Methotrexate is in a class of drugs known as Disease Modifying Anti Rheumatic Drugs (DMARDs). It is used to treat inflammatory conditions such as Rheumatoid Arthritis, Psoriatic Arthritis, Systemic Lupus Erythematosus (SLE or Lupus), Ankylosing Spondylitis, and Juvenile Idiopathic Arthritis. These conditions are autoimmune diseases because they are related to an “overactive” immune system.

If you are prescribed Methotrexate, you will be given information on how and when to take it and will have a conversation with your prescriber or pharmacist about what to expect, side effects, other medications or complementary therapies that might interact, side effects and how to manage them.

One of the most common side effects is nausea, feeling unwell or tired 24-48 hours after taking your medication. As your body gets used to the medication, this will probably get better over time and your side effects will subside. If this doesn’t happen and you are having trouble managing your side effects, call your doctor. They will be able to advise you on what to do.

There are a few things you can do to combat nausea.

  • Food. Methotrexate is best taken on an empty stomach, but if it makes you feel nauseous or sick, try taking it with food.
  • Limit your alcohol intake to 2 standard drinks per week. Avoid heavy or binge drinking as this may make your side effects worse and will increase the work your liver has to cope with.
  • Folic acid. Methotrexate has the effect of lowering folic acid levels in your body, taking a folic acid supplement will help to mitigate the side effects of methotrexate such as nausea, vomiting, abdominal pain, mouth ulcers and assist your liver in metabolizing the medicine. Folic acid should be taken as long as you are taking methotrexate. If your prescriber hasn’t mentioned folic acid and you are taking methotrexate, talk to them as soon as possible about this.
  • Non-steroidal anti-inflammatories (NSAIDs). If you are buying over-the-counter medication for pain relief such as ibuprofen, nurofen, naproxen, or have been prescribed diclofenac, be aware that taking these types of pain relief while you are on methotrexate may be causing increased feelings of nausea.
  • Injection. If you are experiencing gastrointestinal side effects like nausea, diarrhoea and vomiting, you can ask about switching to an injection form of methotrexate instead of the oral tablet.
  • Supplements and herbs. The main one to watch out for with methotrexate is a multivitamin. These contain varying amounts of folic acid and shouldn’t be taken when you are on a folic acid supplement with methotrexate. Or you should let your prescriber know how much folic acid you are already taking in your multivitamin so that the folic acid prescribed can be adjusted. Make sure you talk to your prescriber about all supplements and herbs you are taking.
  • Blood tests. Blood tests are done every 4-12 weeks while you are on methotrexate. This is important for your doctor to be able to monitor your liver function and adjust your methotrexate dose as necessary.

Call your doctor.

  • If you feel sick and want to stop
  • If you are concerned about any side effects
  • If you want to or have already stopped the medicine

Click here to learn more about Methotrexate from Health Navigator.

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