Friday, May 09, 2008 AmyAria, Community Member, asks

Q: Methotrexate & long will it last?

Only the second week I've taken this drug but holy-schmoly it wipes me out!!  First day I took it had me on the couch all day with a manageable headache, but felt somewhat better the next day.  All the same, last week I continually felt like my "get up and go" had got up and went!  Took it again today and I just wanna have a lie down with my blankie!  I can handle a day or two a week of this for the "greater good" and all, but then I just got stuff I gotta do!!  I'm not like completely incapacitated or anything but I am getting really tired of my husband's cooking...God bless him!  Sheez!  I even find myself pining to do the stuff I used to complain about doing!  Oh what bliss it t'would be to scrub some toilets...I mean what the heck!!  Will this gradually get any better as my body acclimates?!

Answer This
Answers (16)
Lene Andersen, Health Guide
5/11/08 2:41pm


I've also used methotrexate and boy, does it ever pack a wallop in the beginning.  As the treatment progresses, your body will adjust and the fatigue should start simmering down soon.  With any drug like this, it's a good idea to make sure that you eat regularly and stick to a balanced diet, high in fruit and vegetables.  I find that making the rest of me as healthy as possible can help reduce the side effects a little bit.  You can also speak to your doctor about it - maybe you need to start at a lower dose and increase it gradually, giving your body a chance to acclimatize over time. 


Good luck with it!

Clara, Community Member
1/14/13 9:07am

I have been on methotrexate 2 1/2 yrs and still suffer from the wallop it causes. Next day I am out of commission, all I want to do is sleep. I have a med to take the day after helps alittle but not completely. I have just accepted this is how it is. Benefits out weight the side effects.


Lene Andersen, Health Guide
1/14/13 11:29am

you're right - often, it's abotu weighing cost and benefit and if the meds are working, it's a small price to pay.

Clara, Community Member
1/14/13 4:54pm

I take 5  2.5mg every 7 days and from the first dose to the present time it still effects me the same, I have tried everything diet, etc. Doctor said  most people adjust and then some never do, and continue to have these nasty effects. I take a medication the next morning like I said it

helps alittle, but not much. So the next day  or two I am down and sleep most of the day. Like I said benefits out weigh the side effects so I just accept it and go on, I take it to treat SLE.

Clara, Community Member
1/14/13 5:05pm

I forgot to mention I take folic acid, pacqunel, lyrica daily for Systemic Lupus Eyrthamatous is what I am being treated for. Methotrexate is to suppress my immune system. I don't know differences in rheumatoid arthritis and lupus. I do know I have constant pain, nausea, fatigue on a daily basis. I just take it one day at a time. Have a strong support system family and friends who are there to help me whenever I need it. I try to do as much as I can on my own but somethings I can no longer do which really sucks. Depression has not been a problem thus far.


Lene Andersen, Health Guide
1/17/13 1:13pm

there's a fair bit of overlap between lupus and RA, but also some differences. One of our writers, Leslie, has both RA and lupus — you may want to check out some of her posts.


The impact on your ability to live your life with RA and/or lupus seems to be very similar. I'm glad you have a good support system. It makes all the difference.

msrainbowfish, Community Member
4/20/13 1:28am

I too have SLE and have been put on Methotrexate injections. I am only on my third week and noticed the next day following my dose I am just totally wiped and unable to do much if anything at all. I was told of the possible nausea and problems with the liver but fatigue was never discussed. I just started to research this and am, well I guess happy is not really a good word, but happy to see that I am not crazy or alone in these reactions. I cannot say if the benefits will outweigh this since I am so new to this medication but am willing to give it a try. I feel like an absolute slug.

