Promised to do a follow-up to my First Dose post. Possible methotrexate side effects, and my thoughts on them.
(Edit to add: nausea was a temporary side effect for me. If you’re considering mtx, don’t let this scare you away. I felt awful the first week, still pretty bad the second week, but increasingly better after that. Now I have no nausea at all. This DMARD is the standard for RA because it works so well. Most people don’t have a problem with it.)
I’m not too keen on this med, but am told it’s temporary. I feel awful, and can’t even figure out how to make complete sentences.
Excuse the graphics, but right now, here’s how I feel about methotrexate. (edit: remember, this was temporary)
Without further ado, possible mtx side effects:
Anemia, low white blood cell count, and low platelet count.
I am concerned about this, but the doctor is ordering monthly lab work. Any problems can be caught and addressed. My white cells and platelets have already taken a nose-dive over the past two years. Because of this, I’m not sure that any further decline could rightly be attributed to the mtx.
Risk of infection. Avoid people with infections, colds, or flu.
Is this even possible? I don’t live in a plastic bubble. I’ve had a sore throat for a few days, and two of my kids have been sick (as in, I need to shampoo the carpet). My rheumy thought it would be okay to go ahead and start the mtx, so she must not be overly concerned about it.
Nausea or vomiting. Small frequent meals, frequent mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help.
See above picture. The idea of taking the mtx at bedtime is so you sleep through the worst of the side effects. Hate to think what I’d feel like otherwise. I tried the gum trick. It helped for a while. I can’t chew gum all the time, though.
I’m okay with not being hungry, so this side effect isn’t really a problem. I forced down enough food that I could take my meds. With any luck I’ll even lose some weight in the next couple weeks.
This is the only side effect I remember my rheumy warning me about. She said to make sure I’m near a bathroom for a couple days when I take this medicine. Fortunately, it hasn’t been an issue. Whew!
Mouth irritation. Frequent mouth care with a soft toothbrush or cotton swabs and rinsing mouth may help.
Supposedly, mouth sores with mtx are from a folic acid deficiency. Thus, the prescription for folic acid. I already get mouth sores periodically, even without the mtx.
Quite severe. I finally thought to take some acetaminophen. Weekly headaches could be a problem so I’m hoping this is temporary.
Hair loss. Hair usually grows back when medicine is stopped.
I’m already losing my hair. What hasn’t fallen out is breaking, so I can’t imagine that mtx is going to make it any worse. It’s just hair; I can get a wig if it gets too bad.
Liver damage can rarely occur.
Frequent LFTs will monitor this. If there’s even a hint of a problem, it should be caught early.
Lung damage can rarely occur.
I don’t recall seeing anyone discuss this before. Probably because it’s so rare. I’m on a low dose, so doubt that there’s much chance of this being a problem.
Other forms of cancer can rarely occur later in life.
The risks are still pretty small. And I wonder, how much later in life? Given my crummy genes, it’s not likely that I’ll live to be 100. I control the risk factors I can, and don’t worry about the rest.
What it really boils down to is that these potential side effects fall into three categories:
- extremely rare
- common, but temporary while adjusting to the medication
- already happen even without the mtx
It will be interesting to look back at this list in a year and see if I still feel the same way.