There are many medications currently available to treat autoimmune diseases, and one of the most commonly used is methotrexate. It was first invented in 1947 for use in oncology, and has since become a first-line medicine in the treatment of Rheumatoid Arthritis and other inflammatory conditions. Methotrexate is in a class of chemicals known as disease-modifying anti-rheumatic drugs (or ‘DMARDs’ for brevity). DMARDs were designed to target specific pathways and/or proteins in order to suppress inflammatory immune responses at the cellular level. Methotrexate can be taken orally or via injection, and often takes several weeks to fully take effect. As a result, it may be prescribed with other medications to help manage illness in the short-term, like corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs).

This can all sound pretty heavy and be intimidating to those just starting Methotrexate. I know I was nervous when I was first prescribed it. But I’ve built great rapport with my rheumatologist and I trust him. So I gave it a try, and I’m so glad I did, because it has been a total life changer for me. Methotrexate helps to exponentially improve my energy levels and reduce the overall pain caused by my Sjogren’s, and I started noticing improvements from weekly injections almost immediately. Unfortunately, many methotrexate users may experience unpleasant or disabling side-effects, especially an intense neurological malaise collectively known as the methotrexate “blahs.” Thankfully, there is a simple, accessible, and over-the-counter remedy to manage this unpleasant complication, and it can be picked up at just about any drug store. Please note: Since I personally take methotrexate via injection, I will be focusing on that specific delivery method in this article.

WHAT ARE THE METHOTREXATE ‘BLAHS’?

Methotrexate fog or “blahs” describe a cluster of neurological symptoms, including debilitating fatigue, brain fog, and a general sense of unwellness and feeling “low.” I’ve personally found it to be one of the most disabling side effects of methotrexate use — and I’m not the only one. Around half of methotrexate users experience neurological complications, including fatigue, somnolence, headaches, nausea, dizziness, and cognitive dysfunction. As a writer, words rarely escape me, but it’s nearly impossible for me to describe this awful sensation – and I’m a grizzled veteran who is already “used to” managing fatigue from my preexisting conditions.

It was like I was made out of lead that was tied to cement blocks and dropped into a lake, but no matter how much I struggled to get up from the bottom, all I could do was just lay there in a haze. It was almost impossible for me to do anything besides sleep, and even the few basic abilities I’m normally left with while dealing with chronic fatigue were being stripped away. I knew there was no way I could keep using this medication if the side effects were going to be this disabling, so I rolled up my sleeves and did some research. I may not be a pharmacologist, but I have a basic understanding of it, and I can read. So, I scoured the internet for answers, and I was not left disappointed.

HOW TO BEAT THE BLAHS

Much to my relief, the methotrexate “blahs” have been addressed at some length in medical literature, which states the cause is from central nervous system toxicity. Which probably isn’t a good thing. Thankfully, an elegant and easily accessible solution for methotrexate neurotoxicity has been found and used in numerous documented cases, including hospital settings – dextromethorphan (DXM). This is a common ingredient found in many cold medicines that can be purchased just about anywhere, such as Mucinex DM.

The recommended dose is 20-50 milligrams DXM at the time of injection, followed by an additional 20-50 milligrams 8-12 hours later. If you would like to nerd out on the mechanisms of action and other heavy science involved with exactly how this all works, please read more here. I can grasp most of what’s being described in these articles, but the science definitely goes above my pay grade and I’d butcher it if I tried to repeat it here (Please note: ALWAYS discuss any medications with your medical team before trying them).

TIMING IS EVERYTHING

After getting the okay from my rheumatologist, I’ve tried this method personally, and I can tell you that it works phenomenally! However, it is pertinent to note that timing is everything. When I initially learned about and implemented the DXM method, it was a few days after my first methotrexate injection. I noticed massive improvements in the following few hours which lasted for the rest of that day, and I rejoiced! Sadly, the benefits faded by the following morning.

However, the next time I was due for an injection, I followed the listed protocol and took 20-50 mg DXM at the same time. I then followed this with the same amount of DXM 8-12 hours later. And guess what? No blahs at all for the entire week! Not a single hint of them reared their ugly little heads. I found a way to be free of the demon, and have been happily self-injecting methotrexate every week for nearly six months now.

Well, “happily” may be too strong of a word — I still have some mild side effects mostly the day after the shot, but that’s infinitely more tolerable than the week-long funk I was drowning in before. And the positive effects of methotrexate make me incredibly grateful to have access to it, and for the ability to continue using it.

Please note: I have found that Mucinex DM (or equivalent brands) works better for methotrexate hangovers than straight DXM, for whatever reason. My guess is that the other active ingredient amplifies/synergizes the detoxification effect of DXM.

I hope you find this information as helpful as I have! I’m honestly surprised it’s not more widely known or discussed. Have you tried the DXM method to manage methotrexate side effects? How helpful (or not helpful) have you found it to be?

Thanks for reading, and keep on truckin’!
– Renata

PS – If you have some spare time, I found this article detailing the complete history of methotrexate to be quite fascinating. Enjoy!