Arthritis Today Expert Q & A: Is there any benefit to receiving MTX by injection versus orally?

[Guest guest]

Arthritis Today

Expert Q & A

Methotrexate Injection

Q: Is there any benefit to receiving methotrexate by injection as

opposed to taking it orally? Is it metabolized differently? Are the

side effects of methotrexate injection different?

A: Methotrexate is a disease-modifying antirheumatic drug (DMARD) used

to slow the disease process and treat the pain and swelling of

rheumatoid arthritis. The body's absorption of the drug, and therefore

its effectiveness, varies among individual patients when the drug is

taken orally. To improve methotrexate's effectiveness, physicians may

increase the oral dosages or try intramuscular methotrexate injection.

Although the injections may help improve the medication's

effectiveness, the potential side effects and benefits of methotrexate

are virtually the same whether it is given orally or by injection.

Liver damage remains the main concern, and is monitored by frequent

blood tests. Taking 1 mg of folic acid per day can help reduce other

side effects related to methotrexate use, such as mouth sores or

gastrointestinal irritation.

Pisetsky, MD, PhD, Rheumatologist

http://www.arthritistoday.org/community/expert-q--a/medications/methotrexate-inj\

ection.php

Not an MD

[Guest guest]

I've always heard and was instructed to inject MTX Sub-Q instead of IM. The

links posted on Youtube about injecting calls for and shows the injection to

be sub-Q. Why does this post of an " Expert's " statement seem to go against

all we know at this point? Or am I being picky?

I inject 1.0 ml each Saturday night sub-q and have no reactions from the

MTX, only from the temperature when I don't warm it to at least room temp.

I've never had a bad reaction from the MTX, but I do take 1 or 2 mg of Folic

Acid every day along with my other vitamins because of the chance of mouth

sores caused by the MTX.

Dennis in eastexas

On Sun, Mar 6, 2011 at 7:58 PM, <

Rheumatoid.Arthritis.Support@...> wrote:

>

>

> Arthritis Today

> Expert Q & A

>

> Methotrexate Injection

>

> Q: Is there any benefit to receiving methotrexate by injection as

> opposed to taking it orally? Is it metabolized differently? Are the

> side effects of methotrexate injection different?

>

> A: Methotrexate is a disease-modifying antirheumatic drug (DMARD) used

> to slow the disease process and treat the pain and swelling of

> rheumatoid arthritis. The body's absorption of the drug, and therefore

> its effectiveness, varies among individual patients when the drug is

> taken orally. To improve methotrexate's effectiveness, physicians may

> increase the oral dosages or try intramuscular methotrexate injection.

>

> Although the injections may help improve the medication's

> effectiveness, the potential side effects and benefits of methotrexate

> are virtually the same whether it is given orally or by injection.

> Liver damage remains the main concern, and is monitored by frequent

> blood tests. Taking 1 mg of folic acid per day can help reduce other

> side effects related to methotrexate use, such as mouth sores or

> gastrointestinal irritation.

>

> Pisetsky, MD, PhD, Rheumatologist

>

>

>

http://www.arthritistoday.org/community/expert-q--a/medications/methotrexate-inj\

ection.php

>

>

> Not an MD

>

>

[Guest guest]

Dennis, are you also injecting Enbrel these days? Just wondering if it

did happen this time.

Sue

On Mar 11, 2011, at 6:21 PM, Dennis W wrote:

> I've always heard and was instructed to inject MTX Sub-Q instead of

> IM. The

> links posted on Youtube about injecting calls for and shows the

> injection to

> be sub-Q. Why does this post of an " Expert's " statement seem to go

> against

> all we know at this point? Or am I being picky?

>

> I inject 1.0 ml each Saturday night sub-q and have no reactions from

> the

> MTX, only from the temperature when I don't warm it to at least room

> temp.

> I've never had a bad reaction from the MTX, but I do take 1 or 2 mg

> of Folic

> Acid every day along with my other vitamins because of the chance of

> mouth

> sores caused by the MTX.

>

> Dennis in eastexas

[Guest guest]

Hi, Dennis.

It's OK to inject MTX either way - intramuscularly or subcutaneously.

Studies have shown that there is no big difference in bioavailability.

BUT subcutaneous injections are usually easier for and preferred by patients.

Not an MD

On Fri, Mar 11, 2011 at 5:21 PM, Dennis W <betnden@...> wrote:

> I've always heard and was instructed to inject MTX Sub-Q instead of IM. The

> links posted on Youtube about injecting calls for and shows the injection to

> be sub-Q. Why does this post of an " Expert's " statement seem to go against

> all we know at this point? Or am I being picky?

>

> I inject 1.0 ml each Saturday night sub-q and have no reactions from the

> MTX, only from the temperature when I don't warm it to at least room temp.

> I've never had a bad reaction from the MTX, but I do take 1 or 2 mg of Folic

> Acid every day along with my other vitamins because of the chance of mouth

> sores caused by the MTX.

>

> Dennis in eastexas

[Guest guest]

No, Sue, it hasn't happened. My Rummy is playing stupid (being himself) and

won't tell me anything. He only handles RA, not anything about Enbrel or

anything else that's not " RA related " .

I asked him about mixing my own, and what to mix them with, or should I try

1 50 mg shot or 2 25 mg shots. His answer is, " I only do RA, not the rest " .

So far he ordered a blood test for TB and not for the more important tests.

I've had to have my PCP do my labs.

