Starting dosage of methotrexate?

I started on 15 mg and tolerated it ok. Not great, but ok. More fatigue and some kidney issues. Good things were a great reduction in joint pain and swelling. Then when they raised it to 20mg my heart got affected, profound fatigue and GI symptoms, and have had to go off it. Starting on Myfortic tomorrow. Fingers crossed. Many people do well on methotrexate for years. I’m just not one of them.

Thank you for your comments!

@theodorastronger Medication doses are frequently discussed and questioned and pondered over. Have you asked your doctor about the higher dose that they want you to start on? You could ask on the portal (do you have access and/or, does the doctor’s office even use one ?) You could ask the question and then delay the first dose until you get an answer. How do you think the doctor will respond?

Yes, thank you; that is excellent advice. I feel like I'm asking a lot of questions of her and apologizing for that--but I know I should just go ahead and ask my doctor!

I've been reading up on this and found some interesting studies that were published in NIH saying that a larger dose does not worsen side effects compared to a smaller dose. But I'll ask.

The 15 mg dose is not excessive to start. Don’t be reluctant to ask questions
of your physician. Once you respond they can alter the dose accordingly.
Ask them if you can take folate to minimize side effects.

Yes, I have been prescribed daily folate. Thank you very much.

@theodorastronger perhaps you could ask if you could take the Methotrexate in pill form which you may be able to tolerate better …?

IThank you. t's my understanding that the injectable may cause less nausea. I'll try it and see. . .

I tried 20 mg per week for about 9 months- caused issues with severe brain fog- fatigue and kidney damage. NOT FOR ME!

I have taken methotrexate for years, both the oral and injectable forms and have done well on it. The injections bypass the G.I. tract which lessens the chance of nausea but many people do well on the oral doses without any nausea at all. I have been on as high as 25 mg a week, although most physicians like to keep it at 20 mg or less. I would guess your physician chose your starting dose with your symptoms and level of severity in mind to give you relief as quickly as possible without causing undue side effects. Doses Can be adjusted upward or downward, depending on your response. I hope it works well for you!