Hi. A few years ago, I stopped methotrexate after one month as it elevated my liver levels & switched to leflunomide and have had no issues. As far as fatigue, I would have been hard pressed to say for sure if it was the methotrexate was the primary fatigue culprit or if it was that coupled with diagnoses and other meds. Leflunomide has less side effects than methotrexate, and my opinion is that it should NOT be a first line, gold standard medication…. It was poison for me and many others in my circle. Leflunomide does take a little while to start working for you to feel the benefit. Also, I take it in the morning The best to you.