Re: Methotrexate and Folic Acid question

[Guest guest]

There's no one standard about how much folic acid to take with MTX and when.

Some rheumatologists believe that folic acid interferes with the

effectiveness of MTX. Others believe any possible reduction in

effectiveness is not significant and that the benefit of folic acid

outweighs that risk.

Many people on MTX are instructed to take folic acid every single day.

Others are advised to take it every day but MTX day. Still others take

folic acid on one day after MTX day.

Not an MD

On Mon, Mar 30, 2009 at 11:10 PM, sgp <sgp2525@...> wrote:

> Regarding MTX - I take the pills and have done so for 6 months.  I'm up to

> 10 pills a week.

> I believe they are helping but they are not completely  controlling the

> symptoms.  I now inject Humira bi-weekly.  AS FOR FOLIC ACID, my

> rheumatologist has me take 1200 mcgs per day every day.  It sounds like the

> people on this list are taking it quite differently.  Does anyone know why

> the instructions for folic acid dosing would vary that much from doc to doc?

[Guest guest]

I was using Methotrexate (Intramuscular injection) once a week and I was

using 2mg of Folic acid tablets a day. I had found the injection works much

better if I dont take Folic acid on the same day when I take Methotrexate as it

does interfere with its absorption. I am now using Minocycline and I am free of

most of my symptoms. I dont take Methotrexate anymore.

> Regarding MTX - I take the pills and have done so for 6 months.  I'm up to

> 10 pills a week.

> I believe they are helping but they are not completely  controlling the

> symptoms.  I now inject Humira bi-weekly.  AS FOR FOLIC ACID, my

> rheumatologist has me take 1200 mcgs per day every day.  It sounds like the

> people on this list are taking it quite differently.  Does anyone know why

> the instructions for folic acid dosing would vary that much from doc to doc?

[Guest guest]

What happens if you don't take folic acid at all? Just curious. I was once on

MTX but never was told to take folic acid and I had severe problems with it to

the point they had to take me off of it immediately. Now I am wondering if all

the problems I had was due to the fact I was not on folic acid? !!

Thanks,

in SC

ltdavis_jrdavis@...

> Regarding MTX - I take the pills and have done so for 6 months.  I'm up to

> 10 pills a week.

> I believe they are helping but they are not completely  controlling the

> symptoms.  I now inject Humira bi-weekly.  AS FOR FOLIC ACID, my

> rheumatologist has me take 1200 mcgs per day every day.  It sounds like the

> people on this list are taking it quite differently.  Does anyone know why

> the instructions for folic acid dosing would vary that much from doc to doc?

[Guest guest]

Hi , Folic acid counteracts the toxic side effects from Methotrexate as MTX

is a very toxic and powerful medication. It should only be prescribed after

close inspection of your joints like xrays and MRI but most Rheumys prescribe it

without doing any Xrays and MRIs. Some of my doctors were not happy when I told

them that I am taking MTX without xrays or MRIs. They told Rheumys should do

XRays and MRIs before prescribing MTX. Folic acid was recommended by all of them

to prevent toxicity by MTX. MTX causes kidney and liver toxicities as well as

falling hair all of which can be found out by googling and on the inserts on

MTX med. Hope that helps

> Regarding MTX - I take the pills and have done so for 6 months.  I'm up to

> 10 pills a week.

> I believe they are helping but they are not completely  controlling the

> symptoms.  I now inject Humira bi-weekly.  AS FOR FOLIC ACID, my

> rheumatologist has me take 1200 mcgs per day every day.  It sounds like the

> people on this list are taking it quite differently.  Does anyone know why

> the instructions for folic acid dosing would vary that much from doc to doc?

[Guest guest]

Hi :

My Rheumy always does x-rays, blood work, etc. She is constantly

monitoring my RA, and is always on top of things. I do have blood drawn

each month, and she is always checking the levels, plus my Liver, and

all other things that the RA affects.

I have always taken my Leucovorine ( follic acid ) 2 pills, 12 hours

after I inject my MTX. This also helps if you have Nausea.

I have been doing this since I got diag. with RA 6 years ago.

Wishing you pain free days ahead.

Hugs,

Barbara

> > Regarding MTX - I take the pills and have done so for 6 months. I'm

up to

> > 10 pills a week.

> > I believe they are helping but they are not completely controlling

the

> > symptoms. I now inject Humira bi-weekly. AS FOR FOLIC ACID, my

> > rheumatologist has me take 1200 mcgs per day every day. It sounds

like the

> > people on this list are taking it quite differently. Does anyone

know why

> > the instructions for folic acid dosing would vary that much from doc

to doc?

>

>

[Guest guest]

, what problems were you having with MTX? Two of the most common

side effects are nausea and mouth sores. Folic acid may help with

those.

