[Member Discussions and Questions] Frequency of taking doses of Methotrexate and Enbrel for Rheumatoid Arthritis?

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January 8, 2013

One member has a question about frequency of Methotrexate and Enbrel dosage. Can you help?:

I was wondering if anyone takes Methotrexate or Enbrel every other week instead of every week? I am feeling good but the side effects are terrible and I would like to start taking these meds biweekly. Thanks for your help!

Thank you in advance for taking the time to help her out and answer her message. (((pain-free internet hugs)))

What our members have said so far:

Brenda – a great alternative is to take the Mtx in shot form. No nausea! It’s still weekly, but I swear. It’s like night and day! I’ll never go back to the pill form of Mtx. And it’s a very tiny needle. Smaller than Enbrels.

Vee – ask your doc, depends on lot of variables.

Amanda – I take Enbrel 1 x a week . I was on Methotrexate as well but it was causing symptoms of IBS . Still having troubles so seeing a Gastroenteritis ..

Martha – yes, it’s a butterfly needle. I have side effects from the pill and minimal, if it all, with the shot

Donna – Agreed with above. I inject methotrexate and enbrel weekly. Plus take folic acid every day except day of methotrexate as this helps with the side effects too x

Judy – I did take my enbrel every other week, once I was feeling good…and I didn’t notice any decrease in efficacy..some people are prescribed every other week anyhow. Sorry you are having a rough time with the side effects!!

Julie – My daughter took them for 2 yrs twice a week and slowly reduced them over a yr taking half a tablet away a time. When it wasn’t a good day she didn’t reduce. But by taking it slowly she got over the side effects very well. But only due it with doctors help and let him know how your getting on. No two pele are the same tc xxx

Jessica – Donna, why don’t you take folic acid the same day as methotrexate?

Cindy – I also take the injectable MTX weekly and have been doing so for at least 4 years. I had terrible side effects with the pill form and the injection gives me absolutely no side effects. I know it’s another injection, but it’s so worth it! Good luck!!

Jelly – A few points that may prevent you limiting to 2 weeks: I got put on Ondansetron for nausea from the Methotrexate and find it really good. I take it approx 1 1/2 hr before the mtx so it is properly in my system. And always eat before Mtx too. Its been the only nausea tab that has really worked for me. It has stopped me having to reduce my mtx dose. Also do not take Mtx & Enbrel on same day as they can effect each other & increase side effects. I leave a few days between the two each week and alternate the side I inject each week so eg: inject Mtx on left side on Monday, then inject Enbrel on right side on Thursday. Hope that helps! x PS still get nausea some weeks but not as bad as before the Ondansetron

Toni – recommend shots over tablets, I have both an take them a few days apart x

Maria – I don’t have many side effects with the shot. The pill, yes. But I still notice that the 24 hours after the shot, I am a little sick. Depends on too many things. Take it before bed.

Colleen – I spread out my pills throughout the day and eat a full meal before each and give myself some time to digest and then take a pill. Very little to no nausea this is what my doctor suggested and it makes a difference.

Carol – Jessica, the way it was explained to me, mtx and folic acid compete for the same chemical receptors in your body (in other words, the molecules are fighting for the same spot to connect to another molecule), so when they’re taken together, they each block the other. As a result they both work less well. Don’t take folic acid of any kind within 24 hours on either side of your mtx dose. I will even skip my multivitamin that day, as it contains folic acid.

Gail – Omg I get nauseated . & Have headaches just feel like crap from the metho injections every week

Patsy – I started having IBS as well..Dr switched me to injectable MTX…no problems. I’m on Orencia weekly.

Jill – I was a bad patient when it came to the MTX. The only reason they give you that with the TNF drug (enbrel) is because it potential the effects thus causing shorter flare-ups and hope for remission. I used to drag out my weekly dose and “forget” it on purpose. I now take Simponi and no MTX is needed. Another reason they give you the MTX with the TNF drug is so the insurance will pay for the TNF drug.

