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Doctor insights on: Methotrexate Injections Vs Pills

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Methotrexate injections and pills didn't work for scleritis and was wondering if remicade (infliximab) is good medicine for the scletitis?

Methotrexate injections and pills didn't work for scleritis and was wondering if remicade (infliximab) is good medicine for the scletitis?

Resistant scleritis: Initial therapy always requires systemic nsaids, glucocorticoids, or other immunosuppressives (rituximab & cyclophosphamide). Cyclosporine & mycophenolate may also work. Azathioprine or mtx may be most beneficial for maintenance. Tnf Alpha inhibitors (eg infliximab) may be effective in resistant disease. Scleritis should ideally be managed by ophthalmologist+rheumatologist experts. ...Read more

Methotrexate (Definition)

Methotrexate was originally used in the early 1950's as a treatment for cancer but was also found to be effective in many other diseases including rheumatoid arthritis and psoriasis. It has anti inflammatory and immunosuppressive properties which make it an excellent first line therapy for RA ...Read more


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What would weekly methotrexate injections do to a person?

What would weekly methotrexate injections do to a person?

A mainstay for...: The treatment of rheumatoid arthritis and psoriatic arthritis, and other inflammatory conditions! I administer to my patients mtx by the subcutaneous route, thereby insuring 100% absorption and bypassing stomach and liver. When given with folic acid, I rarely see significant problems for my patients! ...Read more

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Why do I feel pain the day before I do my methotrexate injection?

Why do I feel pain the day before I do my methotrexate injection?

See details: There are some RA patients in which methotrexate does not provide a full week of disease control. In those instances an increased dose may solve the issue. ...Read more

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What could be causing my pain the day before I do my methotrexate injection?

What could be causing my pain the day before I do my methotrexate injection?

? flare of arthritis: Why are you taking Methotrexate in the first place? If it is for ra, it is possible that your arthritis is breaking through and it is possible the dose needs to be adjusted. ...Read more

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Can I take the 8 pills of Methotrexate once a week or is it better to divide it and take it everyday one pill a day on the 7th day two pills?

Can I take the 8 pills of Methotrexate once a week or is it better to divide it and take it everyday one pill a day on the 7th day two pills?

Depends: Please talk to your doctor. I am an oncologist and am more familiar with weekly dosing (taken all at once, once per week), but please make sure that is what your doctor intended for your treatment. Thank you. ...Read more

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Can I have one drink a week on methotrexate injections?

No: Would not advise it Methotrexate and alcohol can accelerate liver damage that each can do alone. The combination is worse. ...Read more

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How long before methotrexate injections start working when used for jra?

How long before methotrexate injections start working when used for jra?

See details: That is difficult to answer because it depends on the dose. I will generally increase the Methotrexate dose if there has not been a response in 6 weeks. ...Read more

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Child weighs 53pounds what is the highest dose of methotrexate injections can be used for jra? She is already on 25mg injections weekly

Child weighs 53pounds what is the highest dose of methotrexate injections can be used for jra? She is already on 25mg injections weekly

See details: A 6 year old is already on too high a Methotrexate dose imo. You keep asking variations of the same question over and over and over again. Why? ...Read more

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6y/o has jra/jia and on 22.5 methotrexate injections for 3 months and lil improvement but rheumo won't add or change meds. What do I do?

Ask why not: Is your child's rheumatologist an adult or pediatric rheumatologist? Adult rheumatologists often are less aggressive with using tnf-inhibitors (enbrel/humira/remicade)because adults do get more infections with more aggressive treatment--almost all kids do not have this problem. Our group is very aggressive and we get great results-if rheum doc not willing to try Enbrel (etanercept) or humira, look for a new doc. ...Read more

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Can going from 22.5mg of methotrexate injections to 25mg (in a 6year old) increase your chance of side effects? So if didn't have before can have now?

Can going from 22.5mg of methotrexate injections to 25mg (in a 6year old) increase your chance of side effects? So if didn't have before can have now?