Hollybgroovin, Health Guide
5/12/08 12:26pm

Oh the fatigue.  I deal with it too on a weekly basis.  I take 25mg a week, as maintenance until I can get on a biologic.  Here is the tricky thing that I like to explain to people about methotrexate.  Methotrexate can cause severe fatigue which in return can cause sever depression which also cause fatigue.  Now if you have recognized that it is purely fatigue from the methotrexate have no fear.  Slowly but surely the methotrexate will build up in your body and your side effects will become less severe.  Now I cannot promise you that the fatigue will go away.  It does for some, but I have been on it for over three years and experience fatigue.  Now I completely understand the anxiety of not being able to get up and do what needs to be done.  Here is something that might help, even out your days.  Here is what I do.  I make a list of things that need to be done throughout the week.  And instead of overduing it before I take my methotrexate (which makes the fatigue even more severe), even the chores out throughout the week. Say there are 5 important chores that need to be done throughout the weekdays.  Instead of doing two or three of them the days before you take you methotrexate (as we tend to do because we know the fatigue will knock us out) do one chore a day, even on the day you take your methotrexate.  If you can't accomplish it, then put it on the list for either the weekend or the next week.  You will find that it you don't overdue it before and after you take the methotrexate the fatigue won't be near as bad.  I hope this helps.  Good luck and best wishes!

YellowRose22, Community Member
5/29/09 3:13pm

I started MTX about 5 weeks ago. I have increasingly gotten fatigued, and very depressed. I had no idea this came from MTX. I didnt take my meds today, not sure I should take them or not. The depression scares me though.

Hollybgroovin, Health Guide
5/29/09 6:08pm

Make sure you talk to your rheumatologist and let him know what exactly is going on.  He may want to raise your folic acid as well to combat the side effects.  What helped me with fatique was talking vitamin B12 supplements as well, but make sure you ask your rheumatologist first.  I am sending good wishes your way and hope you feel better soon!  Good luck and best wishes!

VGrey, Community Member
12/10/11 10:16pm

I would definitely follow up with your physician and let them know your side effects and concerns.  Weigh the pros and cons; determine the safety for you!

Lisa 698, Community Member
3/26/12 4:31pm
I totally agree with your answers to the chores, I used to run around 100 miles per hour but it's now impossible for me to soil it has to wait. Your health comes first and your housework will always be there to do another day, so don't stress. I'm on 15 mg of methotrexate and yes it does cause severe fatigue at times. I wake up in the morning sometimes and feel as though I have been hit by a bus because I feel so rough, especially the pain in my feet, toes, fingers, neck back and hips, aaahhhhhhhh! Lisa walsh Reply
stramber, Community Member
5/14/08 5:04am

Hello,  Methotrexate is an immune supressant drug and supresses the immune system.  Yeah it does make one tired.   We are already immune supressed just by the rheumatoid.  When y add Methot. or Arava they make system even more supressed. (depressed ?)


Methot. works well for some and not for others.  I am off it and feel much better.It was not working for me - does not work for everyone.  However some do really well on it.


After 6 months or so ask yourself if it is really working.   Ask your Rheumy if you can go off it to see if there is any difference.  Go back on if there is.


Take calcium (citrate), check your Vitamin D levels, iron levels, thyroid too as this can effect RA.



merlinscharm, Community Member
6/17/08 9:26am

I have been on it for about 5 years now and it never goes away and I always ache.  It never goes away unless I have an infection and I"m off my meds. 

RA Dave, Community Member
8/ 6/08 5:15pm

Methotrexate sure does take it out of you. When I was first put on it I had headaches and an upset stomach which could last a day or two.  The next time you go to the doctor as about taking Folic acid.  I found this helps me rebound from the effects of the methotrexate.  I have been on methotrexate for 12 or so years and I am currently taking 17.5 mg a week.  I take Folic acid on a daily basis and it really helps to the point I rarely feel the effects of the methotrexate.

