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!