First Dose

The other day when my rheumatologist wrote me a new prescription, she printed out Methotrexate: Patient Drug Information from UpToDate. This is a site that Doctor D mentioned  a couple weeks ago, and now my rheumy gives me info from there.  Cool.

The insert that the pharmacy gave me mentions that methotrexate can cause dizziness and tiredness.  This I can confirm.  The pharmacy insert also says to contact the doctor immediately if this medicine makes your urine dark.  I’m already taking  prescription cheetohs sulfasalazine; not sure I’d notice more color changes!

A once-a-week med is weird.  From what I’ve heard, most people tolerate methotrexate pretty well; I hope to be so lucky.  But, on the off-chance that I get hit with the bad side effects, I don’t want my weekends ruined.  That means Saturday and Sunday are out.  Since we like to occasionally take off for three-day-weekends, Friday and Monday are out, too.  I have a regular Thursday commitment.  That eliminates a large portion of the week!

In addition to picking a day, I had to decide on a time.  I’ve read that by taking methotrexate at bedtime, you’re likely to sleep through the majority of  unpleasant side effects.  That works for me.

According to quite a few people at Arthritis Foundation’s RA Connect forum, methotrexate in pill form can be hard on the stomach.  I’d be okay with injections, but pills seem easier.  There is a possible solution, though.  Splitting the dose can help alleviate this problem (half the pills in the morning and half in the evening).  I’ll take all the tips I can find – but will run things past my doctor before implementing them.

When I asked my rheumy about splitting the dose, she was surprised that I already knew anything about it (she’s a new doctor to me this past spring; in time she won’t be surprised that I do my homework).   She does not recommend splitting the dose because that’s harder on the liver than taking the mtx all at once.  I’m so glad I asked, because I’d like to keep my liver functioning as well as possible!

Anyhow, I picked bedtime instead of morning, and Tuesday instead of Wednesday.  Which means my first dose was last night.

Another tip I’d picked up is that it can be helpful to carb-load before taking methotrexate.  In the interest of extra carbs, we had pancakes and applesauce for supper (yes, I’m still canning applesauce).  That was a big hit with my younger kids.  Next week we’ll probably have spaghetti.

Methotrexate is supposed to be taken on an empty stomach (another tip that I’d never seen mentioned anywhere).  Three hours after our meal, I took my mtx and settled down with a Sudoku book.  Tired, dizzy.  So much for anything that required my brain to function.  I’ve been working difficult puzzles, and last night couldn’t even solve an easy one.  Next week I’ll wait an extra hour and just take the pills as I crawl into bed.

Next: mtx side effects


5 thoughts on “First Dose

  1. Good luck.

    When I started mtx, I did get rather sick for about 2 weeks. I was very nauseous and sleepy and couldn’t really eat anything. But, after two weeks, those side effects disappeared completely and haven’t been back. So, don’t be discouraged if you do have some side effects at first; they may not last.

    I hope you notice a difference in your RA symptoms soon.

    • Thank you. That is good to hear. Right now I feel so horrible that I’d rather deal with the joint pain than this. I’ll tough it out and hope it gets better.

  2. If you aren’t taking a folic acid supplement, ask you doctor. Once I got enough folic acid in all the side effects went away for me. I have had to up the folic acid as I up’d the dose of mtx. I am with you, take me does Wednesday nights, no need to ruin the weekend. Hope it works fast for you.

  3. Pingback: Methotrexate for RA « ∞ itis

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