Yes, definitely: A weekly dose of 22.5mg of Methotrexate injections is already a pretty high dose for a 6yo child, so I would not go up further. I would reduce it to 12.5 or 15mg of Methotrexate weekly injections and add either Enbrel (etanercept) (less painful) or humira (equally effective and better for eye inflammation and ibd-related arthritis).Talk to your rheumatologist about it. Biologics are very safe with fewer side efx. ...Read more

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What is standard dose of methotrexate injections in a 6 year old with jra/jia? She weighs 50 pounds

Discuss with doctor: There are many ways to effectively treat JIA with Methotrexate and biologics (Enbrel, Remicade, (infliximab) Humira, Orencia).Every doc has their own style and can work as long as the starting dose is titrated to work but not cause too many side effects. I would start a typical 50 lb 6yo with either 10 or 12.5mg of injected Methotrexate weekly but all kids are unique so your doc may start with a different dose ...Read more

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Can I take my methotrexate and humira (adalimumab) injections on the same day? Would it be better to split up?

Can I take my methotrexate and humira (adalimumab) injections on the same day? Would it be better to split up?

Safe on same day: Humira (adalimumab) has a long half life. That means that two weeks after an infusion of it, you still have about half the amount of drug in your blood as you did an hour after the infusion. So it doesn't matter what day you take methotrexate. ...Read more

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Are there more risks or benefits with use of weekly methotrexate as injection vs oral for arthritis or ctds. Why is oral usually prescribed?

Are there more risks or benefits with use of weekly methotrexate as injection vs oral for arthritis or ctds. Why is oral usually prescribed?

No: There is no increased risk in fact many believe the injectable form is better as it gets directly into bloodstream and does not depend on absorption from the gut. ...Read more

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What is the highest dose of methotrexate injections can a (50lbs)6 year old be on when treating jra? She on 22.5mg for 3wks and no improvement yet

See your doctor: You need to speak to your child's doctor about her current state. He or she may want to change her regimen or the dose of her medication. ...Read more

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I take methotrexate injections and been drinking daily for past 18 months and recently notice I itch all over after drinking, should I be concerned?

I take methotrexate injections and been drinking daily for past 18 months and recently notice I itch all over after drinking, should I be concerned?

Yes: Since methotrexate is associated with liver toxicity, avoiding alcohol would be a prudent measures even if itching is not an issue. Regardless whether you are on methotrexate or note, if you itch from alcohol, the best approach is avoidance (alcohol is not in the pie chart). Be sure to get your liver checked out. ...Read more

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Why do methotrexate pills harm the liver?

Why do methotrexate pills harm the liver?

Mechanisim of med: Methotrexate pills are broken down in the liver and effect several liver enzymes. You can get the specific details in Kelly's textbook of Rheumatology or a pharmacology text. This effect is multiplied by alcohol which should be avoided when you take methotrexate. ...Read more

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Is it better to be on 25mg methotrexate injections (53pounds) or lower dose of methotrexate along with a biological in treating juvenile arthritis?

Is it better to be on 25mg methotrexate injections (53pounds) or lower dose of methotrexate along with a biological in treating juvenile arthritis?

JIA treatment option: There are 2 schools of thought. One is to be just on one medicine if you can if that controls the arthritis. If the arthritis is poorly controlled, than add a 2nd medicine. The other approach is to start with multiple medications to get the arthritis under control and then pull back later. Either approach is reasonable. I think many doctors try and just treat with one medication if possible. ...Read more

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Is 22mg of methotrexate injections a high dose or just high for a 6 y/0 with jra to start off with? Please list possibly side effects at this dosage?

Toward high...: While there are variables-size and weight; severity of the condition- I start most adults on this dose and children 15-20mg. But one cannot really say. Certainly for the short term I would not expect issues. One question I would ask: did the medicine get started by a rheumatologist or pediatric rheumatologist! ...Read more

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Can I go back on duromine 2 weeks after a methotrexate injection for etopic pregnancy?

