6 pills is 15mg of MTX and is as much as I ever took orally. But there is evidence that MTX taken orally may not be fully absorbed and comes with more side effects when compared to taking it by weekly sub-cutaneous injection. It can be tolerated in higher doses by injection as well (I currently take 25mg, about the maximum dosage prescribed for RA). Most RA patients taking methotrexate seem eventually to go to subcutaneous injection, mostly because it is more effective and has few side-effects.

Ask you Dr. about taking MTX by injection. The needles are very small and it is actually a lot easier than swallowing a handful of pills.

On my initial adventure with MTX I started with 6 pills as well. I noticed for myself I actually BECAME fatigued after taking the pill & then 24hrs later I would have my energy for the rest of the week like normal. I remember having headaches for the first 2-3 days after each Sunday that I took my MTX & of course I would have nausea especially at those higher dosages. ONce we widdled down to about 4 pills I had no more weird side effects.

I agree with rockery but what you are describing is very possible, especially if MTX is ALL you are taking. Anything that works to alleviate your RA symptoms is going to make you feel better.

Did you really mean you have LESS fatigue Tues-Fri?

The way it worked when I was on higher dose MTX: I'd take MTX Monday nights and about 36 hours or so later the fatigue would kick in and last for a few days.

Seems everyone's disease is a little different. Hard to say whether fatigue is due to the disease or the treatment, but in my experience there is a pattern of more pronounced fatigue (plus headaches) for 24-48 hours after I take my 6 tabs Methotrexate. After that Im still easily fatigued and early to bed every night, but less so than just after the meds. Going up to 7 then 8 tabs over the next few weeks, so I wonder how the fatigue will change with that, or if I switched to injection? Time will tell.

Absolutely less fatigue on days 2-5. Amazing how this can be so different for everyone.

Katie, are you taking Folic Acid?

Definitely switch to injectable mthx. I was on oral for 5 years, and all it did was damage my stomach lining irrepairably. My rheumatologist finally admitted it probably wasn't effective, when I started complaining about the pain. So stupid of me to have put up with that for so long.

My new rheumatologist says in Canada, oral is almost never prescribed because it is so ineffective and damaging to the stomach. He told me he was going to have to "insist" on injectable mthx, and I told him, I was going to "insist" on injectable and under no circumstances would I take the oral. We had a good laugh over that.

I have to think that some people are afraid of giving themselves needles. I do mthx and Orencia with self-injected needles. On Monday night I took the mthx. I use the diabetic needle. It is already at room temperature. I didn't even feel the needle go in, or come out. It was like I had done nothing, except my fingers and hands feel so much better today! (More on that in a minute!)

Today I injected Orencia. It is supposed to be left out for 30 minutes. But a while back I forgot and left it out for hours, and it was totally ineffective. So today, I thought I would inject after 20 minutes. First of all, like all the self injecting needles I have take for biologics, the needle is much bigger than the mthx needles. Second, it obviously was not warm enough. It stung horribly! For about 10 minutes after.

So would I go off Orencia because of a little injection pain? Never! It is essential! But mthx is just so easy and painless to inject! So never be worried about mthx injections. And like I always say - 10 minutes of a little injection pain is worth it to be functional and not in pain in all my body for a week!

Regarding you noticing the lack of exhaustion, I am feeling much the same thing with my mthx. I started back on it about 2 months ago, after being off for 7 years because my liver didn't like it then. The day after, I still have pain and stiffness. The next day (today!) I feel like my hands don't have RA! Whoopee!

In fact, I am only taking 15 mg right now, and it is not lasting the week. So pain and stiffness for me, exhaustion for you. For me, I am going to phone my rheumatologist and see if I can get in earlier, and up the dosage. My liver has been stable, and I tend to think that because I have more fat in my diet than when I was forced off, that might be the reason I couldn't stay on mthx before. I lost 80 lbs in the last year or two before my enzymes went sky high,which meant a basically fat free diet. I read somewhere (don't ask where!) that it was important to have all kinds of fat in the diet, which I just have because that is the way I eat now. So trans, non-trans, Omegas, etc. I use mostly olive oil, coconut oil and butter.

I do need to lose weight, but I talked with my cousin's wife, who is a nutritionist about this, and she said to cut out the carbs instead of fats, and I would lose the weight slowly. I need to work on this! (I know that getting enough fat has been an issue for me in the past when I was a vegan - I had to stop because I was craving fat so badly! Weird, I know)

My unprofessional opinion is that the mthx pills have started to work. But maybe not enough to keep it even over the week? And do talk to your rheumatologist about changing to injectable mthx. I would hate to have anyone go through the horrible migraines and pain I had because my stomach lining was ruined by oral mthx. (I had 2 stomach ulcers during this time, too!)

I have felt the same way. I take it friday night. I think it kicks in monday and wears off by thursday. So there are a few days that I am more symptomatic.

Thanks, Scoates and Marlene. There were some other explanations for my pattern of fatigue that had to do with my schedule, and I wanted to see if anyone else experienced the same ebb and flow that I have from the meds. I'll bring it up at my next appointment. CaliforniaLynn, yes, I'm taking folic acid, I would hope every MD prescribes it with MTX!

I'm definitely not afraid of needles. I have to give my livestock shots, and I once stitched myself up with veterinary supplies (a long and fairly icky story, but it ended well.) That was, of course, when my fingers were working much better. Not something I'd recommend if it wasn't an emergency.

My rheumatologist told me that I might end up switching to the injections, but that her protocol was to start with the 15 mg orally for a trial period. I realize that uncontrolled RA can do additional damage to me, but I felt comfortable starting with that dosage for two months and then assessing it at that point.

So, no objections to doing the injections - just waiting to see if that's going to be the best path for me. Thanks to everyone who has commented for your feedback.