I've been on MTX since 2003 for RA. I started on 4 tablets or 10 mg per week. I'm currently taking 8 tablets or 20 mg weekly. According to my PDR the usual starting dose can be as low as 3 tablets or 7.5 mg weekly, and the maximum dosage per week is what I'm taking 8 tablets or 20 mg. Anything higher than 20 mg you run the risk of severe side effects. My Rheumatologist told me if a patient doesn't respond well to 20 mg weekly, then weekly MTX injections could be given. Right now I'm doing well on 8 tablets per week.
While taking MTX it's important to also take 1 mg of prescription Folic Acid daily. I've been to several Rheumatologists over the years and they all tend to disagree on the proper dosing of Folic Acid. My current doctor says it must be taken daily, others have said every day except the day you take MTX, another one said to skip the Folic Acid the day of and day after the MTX, and one doctor said it wasn't needed at all. I didn't believe him!
It's also important to have regular blood tests to check your blood count (CBC), and liver and kidney functions. At first, the blood tests may be required monthly and later every 3 months. Other labwork may be done also, such as a sed rate (ESR) or C-Reactive Protein, both will detect any inflammatory process in your system.
I haven't had a side effects from the dosage I'm currently taking and never did. My mom has been on MTX for a longer period of time and has done well. The only problem she had was her tongue started to crack alittle, but increasing the Folic Acid to everyday helped cure that side effect. Hope this information helps.
- Methotrexate Information for Consumers
- Methotrexate Information for Healthcare Professionals (includes dosage details)
- Side Effects of Methotrexate (detailed)
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