I think so: I don't think there is a drug interraction, duromine is a weight loss drug. It should not affect the methotrexate; it has likely done its job. That being said make sure the bhcg is going down and consider giving it a few more days out of precaution for the unknown, or use 1/2. There are no absolutes and giving it a couple more days won't hurt. ...Read more

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Why is the injection site yellow after taking methotrexate? It looks like someone colored it with a high lighter

Bruise by injection: Bruise from injection may change color due to the breakdown of hemoglobin from red blood cells in extracellular space. Colors of a bruise are caused by sequential degradation of hemoglobin to biliverdin to bilirubin to hemosiderin, with hemoglobin itself producing red-blue color, biliverdin producing green color, bilirubin producing yellow color. ...Read more

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Is it normal or unusual for me to have to sleep most of the next day after my methotrexate 15 mg injection? Day after that, the fatigue resolves.

Is it normal or unusual for me to have to sleep most of the next day after my methotrexate 15 mg injection? Day after that, the fatigue resolves.

See below: You are describing the classic side effect of fatigue and how it occurs after taking methotrexate. Talk to your doctor if this continues to be bothersome. ...Read more

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What would happen if one took methotrexate injections weekly and their immune system was not overactive? Would they feel sick or have side effects?

What would happen if one took methotrexate injections weekly and their immune system was not overactive? Would they feel sick or have side effects?

Yes: In many patients yes in many patients know it is a liver toxin which causes fibrosis of the liver with long-term use. This has to be monitored all during the drug usage every six months. ...Read more

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I would like to know if botox injections are safe since I have RA and take methotrexate and humira (adalimumab).Thank you?

I would like to know if botox injections are safe since I have RA and take methotrexate and humira (adalimumab).Thank you?

Assuming...: If you are getting the Botox for justifiable medical reasons, there is no contraindications with taking both mtx and/or humira! Ask your rheumatology specialist, if your pcp is unsure. But I see no issue! ...Read more

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My HCG levels dropped and now increasing after Methotrexate shot. 3152 mIU/ml before injection. 48hrs after shot it was 3052. 72hrs after 3108. Nopain?

Rising HCG: I would wait a few more days as the methotrexate may take a week before you see a descent drop in level. If no drop by then, I would start by checking an US to look for retained molar tissue. ...Read more

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Injection of methotrexate caused a raised bump under the skin and turned bright yellow?

Injection of methotrexate caused a raised bump under the skin and turned bright yellow?

Methotrexate toxic: Injection of methotrexate caused a raised bump under the skin and turned bright yellow? ANS; So your whole body is yellow or just the bump area. Need reason you are getting methotrexate at your age. If just around bump then most likely bruise going thru color changes as it resolves. Send pictures. I am here for next 3 hours. ...Read more

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On methotrexate /weekly injections x 3months. In last week, waking up nightly very nauseated. Could increased liver enzymes cause nausea?

On methotrexate /weekly injections x 3months. In last week, waking up nightly very nauseated. Could increased liver enzymes cause nausea?

Maybe: Maybe, but these are not classic symptoms. Methotrexate can impact the stomach lining, and you can feel nauseated due to that. Also, sit down with your doctor and discuss this. Some other drugs you are taking might also be causing this. ...Read more

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Had my methotrexate injection 7 weeks ago for an ectopic pregnancy (about 3 weeks along). Still getting pos. Home pregnancy tests. What's going on?

Had my methotrexate injection 7 weeks ago for an ectopic pregnancy (about 3 weeks along). Still getting pos. Home pregnancy tests. What's going on?

Should be tracked: After Methotrexate it is important that your BHCG levels be tracked all the way down to zero. Usually this is done weekly. This is done to make sure that Methotrexate worked to treat the ectopic pregnancy. Also since it has been 7 weeks are you sure that this is not a new pregnancy? It is possible that you are pregnant again. See an Obgyn for a BHCG blood test. ...Read more

Dr. Robert Lowe
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Rheumatrex (Definition)

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