When I was taking Methotrexate the medicine really helped my RA but the nausea just kept getting worse and worse, so much so that I could barely eat and began losing too much weight. So I began self injecting the Mtx once a week. Doing that really improved the nausea and I took the Mtx for ten years, which kept me on my feet and able to work. Maybe your doc would be willing to try that with you. Good luck!
Andrea

I had the same problem. The methotrexate inj. do not make me as sick as the pills. Also my doctors recommend Folic acid to help with the side effects. The fatigue is and can be a problem. it can be from the RA or the meds. You can usually count on being down for two days. My doctors also prescribes Ondansetron when I'm sick. Its like morning sickness. He writes me for twelve a mth. I will usually have a sick day and then a tired day. Next I'm up and running for another few days until the next inj. in which I only take once a week aalong with Orencia. Do you take Plaquenil? that med. is used often along with methotrexate and can add on to your symptoms. Please don't get discouraged first talk with your doctor, tell him you are very sick and ask about the inj.If you don't have and keep an open line of communication you wont benefit whats best for you and have what maybe easier for you. Always make lists, ask questions. Last but not least if he doesn't give you the support you need there's always someone else to see you. Don't be afraid to run anything by your doctor. I promise no matter how bad or whatever comes and goes you will do fine. That's why we are here for you and you for us. Also last is read, read, and then read some more, making sure you are on the best web sites offered and dependable

It's interesting how different doctors give different directions. My doctor told me the body can absorb more than 6 methotrexate at once, so when I moved up to 8 pills, he said to take 4 in the morning and 4 at night. Maybe that also helped with the side effects.

I take mine before bed on Friday. I usually wake up durng the night with a killer headache or vertigo.
This happens Saturday and Sunday; I'm usually good to go on Monday. Are you taking folic acid? When my Dr increased the folic to 2 is when I started with the awful taste in my mouth. I took myself down to 1 and now I have changed to 5 days a week not 7. My teeth were really hurting (not like a tooth ache) and the acid reflux was bad. This is the first week decreasing folic and already my teeth feel better. I will not
take the folic on Friday, my mrtx day, and not on Saturday...just because I'm trying to find my way with the
drugs. I have heard that since the injection bypasses the stomach, the tummy issues do not exist.

Thank you for all the great advise. I take 2 in morning , 2 afternoon, 2 at dinner. At this point I am ok. Then I take the final 2 before bed. Next day I feel sick - just the thought of food 😥. I will ask Dr about injecting mtx. Makes me not want to take mtx. Sometimes I wonder how do I know mtx is working and worth the awful feelings. Very discouraged.