How do you approach managing nausea and GI side effects when initiating methotrexate?  

There are several strategies to minimize nausea and gastrointestinal symptoms with the use of methotrexate. The medication can be taken with food, just not with caffeine. The dose can be split throughout the day it is taken such as half the dose in the morning and the other half in the evening. The ...

I agree with Dr. @Ware. With all medications that potentially cause GI side effects, my recommendation would be to start low, go slow, and warn the patient that GI side effects may occur, but they usually diminish with time. Methotrexate should be taken in split dose to maximize efficacy and adsorpt...

OTC dextromethorphan is often quite effective for gastrointestinal discomfort from methotrexate.

Very few is the patient that has to be on methotrexate. We are so lucky to have many options for inflammatory arthritis management. Leflunomide is non-inferior in RA and has less side effects; we do not use it enough in kids or adults! For children, although the actual milligram dose can b...

Agree with PM dosing. Ondansetron 4-8 mg po/ SL given as premedication 30" prior to methotrexate and repeated the next AM is often very effective when used with low doses (7.5- 15 mg). SQ tends to be better tolerated wrt GI AE.