Subcut methotrexate

[GoldFrankensteinAndGrrr]

I was diagnosed with RA 10 years ago and I've been on several meds over the years, but haven't taken anything for a while (was due to have it sorted last March but my appointment was cancelled due to covid, finally had it yesterday). I'm starting subcut mtx next week - I was on the pills years ago but stopped due to terrible nausea/stomach issues, which I'm told aren't so much of an issue with the injections. I'll be on 10mg pw initially.

Lots of stuff I forgot to ask at the hospital yesterday so I thought I'd come and ask people who may actually take it for advice if that's ok!

In terms of side effects, how long after you take the dose do they hit you with the injectable mtx? The pills left me wiped out the following day and unable to leave the bathroom. Trying to work it so I'm not wasting weekends feeling lousy if possible.

Alcohol - how many units a week, if any? I know 10mg is a low dose and iirc on the pills I was told no more than govt guidelines ie 14 units a week (not that I drink more than that because I'm a lightweight these days!). Is it the same on the subcut?

Also, what advice were you given re covid? Did you have to shield or anything?

I know I can ask all this when I go back next week but I'm impatient

Thanks all!

Hi, I was on subcut mtx for years (now onto a biologic) for PSA. I went onto it because the pills made me extremely tired, I fell asleep at my desk once 🤣. I found the side effects were hugely reduced with subcut. I tended to take it in the evenings, which meant I had a good nights sleep and then was fine the next day. Side effects seemed to pass quicker as well as being less.

Alcohol wise I think the advice remains similar to the pills. I always took it mid week so if I was to have a drink or two at the weekend it wouldn't be an issue. I did once overdo it and can safely say never again.

Haven't been on it during COVID so I am not 100% of the guidelines. I don't think it makes a difference though whether you take pills or subcut, so would stay as you are. If you are on 10mg and nothing else you might be ok.

Good luck, I much preferred subcut, although the injections weekly got a bit much after a while. When I first started I had to use a proper needle and vial, but they come as a pen type injector now which is easier.

@BlackboardMonitorVimes thank you so much for this, it's so helpful and reassuring!

Yes I'll be getting the clicky pen thank goodness - in not at all squeamish but stabbing myself with a needle weekly may have been a bit much!

So reassuring to hear that the side effects may be less severe. I'm thinking Wednesday will be the best day to take it because although I usually have no more than four beers I do enjoy a Friday evening drink!

Am I right in recalling that there are some foods you need to avoid on mtx? Things like unpasteurised milk, soft cheese, raw egg, basically the stuff you avoid when pregnant? If so I'm going to eat a whole brie today while I'm able

Hope you're well, and thanks again

I never avoided any foods nor was I told to! Just the alcohol part. I would check with your doctor before giving up Brie!

It's surprising how quickly you get used to injecting yourself. Having bloods taken starts to feel like a treat as someone else does the needles for you.

Travel was the only other thing that could get odd as you need to travel with your whole kit and can't put it in the hold. I never had any issue with airport staff questioning the validity of why I was taking it onboard. If anything they were curious and I tended to get special treatment 😁 ...with the monthlies now I tend to book travel outside of the medication day.

I read an interesting article yesterday that said that biologics have now been approved for people with medium disease activity. It will take a good few months to filter down to clinical level but if you find that you can't cope on the subcut after a few months it's quit raising this as a possible treatment. I've been on biologics for 7 years as I couldn't handle the sulphasalazine and methotrexate. My stomach has been destroyed. But biologics have given me back.

@BlackboardMonitorVimes I really hope I'm misremembering the food thing because having to give up brie/smoked salmon would be the crowning turd in the water pipe! But I think I'll eat a stack of brie today anyway, y'know, just in case

Thanks for the advice re travel, I'd not considered that. No imminent plans to go anywhere but when I do I shall bear that in mind.

@fantastaballs that's really interesting. Sulphasalazine was easily the worst of the meds I've been on. I had absolutely debilitating migraines - the first one I had a few days after starting was so awful I went to A&E. I hadn't been warned it might happen and I honestly thought there was something seriously wrong. I'd never had migraines before but even after I stopped the sulpha (I persevered for a year) they continued. They only started to ease a couple of years ago, and I stopped taking it in 2015. Plus, it turned my pee bright orange! I'd never take them again.

I'm glad you've found something that works for you. Thanks for the advice and if I can't cope with the mtx I shall certainly raise it with my consultant.