Side Effects of Methotrexate
I have several psoriasis patients on 25 mg/week oral methotrexate. Their response has been very good, but after 4 weeks of therapy they have asked me to stop the drug because of disturbing nausea. Is there any way to overcome this side effect?
Mona Sami, MD
Nausea can be very severe with methotrexate treatment and can limit the use of the drug. Many things can be done to reduce nausea. First, the drug can be given in divided doses (5 pills in the morning and 5 in the evening once a week instead of 10 all at once). Second, folic acid can be given in doses of 1-5 mg/day. This can be given every day or skipping the day methotrexate is given. There is some limited evidence suggesting that folic acid does reduce the effectiveness of the methotrexate. Third, some patients find that there is less nausea when the methotrexate is given intramuscularly rather than orally. Oral antiemetics can be used. Finally, there is a report that acupressure devices used to reduce motion sickness may help. These appear to be completely safe and are available over the counter.
I have several psoriasis patients on 25 mg/week oral methotrexate. Their response has been very good, but after 4 weeks of therapy they have asked me to stop the drug because of disturbing nausea. Is there any way to overcome this side effect?
Mona Sami, MD
Nausea can be very severe with methotrexate treatment and can limit the use of the drug. Many things can be done to reduce nausea. First, the drug can be given in divided doses (5 pills in the morning and 5 in the evening once a week instead of 10 all at once). Second, folic acid can be given in doses of 1-5 mg/day. This can be given every day or skipping the day methotrexate is given. There is some limited evidence suggesting that folic acid does reduce the effectiveness of the methotrexate. Third, some patients find that there is less nausea when the methotrexate is given intramuscularly rather than orally. Oral antiemetics can be used. Finally, there is a report that acupressure devices used to reduce motion sickness may help. These appear to be completely safe and are available over the counter.