My daughter had a VERY hard time with MTX. She'd be in bed for two days after the shot -- so nauseous and dizzy that she could not even walk. Sometimes she'd throw up.
We tried everything -- lowering the dose (25 mg to 15 mg to 7.5), which helped a little.
Extra Zofran - helped a little
A different nausea medication - Kytril (used for chemo) - which also helped
Leucovorin - which is folinic acid. It is actually given to cancer patients on very high doses of MTX as a "rescue drug." It helped a lot with symptoms.
Folic acid -- went from 1 mg to 2 mg. I asked our pediatric rheumatologist about going higher. She said we can only absorb a certain amount of folic acid, so for example, if we went to 5 mg, the extra would just be excreted out (so it won't hurt but probably won't help much).
The bad part was that MTX actually worked very well for her -- especially for her joints. We eventually took her off it because she was just SO miserable and losing 2-3 days every week didn't make any sense.
She was put on Imuran which she has tolerated well.
My older daughter, however, has no issues with MTX. Mild nausea and fatigue but doesn't even need Zofran.
For BOTH girls, switching from pills to shots made a huge difference. I'd try that first before giving up on MTX.
