Yea methotrexate (mtx) is hard on the liver. I kept trying to reduce mine enough to get my liver enzymes in check but had to stop pills and went to injectable form - but finally had to give up the drug altogether to protect my liver. ALT and AST were just too high. I was taking it as an adjunct to Enbrel so I just did without.

If you can’t tolerate the full
Dose of mtx in pill form, ask if you can switch to injectable. That helped me with the nausea.