrexate a week, followed by 2 tablets per week of 2.5 mg of apo-folic. I am on so much meds already, is the doctor just guessing. I am presently taking plaquenil and Pennsaid for the RA.I also take oxycontin for pain and blood pressure (240 mg) meds. How much can the body take and what effects does taking Metho and apo-folic and do they interact with the other drugs I am taking. You tell the specialists (doctors) what drugs you are taking and maybe they don't listen and somehow some drugs don't interact. My GP has told me not to take the Metho and Apo Folic drugs. I am so confused. Is there anyone or a doctor that could advise me of what to do. All your suggestions will be taken into account. Thank you for listening. I am 71 year old female.
brenda
02 Jul 2010, 21:35
Hello, my name is Brenda im 25 years old i was diagnosed with JRA 2004, bout never wanted to take medication didnt want to admit the fact i had RA but every year is being afecting different parts of my body my knees,shoulders,elbows,wrist,fingers, neck,back and now my feet.Particly all my joints i taken all the pain many nights i woken up from the pain,cried to many times i get depressed every time the weather changes and im in pain, i start thinking of sad thing as well as my RA and think about how i will look when my fingers start to deform so now i will start taking 25mg methotrexate once a week plus the folicacid if you have any advise plz email me at www.pinkhotrock@yahoo.com
Heather
22 Jun 2010, 03:32
I have been taking 10mg methotrexate a week for the last 12 weeks. i take it orally on a monday after tea and i take 5mg folic acid on a friday. After about 6 weeks i really felt the benefit after about 12 months of struggling to walk , bend, and get out of bed. However i find the side effects awful. sore and tender arms and breasts, Dizzy, tired,diarrhea and generally feeling unwell and not myself at all. I have the occasional day or 1/2 day when i feel ok. Does this get any better?
Eva
07 Jun 2010, 15:28
I'm 61 and I was using Methotrexate tabs with Folic Acid / Enbral injections for about 4 yrs. and noticed that my hair was falling out,not a little but alot. Very thinning on top,from a thick head of hair to almost nothing.I talked to my Ra Doctor and I stoped using Methotrexate and my hair started coming back.This is a side effict I can do without.Still not full like I had but I can live with it.Some people may not loose there hair. So now I just use Enbral once a week and melaxacam.I'm not telling anyone not to use Methotrexate , it was ok but I still had pain and felt miserable and head achs for 2 days. Talk to your own Doctor listen to what they have to say.
michelle polit
19 May 2010, 20:19
I am on methoxtexate and have horrible side affects like flu like symptoms chills,fever,aches,sweating . Does anyone else have these or am I all alone? help...
Nicole Muller
10 May 2010, 19:04
Injectible seems to cause a bit less tummy upset, especially if you have IBS or are prone to heartburn or the runs. It also seems to help to split the dose, as other's here mentioned, injecting half before bed one night, and the other half the next. Just make sure and take the whole dose within the 24 hour window. Folic acid, up to 1 MG, should be taken daily (somebody asked).
Becky
20 Apr 2010, 06:34
Hello all,

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
anika
17 Apr 2010, 12:22
hi

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
Myrna
09 Apr 2010, 21:02
For all those who need to take Methotrexate for the rest of their lives like me...the shots are no big deal once you get used to doing it yourself. Meth has made me feel much better and reduced inflammation dramatically. i take plaquenil and folic acid once a day. you should take these pills with food. No stomach problems if you do. We are lucky to live in a time when we have medicines which really help these autoimmune conditions.
tracey atcheson
22 Mar 2010, 07:46
I have Psoriatic arthropathy and i currently take 15mg methotrexate plus naproxen,tramadol,ondanestron,lansoprazole,folic acid and senna. I have been experiencing a lot of flair ups over the last 2 years and ended up on morphine to control the pain, i have spoken to my consultant about these episodes, and she has spoken to me about injected methotrexate, do you think it works better than the oral medication.
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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