I don't know about how it will affect me, physically or monetarily. The cost

of it will put me in the 'donut hole' really early in the year and I'll have

to pay more for the rest of my meds for the rest of the year, even though I

won't have to pay anything for a co-pay. The saddest part for me is that

there are only 2 Rheummys in the area and I fired the other one because he

was worse than this one. I'm thinking I should go back to straight Medicare

my next chance.

Betty was having a rather rough time for the last few weeks and I finally

took her to the E.R. Saturday night. They couldn't find anything wrong, all

tests came back clean. Sunday morning I figured out what was wrong, and

happened to have the meds to fix her. She had run out of her Gabapentin, for

nerve pain, and was suffering withdrawals! Within 2 hours from the time I

gave her one of my Lyrica (that I don't take any more) she was kicking up

her heels. I also got her an emergency fill of her script. Now things are

lots better for her, and me.

Dennis in eastexas

On Fri, Mar 11, 2011 at 6:13 PM, marysue <marysue@...> wrote:

>

>

> Dennis, are you also injecting Enbrel these days? Just wondering if it

> did happen this time.

>

> Sue

>

>

> On Mar 11, 2011, at 6:21 PM, Dennis W wrote:

>

> > I've always heard and was instructed to inject MTX Sub-Q instead of

> > IM. The

> > links posted on Youtube about injecting calls for and shows the

> > injection to

> > be sub-Q. Why does this post of an " Expert's " statement seem to go

> > against

> > all we know at this point? Or am I being picky?

> >

> > I inject 1.0 ml each Saturday night sub-q and have no reactions from

> > the

> > MTX, only from the temperature when I don't warm it to at least room

> > temp.

> > I've never had a bad reaction from the MTX, but I do take 1 or 2 mg

> > of Folic

> > Acid every day along with my other vitamins because of the chance of

> > mouth

> > sores caused by the MTX.

> >

> > Dennis in eastexas

>

>

>

[Guest guest]

That's new to me. So, I don't have to 'pinch an inch', and can just 'stab

and shoot', huh? lol

Dennis in eastexas

On Fri, Mar 11, 2011 at 8:10 PM, <

Rheumatoid.Arthritis.Support@...> wrote:

>

>

> Hi, Dennis.

>

> It's OK to inject MTX either way - intramuscularly or subcutaneously.

> Studies have shown that there is no big difference in bioavailability.

>

> BUT subcutaneous injections are usually easier for and preferred by

> patients.

>

>

> Not an MD

>

>

> On Fri, Mar 11, 2011 at 5:21 PM, Dennis W <betnden@...> wrote:

> > I've always heard and was instructed to inject MTX Sub-Q instead of IM.

> The

> > links posted on Youtube about injecting calls for and shows the injection

> to

> > be sub-Q. Why does this post of an " Expert's " statement seem to go

> against

> > all we know at this point? Or am I being picky?

> >

> > I inject 1.0 ml each Saturday night sub-q and have no reactions from the

> > MTX, only from the temperature when I don't warm it to at least room

> temp.

> > I've never had a bad reaction from the MTX, but I do take 1 or 2 mg of

> Folic

> > Acid every day along with my other vitamins because of the chance of

> mouth

> > sores caused by the MTX.

> >

> > Dennis in eastexas

>

>

>

[Guest guest]

My goodness, Dennis, what a rheumy you have. Does he not think that

Enbrel is RA related?

If you do ever get to use Enbrel, I would recommend the twice weekly

25mg one. It comes with everything you need to mix it together. You

have to mix it, because it doesn't contain preservatives, so I don't

think it stings like that with preservatives. It's really easy to do.

If you need help, just ask those of us here who use that kind. And we

won't even send you a bill. At least he's checking you for TB, so

that's one point for him.

I'm sorry that Betty's had such a rough time. It's good that you

figured out her problem. I hope that she keeps on kicking up her heels.

The best to both of you.

Sue

On Mar 11, 2011, at 9:21 PM, Dennis W wrote:

> No, Sue, it hasn't happened. My Rummy is playing stupid (being

> himself) and

> won't tell me anything. He only handles RA, not anything about

> Enbrel or

> anything else that's not " RA related " .

>

> I asked him about mixing my own, and what to mix them with, or

> should I try

> 1 50 mg shot or 2 25 mg shots. His answer is, " I only do RA, not

> the rest " .

> So far he ordered a blood test for TB and not for the more important

> tests.

> I've had to have my PCP do my labs.

>

> I don't know about how it will affect me, physically or monetarily.

> The cost

> of it will put me in the 'donut hole' really early in the year and

> I'll have

> to pay more for the rest of my meds for the rest of the year, even

> though I

> won't have to pay anything for a co-pay. The saddest part for me is

> that

> there are only 2 Rheummys in the area and I fired the other one

> because he

> was worse than this one. I'm thinking I should go back to straight

> Medicare

> my next chance.

>

> Betty was having a rather rough time for the last few weeks and I

> finally

> took her to the E.R. Saturday night. They couldn't find anything

> wrong, all

> tests came back clean. Sunday morning I figured out what was wrong,

> and

> happened to have the meds to fix her. She had run out of her

> Gabapentin, for

> nerve pain, and was suffering withdrawals! Within 2 hours from the

> time I

> gave her one of my Lyrica (that I don't take any more) she was

> kicking up

> her heels. I also got her an emergency fill of her script. Now

> things are

> lots better for her, and me.

>

> Dennis in eastexas

>