Linda, Community Member
9/16/08 11:05am

I have been on methotrexate for more than 3 years - have gone off it twice to see if there was a difference.  No.  The fatigue is overwhelming.  I thought it would decrease as time went on but it has not.  I take 8 pills on Saturday - even tried spacing them out (half and half, at my doctor's advice), to no avail.  I spend the entire Saturday on the couch in a half-dream state.  My house is a mess.  I'm limited in what I can do cleaning wise anyway due to the pain from the RA and OA and Fibromyalgia.  The folic acid does help a little little bit but not enough.  There has to be something one can take to fight off the fatigue and bring back some energy to my tired old body.  Any suggestions out there? 

clymbon, Community Member
12/12/08 11:36pm

I can only give you my experience.  I've been on Methotrexate for about a year, taking 25 mg a week.  I take it by injection, subcutaneously.  It's a bit of a drag to have to do the injections (I do them myself), but it avoids the nausea I was experienced when I was taking it orally.  I do suffer from fatigue, but I don't know if it's related to the Methotrexate.  Perhaps not, because I take the Methrotrexate usually on Monday night, and my fatigue seems to peak on Wednesday and Thursday.  One thing that seems to help is exercise.  This may seem like it would have the opposite effect, but I think just getting the blood pumping and the body working really helps.

Polar bear, Community Member
4/13/09 12:05am

I am taking mtx for severe facial seborrheic dermatitis (although I hope I don't get rheumatoid arthritis, I've got one parent with RA and it looks like I've already started down the autoimmune disorder pathway at my young age-- 20's). Anyway, I've taken three doses of mtx so far (three pills per week). I take it on Friday nights and sleep in on Saturday until about 10 or 11 AM. I haven't experienced fatigue (although if I did, I'm not sure I would've noticed, school keeps me so sleep-deprived/stressed/tired anyway lol). But I don't think I was extra-tired. I am taking daily folic acid supplements, plus I have a super-healthy diet-- veggies, brown rice, low-fat, cooked in olive oil+ extra olive oil poured on top of my food. I don't know if that has anything to do with it.

JonP, Community Member
9/ 6/09 11:45pm

Compared to some here it seems I'm realatively lucky. I suffer from Psoric (spelling??) Arthritis and am on 25mg a week of Methotrexate, taken in one hit on Sunday night. I'm pretty much wiped out from fatigue and a little nausea for most of monday, but I'd rather feel down and out at work than on the weekend!


For me the secret to knocking the fatigue on the head is some excercise!! I stumbled across this purely by accident. I take my daughter to swimming lessons every other Monday and decided to do a couple of laps while there with her. I quickly found the more I swam, the better I felt. The natural endorphins seemed to wipe out the fatigue and the depression that often accompainied it.


On the weeks that I don't swim with my daughter the hard part is finding the will to over come the fatigue and get some excecise .


This will not obviously work for all, but if you can find something you can do excercise wise you might find it helps.

JonP, Community Member
9/ 6/09 11:59pm

Well I feel silly after reading my post (my excuse is, it is monday!) I'm on 150mg weekly not 25!

Cj, Community Member
12/14/13 1:25pm

I take 20 mg of methotrexate a week. I always plan on getting extra sleep the night that I take it. I totally agree with the exercise thing. I swim about three times a week (followed by a hot tub soak and then a sauna). I also lift weights to strengthen the muscles around my joints. I also take folic acid and stay hydrated (especially after taking the methotrexate).

Don, Community Member
3/25/10 3:34pm

All of you should investigate the elimination diet.  Jill Harrington wrote an excellent book about it titled "The Lupus Recoveryt Diet" and I have been following it for 32 days.  I stopped my 50mg of methotrexate per week and 20mg of plaquenil per day.  As of now, I have no pain and I don't expect to have any.  I ran into an MD from The Netherlands who is an emunologist and a professor an the medical school in Amsterdam.  He has connecting tissue, put himself on the diet, takes no medication and is controlling his disease.  His words to me were "Your medications will kill you."

PattiJean, Community Member
3/ 6/12 8:25am

I noticed the date of your post was a few months ago.   I was wondering if you are still doing well with diet changes alone.  


