Methotrexate side effect duration

I took my first dose of Methoject 10mg today at the hospital, with the guidance of the Rheumy Nurse around lunchtime. The injection itself was painless, with only some very mild itching/burning at the injection site for a couple of mins after. Within 20 to 30 mins I started to feel queasy and light headed (on the bus I thought I would vomit). I came home planning to work from home, but by 2.30pm I knew that would not be possible, nausea and dizziness got pretty bad (tolerable when lying down, worse when I sit or stand - at it’s worse when I move). I’m now in bed with stomach cramps (had a horrendous cramps, followed by a very bad bought of diarrhoea around 4.30). I have been prescribed folic acid to be taken the day after the injections once a week.

My plan going forward is to do the injection just before bed on a Monday evening, in the hopes I don’t feel the full effects because I’m asleep. My question to those on Methotrexate , is do these symptoms ease up over time, or am I destined to feel horrendous every time I have to take my injection? Also, how long do these symptoms last and if you get the tiredness the day after, again how long does last and does it get better with time?

I know everyone’s is different, and some may not have any symptoms, and others many, but just trying to understand what it will be like for me going forward as I’m feeling a bit sorry for myself and wishing medication was not my only option to stop the progression of this disease.

thanks very much


  • Fif
    Fif Member Posts: 107

    I take methotrexate in tablet form once a week. I started on a low dose which was gradually increased. I take it on Friday night, with folic acid on Saturday. I have experienced nothing like your side effects. At first I felt very tired and dozy, but over time that has decreased. Sometimes I have diarrhoea the following day, but nothing horrendous. I think you probably just need to give it time for your body to adjust. It has certainly got my symptoms under control so I think persevering a bit longer would be worth it. Until my diagnosis, the only medication I had taken was paracetamol or ibuprofen so I understand your feeling about being on drugs long term, but I tell myself that without the drugs I would be back to where I started with swollen joints and horrible pain and then I'm grateful that I have that option. Remember that if methotrexate doesn't work for you, there are other things that might, so don't get too downhearted. Hope things settle down for you.

  • frogmorton
    frogmorton Member Posts: 29,020

    In my own experience it gets better @Asnina

    A lot of us take our medication later on in the day just before bed and sleep off some of the side effects. Some of us go for certain days of the week too when they can have a lie in the following day. Like a Friday.

    I hope you don't feel too downhearted for some of us MTX is like wonderful a miracle drug ((()))

    Toni x

  • Arthuritis
    Arthuritis Member Posts: 412

    @Asnina @frogmorton Good advice there on taking it at the end of the day and pref, end of week, like Saturday night, knowing that Sunday has always been the day of sleeping off excesses! I gradually moved up from 5mg to 25mg, the uk max, and while the max dose just about worked for me, nausea set in at 15mg, and by the time I was at 25, nausea was not the only problem, suicidal thoughts were a constant intrusion which was weird as I recognised them as being uncharacteristic and so taking folic 24hrs later was critical. The other side effect at the max dose was frequent infections and shingles as my immune system was so weakened (which is what it took to make the joint situation bearable). Some things in diet also impact the inflammation response in some people, so keep notes to see if anything correlates to flare ups. Beans and some fruits (fructose) caused mine. That said, i am no longer immune suppressed but that’s a different story and a lucky break.

  • Nic1974
    Nic1974 Member Posts: 2

    I'm moving from tablet form to injection start tomorrow and I'm very nervous about it. Haven't been taken my tablets from March as I was advised by the hospital to stop before my surgery( hip replacement). I know it takes a couple of weeks for the sickness and triedNess to leave but I can really feel the In effect of not taken it from March so I'm more then ready to get back on it 🙏❤️

  • Chris_R
    Chris_R Moderator Posts: 764
    edited 11. Aug 2023, 09:01

    Hi @Nic1974

    Welcome to the online community,glad you are posting and getting replys from people who know what its like to be on Methetrexate,all good advice.I would also say that if these symptoms persist it might be good to check with your Rhuemy nurse for their advice aswell.Meanwhile here is a link that may help you

    Take care and do tell us how you get on and please keep on chatting to others on our forums.

    All the best Christine

    Need more help? - call our Helpline on 0800 5200 520 Monday to Friday 9am to 6pm

  • Asnina
    Asnina Member Posts: 23

    Thank you for all your comments everyone. I didn’t have a good few weeks on methotrexate, and had a bunch of side effects, due to some pretty bad bladder issues (amongst other things, I had quite a few side effects), the Rhemu nurse has told me to stop. She’s now talking about biologics, have an appointment next week. The other thing that happened, was that I was doing really well and within a few days of starting Metho, I went into a pretty bad flare, which is getting progressively worse, maybe just coincidence, who knows.