Elaine – I take methotrexate tabs once a week with no side effects and folic acid at least 24 hours after! However my friend couldn’t tolerate methotrexate tabs in one dose so the rheumatologist split the dose over 2 days and this worked well for her.

Cyndi – Methotrexate gave me diarrhea for 3-4 days so doctor switched my med to hydrochlorot. I haven’t had a problem since.

Carmela – I get mtx injections every other week. not sure that it’s enough. Still in lots of pain all the time.and new pains always popping up

Carol – Carmela, I take the equivalent of 20 mg by injection once a week. Some patients take a higher dose but 10 to 20 mg is pretty common. What dosage are you taking?

Kristina – every week for 15 years. I take folic acid all at one time after my dosage and that works better.

Debbie – I couldn’t tolerate MTX orally so have the injections now as well as enbrel. I inject both on the same day and take folic acid the six days in between. No more side effects and less flare ups.

Danielle – I could not tolerate the MTX. My Rheumy switched me to leflunamide. Much better! I feel for ya!

Sher – Every week I take 8 mtx… it has helped! Thank God

Shandy – I go into every Thurs & my doc gives me injection feel crappy for a few days&take folic acid everyday but mtx day!
Andrea – I am not on mtx now but when I was I had to do the injections bc of the side affects. Be sure to take your folic acid! As for the Enbrel, I take mine weekly but I am able to do it every other week and have in the past, some ppl react differently with it, sometimes it takes a while for it to build up other you get results quickly, just depends what works best for you

Jodi – I always forget to take folic acid. Is it really that important ?

Lori – I’m sure you have heard that everyone is different….. that being said try it and see if it works for you. I know a friend that over a few years has went out 1 day at a time with Enbrel and now only has to take 1 shot every 2 months to keep her Severe RA under control. I think it takes time and depends also on how well you are taking care of yourself otherwise…eating right?….proper supplements?…stretching exercise when possible?… of luck but always think positive!

Shirley – I had to stop taking it, It gave me such bad headaches.

Lori – Another thought if you doing that well do you need mtx? I’m on Enbrel alone at it has controlled it quite nicely…my doctor wanted me on both and I refused to do both until I knew if I needed both or not and I didn’t…

Lisa – I take 6 Mtx once a week plus hydroxychloroquine once a day no side effects but have to have blood tests every 2 weeks to check I OK, as only just been diagnosed. So all a bit new to me. X

Kelly – I inject MTX 0.8 ml every other week. Sick for a day or so then good. Tried 0.4 ml every week and ended up in hospital with serious lung infection. Try what works for u. Prayers and hugs to u

Jessica – Jody, I would always forget to take the folic acid and it wouldn’t bother me at first. After awhile, I noticed that I would get some small mouth sores and my hair would start thinning out. I try to take it every day now. It looks like several take it on every day but the day they take the mtx. This I never heard of. I may try it since even with the mtx and enbrel I am in a flare.

Debi – I take MTX and Humira every other week. Enbrel didn’t work for me. I have never taken Humira every week. I take the MTX every week.

Jessa – I take enbrel about every 9 or 10 days. I try to take the least amount of drug that is effective. Remember that when clinical trials are performed, they usually look at the highest effective dose that’s safe, not the lowest. So if your doctor is ok with it, it’s a good idea to titrate.

Diane – I take Humira and MTX every week…Humira on Friday, MTX on Sunday. Also take 2 folic acid every day. I am in horrible pain, anxiety and panic attacks, can’t sleep, terrible pain in my chest and stomach. Sometimes don’t eat for days. My hands are so swollen and its excruciating to bend them. I’m ready to give up!

Cate – I’d stop the Mtx altogether before cutting back on Enbrel. Enbrel is more effective and side effects more minimal. If that works, then you could try doing Enbrel less often.

Nilsa – I recommend you talk to your doctor, he(she) is the only one who can advise of what treatment you can try and what.