Not an MD

On Tue, Mar 31, 2009 at 9:27 AM, <ltdavis_jrdavis@...> wrote:

> What happens if you don't take folic acid at all? Just curious. I was once

> on MTX but never was told to take folic acid and I had severe problems with

> it to the point they had to take me off of it immediately. Now I am

> wondering if all the problems I had was due to the fact I was not on folic

> acid? !!

> Thanks,

> in SC

[Guest guest]

People who are newly diagnosed with RA should have baseline x-rays or

MRIs. Existing damage or not, a DMARD should be started. The goal is

to prevent damage and alter the disease course, not to wait until

there is damage and then treat.

Usually MTX will be one of the first DMARDs tried because it is a very

inexpensive and effective agent. It has been used for decades, and the

toxicity profile is well-established. With proper screening and

monitoring, MTX is generally a very safe DMARD.

Not an MD

On Fri, Apr 3, 2009 at 9:37 AM, Arshad Amdani <a_amdani2000@...> wrote:

>

> Hi , Folic acid counteracts the toxic side effects from Methotrexate as

> MTX is a very toxic and powerful medication. It should be prescribed

> after close inspection of your joints like xrays and MRI but most Rheumys

> prescribe it without doing any Xrays and MRIs. Some of my doctors were not

> happy when I told them that I am taking MTX without xrays or MRIs. They told

> Rheumys should do XRays and MRIs before prescribing MTX. Folic acid was

> recommended by all of them to prevent toxicity by MTX. MTX causes kidney and

> liver toxicities as well as falling hair all of which can be found out by

> googling and on the inserts on MTX med. Hope that helps

[Guest guest]

Thanks Barbara for your reply!  Well, it's been about 4 years since I was put

on   MTX and at that time I was being treated by my regular doctor.. I have a

lot of drug allergies so he started me on a very low dose of pillls and worked

me up to the full dose, never having me take folic acid.

 

The very day I increased the MTX &   mind you , I was on no other meds whatsover,

I had a seizure at home - dislocated left shoulder (as well as cracking a bone)

and not knowing that I had had a seizure, I drove myself to the hospital where

my husband met me there. I have dislocated my shoulders on many occassions, so I

knew what I had done. Once at the hospital, I had another seizure while they

were trying to x-ray me and then another in the room.

They said it was from the MTX - not really heard of - but it was the only thing

in my system. And I had never had seizures before. So I was immediately taken

off of it. From that point on, I started seeing a specialist. I only heard aobut

the folic acid from the group and that's why I was curious.

 

I would never take a chance again in taking the drug even with folic acid, but

it made me kind of wonder if that attributed to what all happened, you know? But

thanks - wishing you pain free days too!!!!

in SC

ltdavis_jrdavis@...

From: Barbara <bcreedon@...>

Subject: [ ] Re: Methotrexate and Folic Acid question

Date: Friday, April 3, 2009, 12:17 PM

Hi :

My Rheumy always does x-rays, blood work, etc. She is constantly

monitoring my RA, and is always on top of things. I do have blood drawn

each month, and she is always checking the levels, plus my Liver, and

all other things that the RA affects.

I have always taken my Leucovorine ( follic acid ) 2 pills, 12 hours

after I inject my MTX. This also helps if you have Nausea.

I have been doing this since I got diag. with RA 6 years ago.

Wishing you pain free days ahead.

Hugs,

Barbara

> > Regarding MTX - I take the pills and have done so for 6 months. I'm

up to

> > 10 pills a week.

> > I believe they are helping but they are not completely controlling

the

> > symptoms. I now inject Humira bi-weekly. AS FOR FOLIC ACID, my

> > rheumatologist has me take 1200 mcgs per day every day. It sounds

like the

> > people on this list are taking it quite differently. Does anyone

know why

> > the instructions for folic acid dosing would vary that much from doc

to doc?

>

>

[Guest guest]

Thank you!!!  I can not take it anymore as I just replied to Barbara that when I

took MTX without folic acid (whether or not that had anything to do with it at

all) I had seizures. At that point my regular physcian referred to a Rheumy. I

was just kind of curious as to whether that could have prevented it had my

regular doctor put me on folic acid @ the same time, you know?  But thank you so

much for replying!!

ltdavis_jrdavis@...

> Regarding MTX - I take the pills and have done so for 6 months.  I'm up to

> 10 pills a week.

> I believe they are helping but they are not completely  controlling the

> symptoms.  I now inject Humira bi-weekly.  AS FOR FOLIC ACID, my

> rheumatologist has me take 1200 mcgs per day every day.  It sounds like the

> people on this list are taking it quite differently.  Does anyone know why

> the instructions for folic acid dosing would vary that much from doc to doc?

[Guest guest]

hi :

Gosh, what a terrible experience for you. I hope you never ever have a

reaction like that to anything again.

I would never take MTX again either. It is so awful to have such

allergies.

My daughter has life threatening allergies, and she is lucky to be

alive. You just never know when something will set it off.

Wishing you pain free days ahead.

