Methotrexate and side effects and Anxiety

[Guest guest]

Hi group,

re

Feelings of anxiety around MTX buzzing around on many threads here at present.

Have noticed much recent posting on methotrexate and the wide range of side

effects experienced. Of course there will be a range of tolerance as people

react so differently.

Here are my thoughts on the issue (personal non expert opinion only)

I know that there is an increasing trend in RA medics to start an active

protocol,with a relatively high starting dose (15mg -20 mg) on the basis that

this will have best chance of achieving the desired control of the underlying

immune process, and not being 'wishy-washy'. Yes ,all good logic from the

science point of view.But it would seem a bit heavy handed for some patients,

therfore even 'cruel'.

Having experience of using MTX in my oncology clinical practice, have been aware

when reading some posts of high starting doses that that would inevitably take a

significant extra susceptible minority into the zone of intolerable side

effects, including stomatitis and gi upset after just one dose.

They would , if so affected, quite rightly 'hate' the drug, and it would be

emotionally disressing to contemplate trying it even at a lower dose in the

future even if it might be a useful drug for them.This is an important issue I

feel.

This is just my own humble opinion, but I feel if I were the doc I would start

prescribing lower and work up, if tolerated,to optimum tailored dose and I

believe would give the person more confidence and control of managing their

illness,and trust in the partnership with their doctor at the for many scary

time of starting DMARDs.

It is better to 'stay the course' than withdraw at the first hurdle.

So if concerned just ask the doc to clearly explain their logic for the

starting dose they choose. They don't have the side effects!

Hope I have not worried anyone by this post. Quite the opposite of what I

intend. MTX is tolerated by many very very well and does its job well for many.

The message is just discuss any concerns with your doc early. Let them know of

your 'lost days' in a week. They wont know otherwise.

Best wishes

Chris

UK (retired doc non rheum)

[Guest guest]

hi chris

do you know if mtx by injection is easier on t he liver than taking it

orally? reason i ask is that i now do not tolerate most meds well - pain

killers, antibiotics make me feel very sick. i went into complete

remission on minocin but then after a few yrs had to stop taking it as

it made me sick. liver blood tests are normal but in research i've done

it seems my liver detox pathways are no longer functioning properly. i

also now have severe sensitivity to any chemical smells. so...need to

find another way to control RA that doesn't make me sick. woudl injected

mtx have a better chance of doign this?

thanks

monique

Hi group,

re

Feelings of anxiety around MTX buzzing around on many threads here at

present.

Have noticed much recent posting on methotrexate and the wide range of

side effects experienced. Of course there will be a range of tolerance

as people react so differently.

Here are my thoughts on the issue (personal non expert opinion only)

I know that there is an increasing trend in RA medics to start an active

protocol,with a relatively high starting dose (15mg -20 mg) on the basis

that this will have best chance of achieving the desired control of the

underlying immune process, and not being 'wishy-washy'

.. Yes ,all good logic from the science point of view.But it would seem a

bit heavy handed for some patients, therfore even 'cruel'.

Having experience of using MTX in my oncology clinical practice, have

been aware when reading some posts of high starting doses that that

would inevitably take a significant extra susceptible minority into the

zone of intolerable side effects, including stomatitis and gi upset

after just one dose.

They would , if so affected, quite rightly 'hate' the drug, and it would

be emotionally disressing to contemplate trying it even at a lower dose

in the future even if it might be a useful drug for them.This is an

important issue I feel.

This is just my own humble opinion, but I feel if I were the doc I would

start prescribing lower and work up, if tolerated,to optimum tailored

dose and I believe would give the person more confidence and control of

managing their illness,and trust in the partnership with their doctor at

the for many scary time of starting DMARDs.

It is better to 'stay the course' than withdraw at the first hurdle.

So if concerned just ask the doc to clearly explain their logic for the

starting dose they choose. They don't have the side effects!

Hope I have not worried anyone by this post. Quite the opposite of what

I intend. MTX is tolerated by many very very well and does its job well

for many.

The message is just discuss any concerns with your doc early. Let them

know of your 'lost days' in a week. They wont know otherwise.

Best wishes

Chris

UK (retired doc non rheum)