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Side effects of MTX having recurring effect

My son has been on methotrexate (25mg) for two and half years and it has kept him in remission. However, the associated nausea that he experiences has developed into a whole series of associations that bring waves of nausea even when he hasn't taken the mediation recently. It is at the point where the smell of rubbing alcohol will cause him to vomit, the smell of McDonalds (there is one beside the clinic) will do the same, the sight of a needle, etc. He will vomit before taking the medication now. He's become convinced that Zofran actually makes the nausea worse (again, by association). This is having a major toll on his life and we're starting to wonder if the treatment is becoming worse than the disease. I used to give him his shots but he eventually became very angry with me because he was associating me with the effects - so we switched back to going to a nearby clinic for the weekly shots (a lot less convenient but at least he's not mentally blaming me for how he feels). One of my concerns is that he is developing very strong negative associations with doctors, nurses, clinics, etc. Not a good thing for someone who in all likelihood will have a fair bit of experience with the medical system over his lifetime. Recently we've tried switching to the oral medication (not his doctor's preferred approach but we were at an impasse) but the negative associations continue. We're not sure what to do next - try other medication, try off medication, psychiatry, ???
Anyone have any ideas or experiences?
Is he taking the 1k mg of folic acid?
Ca n also try ginger tea and/or apple cider vinegar to help alleviate the nausea.
Oral MTX usually has more nausea side effects.
Best if you can address the problem and not have to switch from a med that works.


Staff member
Is he seeing a psychologist? A psychologist who deals with kids with chronic illnesses might be able to really help him. How old is he?

My daughter is 18 and seeing a psychologist has made all the difference in the world. She is much better at coping with medical things. It was a huge battle to get her to go, but eventually her GI insisted and now M is happy to see her psychologist.

M also had a lot of trouble with MTX. They thought some of her nausea might be anticipatory nausea (just like your son has) and gave her Ativan before the shot. The Ativan (an anxiety medication) made her sleepy but didn't help the nausea, so they determined all the nausea was from MTX and changed the nausea medication she was on (from Zofran to Kytril). Zofran did work for her, but through trial and error we found the dissolvable form worked better and faster. Perhaps both things could help your son?

I posted a list of tips and tricks about MTX on this thread: http://www.crohnsforum.com/showthread.php?t=74621

Check out the parents' forum - there are lots of parents there whose kids are on MTX.