I was also wondering if anyone out there was aware of a hereditary condition which affects folic acid metabolism.  I believe it is a lack of an enzyme MTHFR.    If i understand it correctly meth depletes folic acid.  If one also suffers from a deficiency, i would think the depletion would be more severe.   I have only begun taking methotrexate two weeks ago and am taking a prescription folic acid supplement - ive experienced severe headache and nausea but so far - not the fatigue.

Hotdo Immanuel, Community Member
3/23/12 5:42pm
Hi Don, how is The diet can maintain your RA by today. I found your posting was 2 years back 2010. Await on your reply. Immanuel Reply
alparnell, Community Member
7/ 9/11 2:43am

My chiropractor warned me I would be tired with Methotrx, she was right! I take Plaquenil, Folic Acid, Ultram (to manage pain)and Methotrex. The day after I take my Methotrex I am sooo sleepy and it seems to stay with me for a few days, BUT, I am starting to feel better. I'm not back to "normal" but I can walk down stairs now. It is frustrating to be tired after taking this drug and my boyfriend asks me why I'm so tired since I slept all day anyway. I work 12 hr night shifts at the hospital as a nurse intern and it's nice to hear others say this drug makes them tired too. I was just feeling like a lazy bum!

Angfinch, Community Member
4/ 6/13 3:20am

I've been on methotrexate for about a year. I take 8 pills Sunday evening in one fail swoop. I find I'm down till Wednesday, extreamly tired. I've also noticed, it's been getting progressivly worse. We are going to be starting Enbrel next...I am VERY nervous about this new med!!!

Berpsie, Community Member
7/ 5/13 4:34pm
Today's my first day on methotrexate and I am nervous. I have been known to suffer side affects from tablets and usually not the common ones. I am taking 20 mg a week for ra followed the day after with leucovorin calcium so will see how I go! It's good to read other people's experiences and to know I am not alone! Reply
Steven D, Community Member
7/ 9/13 7:50am

Hi there - thanks so much for sharing your story. I just started a couple of weeks ago as well. Please see my post. Thanks!

Steven D, Community Member
7/ 9/13 7:49am

I started two weeks ago and also am overwhelmed by the fatigue and a bit of nausea for two to three days after. I started out with 4 2.5 mg pills, the second week was 5 of them. This week I go to six 2.5 pills (15 mg total) and I'm already dreading it after my experience this past week with 5. I took it on Thursday morning and it took until Sunday night/Monday morning for me to feel well enough to do anything. I was exhausted and felt so unwell, even after sleeping. I have begun to really fear Thursdays however it does give me hope to see that some people do eventually get used to the drug after it builds up in your system. I take 5 mg of folic acid on the days that I don't take the mtx (6 days a week). I am also starting on a biologic, Remicade which consists of IV infusions. I have had 1 so far which actually made a very noticeable difference in my psoriatic arthritis. It lasted for a few days but kinda wore off which is to be expected after  only one dose. Next Remicade dose will be next week (week 2) and then again at week 6. After that , it's Remicade infusion every 8 weeks while continuing with the weekly 15 mg of MTX. I have heard from others that if nausea is a problem, ask to switch to the injections instead of the pills. I had been on Stelara for the past year which totally cleared my psoriasis 99% but did nothing for my psoriatic arthritis. So I'm fortunate in that I'm starting with MTX and Remicade with clear skin already. I'm ahead of the game in that way. So now to see if the Remicade will work for the arthritis which has gotten so bad. I was on Enbrel for 11 years and it worked GREAT until about a year and a half ago when it just stopped working. Tried Humira which did nothing at all. Stelara as I mentioned cleared the skin which was wonderful but eventually the pain from psoriatic arthritis became too much. Interested to hear from others on Remicade - apparently the MTX is required with it in order to stop your body from rejecting it because it is made from a mouse protein and not a human protein (true story! not an internet Is anybody on Remicade alone and finding it working without the MTX? And is anybody taking both and has noticed the MTX side effects calming down? Or to ALL taking MTX that DID eventually notice the side effects lessening, how long did it take? Thanks to everybody for posting. Each and every post here gives me hope and show me that I'm not alone. It IS worth it to go through some discomfort in order to beat these nasty diseases we suffer from. Thanks again and please feel free to contact me directly. Located in Toronto Canada here. 

