Injectable Methotrexate

It’s great having few side effects from methotrexate.  I recall how nervous I was about starting this medication, and how sick I was the first couple weeks (despite a low dose).  Thanks to AF’s RA support board, I’d already known that side effects can be minimized by taking pills at bedtime (which lets you sleep through the majority of the nausea).  It was great to discover first-hand that it’s true when they say that side-effects diminish over time – your body gets used to the med and it doesn’t continue to make you sick.  What a relief!

I started taking methotrexate as tablets.  My starting dose was four pills (10 mg).  Then I increased to six pills (15 mg), then to eight (20 mg).  Now my rheumatologist has again increased the dose and also switched me to injectable.  25 mg equals 1 cc in the syringe.

I thought, being experienced with the injectable biologics, that injectable mtx would be the same.  It’s not.

Injectable mtx is stable at room temperature, so it can be kept in the cupboard, unlike biologics that need to be stored in the refrigerator.  Since my refrigerator always seems to have way too much stuff in it, it’s nice to keep the mtx in my cupboard.  A bonus benefit is that this should make the mtx easier to take along on trips, should the need ever arise.

Unlike the huge space-eating boxes that biologics come in, the vials of mtx are small.  Two of the 2 ml vials fit into a regular sized prescription bottle.  Even the 10 ml vial is about the size of a standard prescription bottle.

A large part of the difference is that my biologics have all come in pre-filled syringes with an attached hypodermic needle.  I open the box, remove the medicine, let it warm up briefly, then give the shot.  It’s quite simple.  In contrast, injectable mtx comes in a little vial with separate syringes/needles, and I have to draw it up myself.  It’s not difficult.  My pharmacist was kind enough to give me a demonstration and then let me practice (with a vial of plain water) instead of sending me home to figure it out on my own.

Appearance of the medication is different, too, and I think this is where I’m running into problems.  My biologics have all been clear, looking a bit like water:  familiar, harmless.  Injectable mtx, on the other hand, is bright yellow.  BRIGHT YELLOW!!!  Really, I’m supposed to put that in my body?!  I’m having a little trouble wrapping my head around this one.

In some ways, the injections are even easier than the pills.  Pills are supposed to be taken on an empty stomach, but injections can be done any time of day, without regard to when you last ate.

I also read somewhere (sorry, no link), that sometimes injecting a medicine (bypassing the stomach) can make it easier on your liver.  My liver needs to last many years yet, so I’m in favor of making things easier on it.

Another advantage is that bypassing the stomach is supposed to make the medication more effective.  Who could object to that?

I’m open to tips if anyone has ideas on getting past the concept of injecting that bright yellow stuff into my stomach.

Thank you for reading.

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 *With needles, a bigger number means a smaller needle diameter.  A 27 gauge needle is 0.01625 inches (0.4128 mm).  A 25 gauge needle is 0.02025 inches (0.5144 mm).  Not a huge difference, but definitely noticeable when that thing is poking through your skin!