Methotrexate and Nausea

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tillytop
tillytop Member Posts: 3,460
edited 8. Feb 2011, 06:12 in Living with Arthritis archive
I have seen a few posts on here recently about methotrexate and nausea and thought my experience might be helpful.

I am on my second “go” at mtx, having stopped taking it first time round after a year and a half because of relentless nausea. Injected meth, if anything, made the nausea worse and, although my consultant understood my decision to stop taking it, the implication, particularly when things didn’t improve with the injected meth, was that it was all in my head ( “anticipatory” was the word he used).

But, eight or so years,, many other drugs and two anti-tnfs later, I find myself back on mtx and, much to my surprise, very little nausea. I am now up to 17.5mg per week, which is much further than I got the last time.

So I started to think about why that should be – particularly as I really WAS anticipating the nausea this time round – and the only things different this time round are that I am taking folic acid and I am not taking either sulphasalazine or Diclofenac. I had assumed that it was the mix of the sulpha and the mtx which were causing me the problems (on the basis that both, apparently deplete the body’s folic acid supplies) but I have recently read that anti-inflamms such as Diclo are known to increase the toxicity of mtx. And I seem to remember that, when I did have some nausea a few weeks back, I had been taking Diclo for a few days beforehand. I do pop the occasional Diclo now, but I avoid the days immediately before and after mtx and mtx day itself.

So, if you are struggling with mtx related nausea, even at low doses, and you are also taking anti inflamms, it ight be worth thinking about and discussing with your GP or rheumatologist.

Tilly xxx

Comments

  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    What wise words, tillytop, it is always worth thinking things through because sometimes the second time around can be a very different experience to the first, plus we are all so different in how we react to these various meds. I wish you well with the bigger dose - so far, so good by the sound of things! DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • stickywicket
    stickywicket Member Posts: 27,719
    edited 30. Nov -1, 00:00
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    Delighted it's working for you TT. I've always felt I must be in a minority of one because I've never had sickness with methotrexate despite being on pretty high doses and also having a rubbishy stomach due to years of anti-inflammatories. Maybe the reason I don't get problems is because I'm no longer allowed anti-inflammatories.Hope it keeps doing the job for you.
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • nanasue
    nanasue Member Posts: 465
    edited 30. Nov -1, 00:00
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    Hello everyone and Tilly,
    Iknow that you are doing ok at the moment, but I have a tip for you or anyone else that suffers with nausea (the only thing the nasty rheumy told me that was of any use! ) Split the dose, I'm on 20mg and I take half at lunchtime and half after my evening meal and touchwood I've been ok.

    Sue x
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    Well done collywobble - was it a DIY effort? I hope it went well, anyway. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • tillytop
    tillytop Member Posts: 3,460
    edited 30. Nov -1, 00:00
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    Thanks all for your replies.

    TIlly xxx
  • williamlargs
    williamlargs Member Posts: 143
    edited 30. Nov -1, 00:00
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    My advise to anyone going on to meth, stay off the internet, apart from this site of course :grin:

    I have been on it for 7 months now without any probs, touching all things wood, and it is doing a great job.

    Interesting comment about the diclofenic. It took 3 months for the meth to kick in properly and I am now diclofenic free too. Don't remember being told by any of the 'so called experts' that it placed an additional strain on the sysytem along witht the meth. As DD says we are all different in how we cope with drugs but the worrying thing is the specialists don't seem to know all the potential probs!!
  • tillytop
    tillytop Member Posts: 3,460
    edited 30. Nov -1, 00:00
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    Hi William

    Glad the mtx is working well for you! And I think you are right about the specialists!!!

    Tilly xxx
  • frogmorton
    frogmorton Member Posts: 29,493
    edited 30. Nov -1, 00:00
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    Hi Tilly

    So very glad all is so much better this time round - you were brave to give it another go with such a reaction last time.

    Very interesting thoughts too....might help others in your postition. Just a change of anti-inflams/not taking them eh? Wonder why no-one thought to suggest you try taht last time?

    Whatever I am so glad you are ok.

    Love

    toni xx
  • skezier
    skezier Member Posts: 11,333
    edited 30. Nov -1, 00:00
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    Hi Tilly,

    Tis a very interesting post flower... i have been throwing up for the UK on 25 mtx.... i do take the folic acid but it also makes me feel really sick despite them gibing me liquid ones now.....

    I do diclo's but so need them and there isn't another drug that does their Job so despite the 'ulcer' they have left me on them.... I only take them every other day but the inflamed bits are dictating more often just now.

    I wonder if it would be better to time the days i take them to the days I don't take the mtx....