Berpsie, Community Member
7/10/13 1:35am
Thanks for replying :) I am in Tasmania Australia! I am on folic acid the day after. I have been feeling off and pretty much what you said but have been paranoid that its in my head! I have had headaches and a little nausea and tired. So I will go again Saturday and see what happens! If it works it will all be worthwhile :) Reply
Candi, Community Member
7/16/13 4:07pm

I guess I am really fortunate.  I am also a little disturbed, but glad to see that what disturbs me is something that is normal to most who take Methotrexate.  I have Psoriatic Arthritis.  I have had psoriasis for 42 years, and only the last 2 years has the pain progressively worsened.  Prior to 2 yrs ago I didnt have pain.  But 2 years ago it started and WOW it just got worse and worse.  Dr kept acting like I was crazy.  He would ask where was the pain, I would tell him, here and here and here and here and he I guess thought I was coming for drugs or something stupid.  QUACKS!!!!   Finally a rheumetologist diagnosed me and we are off and running.  I started out with Methotrexate 5 pills a week along with Folic Acid script, and Celebrex.  Well that did NOTHING!!!!  So went back after 5 weeks and he put me up to 7 methotrexate a week, with folic acid daily and Loritab 7.5 3 times a day ( I only take it when I have to have it, dont like narcotics) this is temporary until they get tests back on TB, Chest X-Ray and Liver profile.  (Liver Blood work was also dont prior to starting 5 weeks ago).  Well, I am due to go back on August 8 and they are going to ask for my decision to add Humara or Enbrel.  (I am really undecided on those, SCARED of them).  I got up this morning however, after taking my 7 MTX pills last evening and was soooooo feeling the blues and the fatique.  I cried some and layed down, got back up and pushed on, took my bath, went to dentist appt, grocery shopping and felt much better!!!  I think if maybe we try to push thru it and not give in to the fatique (ITS HARD!!!!!!!!!)  But will help us feel alot better quicker.  I understand when you say you cant I felt the same way, I just didnt think I would make it but I did and I am going to continue pushing, and fighting, anything has to be better than suffering!!!!!!  Let me know how you all deal with it and how your doing with your managment.


ChrisD, Community Member
3/ 4/14 4:48pm
I to have Rheumatoid Arthritis. I have just taken my 3rd weeks doseage of methotrexate. It's too early to tell if it is working yet, but fir a few days after i always feel tired, no nausia or feeling really drained but just tired as if all I want to do is sleep, or like I haven't had any. I have been wondering how long it will last? My doseage is still going up until they find the right amount for me. I presume it will go away the more my body gets used to it?! Reply
Rene, Community Member
3/ 9/14 9:06pm
I have SLE. After discovering that I am allergic to Plaquenil, I was on MTX for six months. Fatigue, depression, and headaches were common, and it did not seem to help the inflammation in my joints. My rheumy just took me off the stuff, and I'm taking a dietary approach...the anti-inflammatory Paleo diet. I eat nothing but meats, eggs, seafood (including shellfish), vegetables, and fruit. All grains, dairy, potatoes, tomatoes, and anything with gluten or casein have been eliminated. We'll see what happens! I've lost 12 pounds in the last several months, and I can't wait to see how I'll feel once the MTX is out of my system! Reply
Answer This

We hope you find this general health information helpful. Please note however, that this Q&A is meant to support not replace the professional medical advice you receive from your doctor. No information in the Answers above is intended to diagnose or treat any condition. The views expressed in the Answers above belong to the individuals who posted them and do not necessarily reflect the views of Remedy Health Media. Remedy Health Media does not review or edit content posted by our community members, but reserves the right to remove any material it deems inappropriate.

By AmyAria, Community Member— Last Modified: 04/09/14, First Published: 05/09/08