You’re going about your day when all of a sudden, your heart starts beating so fast it feels like it’s going to burst out of your chest. You may even feel short of breath or break out in a sweat.

These racing heartbeats are known as heart palpitations. Some medications can trigger heart palpitations, and MyLupusTeam members have asked others if lupus medications — like methotrexate — can cause this symptom.

“Does methotrexate cause heart palpitations and severe weakness? I just started methotrexate two weeks ago, and I’m also on other medications. I woke up feeling bad, then when I was sweeping, I got extremely hot, broke out in a sweat, and started having heart palpitations,” said one MyLupusTeam member.

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Here’s what to know about lupus, methotrexate, and heart palpitations, and when to seek medical care for this symptom.

Can Methotrexate Cause Heart Palpitations?

Methotrexate is a disease-modifying antirheumatic drug that may be used off-label for lupus to help ease joint pain and swelling from lupus-related arthritis. The current U.S. product label for methotrexate does not list lupus as an approved condition. It lists uses such as rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, severe psoriasis, and some cancers.

Methotrexate heart palpitations may happen in some situations, but a fast heartbeat isn’t listed as one of the most common methotrexate side effects. The most common side effects listed in the current methotrexate product information are mouth sores, low white blood cells, nausea, and upset stomach.

Allergic Reaction to Methotrexate

A fast heart rate can be part of a serious allergic reaction to methotrexate. Get medical help right away if a fast heartbeat happens with symptoms such as rash, itching, hives, swelling of the face or throat, wheezing, trouble breathing, dizziness, feeling faint, vomiting, or diarrhea.

Other Methotrexate Side Effects

Other methotrexate side effects can include chills, fever, hair loss, nausea, skin lesions, sun sensitivity, and abnormal liver tests. Your doctor may prescribe folic acid or folinic acid to reduce the risk of certain side effects, such as mouth sores.

If you’re wondering, “Does methotrexate cause high blood pressure?” research hasn’t shown a major blood pressure effect from low-dose methotrexate. One randomized trial analysis found no clinically meaningful blood pressure difference between people assigned to low-dose methotrexate and those assigned to placebo.

If you recently started methotrexate and notice more racing or fluttering, talk to your doctor or rheumatologist.

Can Corticosteroids Cause Heart Palpitations?

Corticosteroids such as prednisone are sometimes used to reduce inflammation and calm immune activity in lupus. Prednisone and other corticosteroids can affect the heart in some people.

For example, prednisone may change levels of electrolytes, such as potassium, sodium, calcium, and magnesium. When these levels shift, the heart may beat slower or faster, and some people feel palpitations. Prednisone can also raise blood pressure by causing the body to hold on to more fluid and sodium.

Don’t stop prednisone suddenly or change your dose yourself. If you think prednisone is causing palpitations or making them worse, contact your doctor.

Other Causes of Heart Palpitations With Lupus

Lupus is an autoimmune disease, meaning the immune system mistakenly attacks healthy tissues. Systemic lupus erythematosus (SLE) — the most common type of lupus — can affect many parts of the body, including the joints, skin, kidneys, blood cells, brain, heart, and lungs.

The body-wide inflammation from lupus can also affect your heart and blood vessels. About half of people with lupus may experience heart complications.

Heart valve problems, rhythm disorders, myocarditis (heart muscle inflammation), and pericarditis (inflammation of the sac around the heart) can all be linked to heart symptoms in lupus.

One member shared, “I also have heart palpitations. I was diagnosed with severe anxiety attacks. My therapist taught me a technique to ground myself when I feel the palpitations coming on.”

If your heart starts racing when you become panicked, anxious, or worried, your doctor or a mental health professional can help. Anxiety disorders can involve physical symptoms such as increased heart rate, rapid breathing, sweating, trembling, and weakness.

MyLupusTeam Members on Their Experiences With Heart Palpitations

MyLupusTeam members have reported heart palpitations during lupus flares. One member wrote, “Does anyone get palpitations during your flare? I’ve been getting lots of palpitations and skipped beats this past year. Just finished several cardiac tests, and my heart rhythm is normal. My cardiologist thinks it’s from lupus, so I was wondering if anyone here has this issue.”

Others replied with similar personal experiences:

• “I do get them during my flares, and they’re alarming! Deep breathing and changing my position helps.”
• “I experience fluttering, and it feels like skipped beats. When this happens, I feel weak and more fatigued.”

These stories show what some members have noticed, but having palpitations during a lupus flare don’t prove that lupus caused them. Medication effects, anemia, thyroid problems, dehydration, and heart rhythm problems can also be causes. You can also read about other SLE complication signs, including heart palpitations, to learn more.

What Should You Do if You’re Having Heart Palpitations?

Heart palpitations can be concerning — especially if you don’t usually have them. They’re often harmless, but it’s best to get medical advice if they’re new, frequent, worsening, or persistent.

If you think methotrexate, prednisone, or another lupus medication may be causing heart palpitations, talk to your doctor or rheumatologist. They can review your symptoms and decide whether any treatment changes are needed.

Don’t stop, restart, or change lupus medication without speaking with your prescriber. Serious methotrexate reactions may require methotrexate to be withheld or discontinued, but that decision should come from your healthcare team.

When Are Heart Palpitations a Concern?

There are some times when palpitations need urgent medical attention. Call 911 or seek emergency care right away if you:

• Suddenly feel like you can’t catch your breath
• Pass out after having palpitations
• Have severe dizziness or lightheadedness
• Have pain, tightness, or pressure in your chest, jaw, neck, shoulders, arms, or upper back

One MyLupusTeam member shared what they do when they’ve had palpitations and other symptoms in the past: “I wound up in the emergency room (ER) several times with chest pain, palpitations, and sweating. It’s way better to go to the ER and be told, ‘Your heart is fine, it’s just a symptom of XYZ’ and know that for the future than not go and worry or actually have a serious problem.”

Let your doctor and rheumatologist know if you visit the ER and get treated for heart palpitations. They can help review your symptoms and treatment plan.