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Understanding Methotrexate: Yes, It’s Low-Dose Chemo — and That Matters

When you hear the word chemotherapy, what comes to mind? For most people, it’s cancer treatment — a difficult, often overwhelming process involving high doses of medication, hair loss, nausea, and fatigue. But what many don’t realize is that chemotherapy drugs aren’t used only for cancer.

One medication in particular, methotrexate, is prescribed to thousands of people every day for chronic illnesses — especially autoimmune diseases like rheumatoid arthritis, lupus, and psoriasis. And yes, it’s a type of chemotherapy — even when used in much lower doses.

So let’s talk about it.

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What Is Methotrexate?

Methotrexate is an older drug that’s been around since the 1940s. It was originally developed as a chemotherapy agent to treat certain cancers, and it works by interfering with how cells grow and divide — especially the fast-growing ones.

In higher doses, it targets cancer cells.

In lower doses, it helps suppress the immune system, which is why it’s become a go-to treatment for autoimmune conditions where the body’s defense system mistakenly attacks itself.

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Yes, It’s Still Chemo

This can be a touchy topic for those of us living with chronic illnesses. People will often say, “Oh, it’s not real chemo,” or “It’s just a small dose, so it doesn’t really count.”

But here’s the truth: Methotrexate is classified as a chemotherapy drug, even at low doses. The fact that it’s helping control autoimmune inflammation instead of attacking cancer cells doesn’t make it any less powerful — or any less serious.

If someone tells you they’re taking methotrexate, please understand:

• They may have to go in for regular blood work to monitor liver function and white blood cell count.
• They’re often told to avoid alcohol to prevent liver damage.
• They might deal with fatigue, nausea, mouth sores, hair thinning, and other side effects that feel all too familiar to anyone who’s been through cancer treatment.
• And they’re often supplementing with high-dose folic acid or leucovorin to reduce some of those side effects — because methotrexate can deplete folate in the body.

So yes, it’s a low dose, but it’s still chemotherapy. Let’s give people the respect they deserve for what they’re carrying.

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My First Reaction: Tears and Terror

When methotrexate was first offered to me as part of my treatment plan, I didn’t feel brave or strong. I felt scared. Really scared. Biologics didn’t shake me nearly as much — but methotrexate? That word hit differently.

I broke down in tears.

I remember sitting on the bathroom floor, completely overwhelmed. My hair was already thinning thanks to autoimmune flares and stress, and the idea of losing more of it? That nearly broke me. I sat there wondering if it would be easier to just shave my head and get a skull tattoo — because at least then I would be in control of the loss, instead of waking up each week wondering how much more would fall out.

The emotional toll of chronic illness is already high. Adding a chemo drug to the mix — even a low-dose one — just made it heavier.

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The Pain and the Decision to Increase My Dosage

I want to be honest with you: If methotrexate didn’t help ease the pain, stiffness, and swelling in my hands, legs, and back, I wouldn’t be taking it. I’ve been through enough with chronic pain to know when a treatment works and when it doesn’t.

In the days leading up to taking methotrexate at its lowest dosage, I’d ache so badly that I’d find myself in tears. It wasn’t just a little discomfort; it was the kind of pain that makes you question your ability to keep going. The day before my dose, I would be exhausted and frustrated, dealing with the intense physical limits of my body. It was so clear that I needed this drug to manage my symptoms.

Eventually, it became obvious that the lower dosage wasn’t cutting it. We upped my dosage, and that made all the difference. The relief I felt in my joints, muscles, and body was undeniable. It didn’t just help with physical function — it helped me reclaim a sense of normalcy.

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Managing the Nausea: Tips from Experience

One thing that’s helped me is splitting up my dose. A lot of doctors won’t always mention it, but it’s okay to take your methotrexate in two doses — one in the morning and one in the evening — on the same day. This has been a game-changer for me. I simply can’t handle taking all my pills at once without becoming overwhelmingly nauseated. The split helps take the edge off.

And on my methotrexate day? You’ll find me with ginger chews in my pocket like a squirrel stashing acorns and clutching a ginger ale like it’s holy water. These small rituals aren’t just comforting — they’re survival tools.

Everyone’s body reacts differently, but if you’re struggling with nausea, talk to your doctor about splitting your dose and don’t be afraid to lean into natural remedies that help your gut and your soul.

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The Emotional Weight of the Dose

Taking a chemo drug every week is not just physically demanding. It’s emotionally exhausting.

For many of us with autoimmune disease, popping that pill (or giving ourselves that injection) every week is a reminder that our bodies are not functioning like they should. It’s a weekly reality check that we have to work twice as hard just to feel halfway functional.

So please, before brushing it off with, “Well, at least it’s not real chemo,” take a breath. Offer a little compassion. Because this is real. It’s real medicine. Real side effects. Real strength.

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In Conclusion

If you or someone you love is taking methotrexate, know this: You are seen. You are valid. Your pain, your struggle, your treatment — it all matters. You are not “overreacting” or “making a big deal out of nothing.” You’re walking a hard road with quiet resilience, and that deserves respect.

So here’s to the weekly warriors. The methotrexate day survivors. The ones who cry in the bathroom, then pull themselves up and keep going. The ones who choose tattoos and bald heads and strength, however that strength looks. The ones splitting their pills, sipping sacred ginger ale, and still showing up.

Whether you take pills, injections, or infusions — your journey is valid.

You are not alone.

Much love and many blessings,
Mrs. B