Robin – Personally I found the injection to be much better than the pills. I still lost 5 days of the week due to fatigue, but nausea was minimal…taking the shot at night also helped a lot. Enbrel didn’t help me at all. I was on Humira every other week, but stopped because of the side effects. Speak to your Dr as they are the best people to guide you. Best of luck to all of the RA CHICKS!

Michele – I take 8 mtx once a week and then get remicade every 6 weeks…no folic acid yet….so far only fatigued for a few days….still pain though about the 4 week mark… weather changes don’t help either

Janet – I take enbrel shots twice a week

Kathy – My liver and eyesight are more important than pain….they (mtx..plaquenil )were doing a number on my blood work…lupus ra fibro all bite pretty hard..I’m trying moderate to minimum exercise and changes in diet..and lots of vit’s and oils.

Niki – I had side effects with Enbrel, fatigue and lots of infections and colds changed to humira which is a fortnightly injection and have been fabulous. I am not sure of the laws in relation to Enbrel and other Drugs in this family in the US but if in Australia and you start altering these drugs you will lose your govt. funding for them and then have to pay the $15000 per year yourself so be wary with this too.

Angie – I take Enbrel every other week. It started out because I would forget. Then I realized I only needed it that often. I take Arava every day. But if I get sick – I skip a few doses until I’m feeling better to let my immune system work a bit. I love this site by the way. Wow. I am not alone. Gentle hugs to all!

Jeannette -Folic acid and b 12 taking for yrs w methotrexate every day pills shot once week

Carrie – I take enbrel shots once a week and dread it. Hate giving myself shots and sometimes have reaction at the site. But a Benadryl usually helps with that. I also take methotrexate pills weekly and folic acid daily. Get nausea from the methotrexate and not sure how to combat that. Not sure if biweekly on either would help. The flare ups are worse than the side effects.

Kathryn – I am like Angie. Because of schedule and forgetting I ended up taking Enbrel once a week (25 mg shot) and noticed that I was doing fine. Fessed up to my doctor and he was okay with my remaining at lower dosage. Had a flare this fall. Went back to 50 mg per week. He allows me to take both shots at the same time now so it is easier to remember. I will eventually try to get to a lower dosage again but needed to get the flare under control. I do not take methotrexate anymore.

Donna – Jessica, sorry for delay in response. I think that the folic acid may slightly reduce the overall effect of the methotrexate therefore reducing the side effects but I have been advised by the ra specialist nurse not take it on the same day as injecting. I suppose it’s so not to reduce the effects too much. Hope that makes sense x

Eva – Most likely the side effects are from the Methotrexate which is an old time drug for RA. I am not a doctor but I would think Enbrel would be enough without the other. If it was me, I would tell the doc to get me off the Methotrexate. It cause me to feel horrible.

Connie – I was told NEVER NEVER take both at the same time?? From my pharmacist as it is too many antinflammatory and can cause liver dmg–

Connie – I read all of your comments and want to cry—I am taking mtx 6 tabs and folic acid every day–SSI Dr told me I have IBS which is not part of my treatments for RA—jack a..—I am so so tired and my knees swell and hurt & are getting worse–why the swelling? It is not fluid either?

Tracey – 8 mtx at 10 pm Monday night. Plaquenil daily. Folio acid once a day Friday to Sunday that’s to increase your folate levels as the mtx depleted it. Sorting of working but only diagnosed march 2012 so still working at getting the dose right. Mtx at night so sleep through side effects is the theory. Feel sick til get use to new dose. We’re all different. This site is great help. So informative, not patronizing and such a support to know you’re not alone. Thanks folks! X.

Janel – I take Enbrel Fri night and MTX 2.5 mg x 6 tabs on sat night + 1 mg folic acid daily. (Am going to be switching to Humira soon, this Fri or next.)


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The above is a discussion created by a member and with member generated responses from our Facebook community ( put into a format so that the discussion can be archived for future answers needed by others in a searchable format while keeping member anonymity. Member provided information, statements and opinions do not reflect on or all individuals with Autoimmune Arthritis. We encourage all members to seek professional medical advice for any specific questions and concerns as this does not substitute competent medical care.

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