    Mind it will stabilize cus I do self right quite well just haven't yet :wink:

    Hope this time you get better results and on the sulfa I also threw up big time so..... well its all interesting eh?

    Good luck flower and hope your doing okish? A nudge from the deer now fully sheeperised :lol: (((( )))) Cris xx
  • Starburst
    Starburst Member Posts: 2,546
    edited 30. Nov -1, 00:00
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    Out of interest, how much folic acid does everyone take? I was on 5mg once a week but now I take 5mg every day (except for MTX day) and my nausea is much better. This will get some controversy going....but marmite is a great source of folic acid. :grin: I've started to eat marmite every day and I'm convinced it helps but I do love marmite!!

    What you said was interesting and definitley food for thought. Thank you for sharing.
  • stickywicket
    stickywicket Member Posts: 27,719
    edited 30. Nov -1, 00:00
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    Interesting, Starburst. I've always (10-12 yrs) taken 5mg Folic acid twice a week. Now on 20 mg methotrexate. Used to be on 22.5. No problems with sickness. Don't eat much marmite.
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • madwestie
    madwestie Member Posts: 383
    edited 30. Nov -1, 00:00
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    Starburst, i have 25mg injected metho and take folic acid tabs 3 days a week. I don't eat marmite but do love twiglets...i do have cereal everyday which has folic acid in it. I have never had any problems with nausea.

    Tracey
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    I take FA once a week, I didn't have a problem with nausea before and I still don't. It keeps the medicos happy. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • skezier
    skezier Member Posts: 11,333
    edited 30. Nov -1, 00:00
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    Hi Sophie,

    its got such a variation on it the floic acid.....

    I have 10mls 5 days a week but I do have side effects to the mtx so maybe that's why its 10 not 5? Its down to what the doc your under favours I think. Cris x

    More ((( )))'s Tilly and a cuppa on the bench xx
  • Starburst
    Starburst Member Posts: 2,546
    edited 30. Nov -1, 00:00
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    Well, I really went up on the folic acid because of my mouth sores and they are much better, thankfully! I noticed it helped the nausea, although it was mild anyway.

    I wonder if varies depending on your dose of MTX too. (I was on 15mg for ages but I'm going up to 20mg.)
  • skezier
    skezier Member Posts: 11,333
    edited 30. Nov -1, 00:00
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    Hi Sophie,

    might be worth asking if you could take it more days? I been on 10 ml 5 days a week ever since 12.5 and now on 25 and well i find the folic makes me feel sick as well... they given me liquid... tastes like over ripe strawberries but its not so nauseating....

    good luck flower and it might be worth asking cus of the sores. mine was always 10 ml but the extra days are cus of the sickness and hair loss..... Cris xx
  • Starburst
    Starburst Member Posts: 2,546
    edited 30. Nov -1, 00:00
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    The nausea and ulcers are bearable for me. *touch wood* The hair loss is a tad depressing. Did the extra folic acid help you with the hair loss?
  • skezier
    skezier Member Posts: 11,333
    edited 30. Nov -1, 00:00
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    Hi Sophie,

    hard to say if its helped or not..... its getting thin but its not coming out as much as it was so maybe the extra has done some good? I did ask the gp recently about it and she said there is thinning but its more obvious to me than anyone else... hold that thought flower. ((( ))) Cris xx
  • madwestie
    madwestie Member Posts: 383
    edited 30. Nov -1, 00:00
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    Starburst, i think the increase in folic acid helped with the hair loss and they even increased the metho.
    The only thing I have found is I have forgotten what a normal amount of hairloss is like. everyone loses hair when they wash or brush it but what I can't do is view it objectively I still think i might be losing more than normal but I asked my hairdresser and he said it is fine and as thick as always so I have learn't to accept what he says as he can see all of my hair and i really only see the bits in my hand.

    I was like you though i could deal with the nausea, ulcers etc but hair loss now that is a different matter.
    I hope you get it all sorted out soon.

    Tracey

    ps for the nausea someone suggested i tried steam ginger in syrup, the ginger is good for the nausea and it comes in a lovely sugary syrup.. yum
  • tillytop
    tillytop Member Posts: 3,460
    edited 30. Nov -1, 00:00
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    Thanks peeps for your posts - and thanks to Cris for the nudge from the "sheeperised deer"! What a wonderful expression Cris!

    Re Folic acid, I don't think I took it at all first time round, but this time I take one 5mg tab each week. I take mtx on Monday and Folic Acid on Friday. There doesn't seem to be a standard dosage.

    Tilly xxx