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Start Methotrexate with Prednisone right away or wait?

Polymyalgia Rheumatica (PMR) | Last Active: Mar 8 11:06am | Replies (16)
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@mtr2601

Hi, i have been on Prednisone for 7 months, was reducing from 22mg without flares. I got to 7.5mg Prednisone and was started on Methotrexate 10mg. It hit me like a ton of bricks on the 3rd weekly dose and i have had bad flares of the PMR over the last 7 weeks while taking it. It takes 6-12 weeks to have a therapeutic effect. The side effects of the methotrexate for me are mild nausea extreme fatigue and brain fog in the 24 to 48hrs after taking it. The folic acid supplement doesnt seem to help. Im going to persevere for the 12 weeks but if thigs dont improve i wont keep taking it. My Rheumatologist wanted me to start at 20mg but im quite sure i could not have tolerated it at that dose. She wasnt optimistic about Methotrexate but i had to trial it for 6mths to have access to the IL-6 inhibitor (Actemra) under our Pharmaceutical Benefits Scheme.

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Replies to "Hi, i have been on Prednisone for 7 months, was reducing from 22mg without flares. I..."
emo | @emo | Mar 6 2:53pm

Ugh, I hate the whole "failing up" notion with medications... Will you still be able to try Actemra if it turns out you can't tolerate the methotrexate? Good idea to try starting at a smaller dose first to test it out.

Thank you for sharing your experience, and I hope the side effects get better or that you'll be able to switch to something more effective soon.

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elayne | @elayne | Mar 6 3:20pm

Hi mtr-
I am sorry you have been going through this. Thanks for the note. My dr. wants to start me on 6pills a week of the Methotrexate, so I think that is more reasonable but I hear 10 is the starting norm. Thanks to you and all for comments/thoughts. it helps.

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linda7 | @linda7 | Mar 6 4:01pm

I had moderate or worse nausea, headaches and extreme fatigue for about 2 days after taking the methotrexate. I wanted to quit but I really needed to give it a good try since the 8 mg prednisone I was stuck on for a year and a half is too high. My labs were good and I did not have significant side effects from the prednisone. I had just been on it too long and the doctor said my body would show damage eventually. It really surprised me when the methotrexate side effects pretty much went away after a month or 6 weeks! I do have fatigue but am not sure if that is from the disease or the drugs. I have had 1 PMR flare-up in 6 months on the MTX.

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