> > > Regarding MTX - I take the pills and have done so for 6 months.

I'm

> up to

> > > 10 pills a week.

> > > I believe they are helping but they are not completely controlling

> the

> > > symptoms. I now inject Humira bi-weekly. AS FOR FOLIC ACID, my

> > > rheumatologist has me take 1200 mcgs per day every day. It sounds

> like the

> > > people on this list are taking it quite differently. Does anyone

> know why

> > > the instructions for folic acid dosing would vary that much from

doc

> to doc?

> >

> >

[Guest guest]

>

> People who are newly diagnosed with RA should have baseline x-rays or

> MRIs. Existing damage or not, a DMARD should be started. The goal is

> to prevent damage and alter the disease course, not to wait until

> there is damage and then treat.

>

> Usually MTX will be one of the first DMARDs tried because it is a very

> inexpensive and effective agent. It has been used for decades, and the

> toxicity profile is well-established. With proper screening and

> monitoring, MTX is generally a very safe DMARD.

>

>

>

> Not an MD

>

If this is generally accepted practice, why is my rheumy avoiding putting me on

it? He keeps saying, come back. I'm currently taking pred and plaquenil. He

wants me off the pred, and I don't think the plaquenil is doing anything.

What's it supposed to do, do you know?

Thanks!

Leanne

[Guest guest]

, I got a question to ask you. Why is that all the GPs or PCPs get scared

immediately when you mention MTX to them? MTX does pose some unique challenges

to your liver enzymes since it controls the transportation of blood in your body

and MTX is very toxic to this organ. Immediately sometime after taking MTX your

liver enzymes rise up in numeric values which pose a threat to your liver and

the big problem in getting a Rheumatologist's appointment quick enough to check

this threat is the biggest challenge

From: Leanne <oldredmom@...>

Subject: [ ] Re: Methotrexate and Folic Acid question

Date: Friday, April 3, 2009, 7:26 PM

>

> People who are newly diagnosed with RA should have baseline x-rays or

> MRIs. Existing damage or not, a DMARD should be started. The goal is

> to prevent damage and alter the disease course, not to wait until

> there is damage and then treat.

>

> Usually MTX will be one of the first DMARDs tried because it is a very

> inexpensive and effective agent. It has been used for decades, and the

> toxicity profile is well-established. With proper screening and

> monitoring, MTX is generally a very safe DMARD.

>

>

>

> Not an MD

>

If this is generally accepted practice, why is my rheumy avoiding putting me on

it? He keeps saying, come back. I'm currently taking pred and plaquenil. He

wants me off the pred, and I don't think the plaquenil is doing anything. What's

it supposed to do, do you know?

Thanks!

Leanne

[Guest guest]

I reject the notion that all GPs and PCPs are fearful of methotrexate.

In fact, there is a worldwide shortage of rheumatologists, so many GPs

treat RA patients with DMARDs, including MTX.

MTX can cause elevation in liver enzymes, but significant elevations

(greater than two times the upper limit of normal) of ALT/AST are

uncommon and reversible.

Many medications and supplements can cause alterations in liver

enzymes. For example, NSAIDs, acetaminophen, statins, and the

minocycline you are taking can all cause elevated liver enzymes.

Because of its effectiveness, safety, and low cost, MTX remains the

gold standard treatment of rheumatoid arthritis.

*********************************************************

http://www.mayoclinic.com/health/elevated-liver-enzymes/hq01011

*********************************************************

J Clin Gastroenterol. 2009 Mar 3.

Long-term Minocycline Use for Acne in Healthy Adolescents can Cause

Severe Autoimmune Hepatitis.

Ramakrishna J, AR, Banner BF.

*Pediatric Gastroenterology and Nutrition, Department of Pediatrics

double daggerDepartment of Pathology, UMass Medical School/UMMHC,

Worcester, MA daggerDepartment of Medicine and Pediatrics, University

of Chicago Medical Center, Chicago, IL.

Over the years, a variety of abnormal immune reactions to minocycline

have been reported including arthritis, systemic lupus erythematosus,

and hepatitis. The current report describes the detailed clinical and

pathologic features of 3 patients who presented with

chronic/autoimmune hepatitis alone while on minocycline at our

hospital over a 2-year period. Minocycline use in these patients was

temporally related to onset of severe hepatitis. Adolescents with such

a reaction to minocycline have been included in previous reports but

have not been well described as a distinct entity. We have compared

our cases with similar cases previously reported with a review of the

literature and a discussion of the implications for prescribing

physicians.

PMID: 19262406

http://www.ncbi.nlm.nih.gov/pubmed/19262406

*********************************************************

Eur J Gastroenterol Hepatol. 2008 Aug;20(8):796-9.

Minocycline hepatitis.

Ford TJ, Dillon JF.

Department of Digestive Diseases and Clinical Nutrition, Ninewells

Hospital and Medical School, University of Dundee, Dundee, Scotland,

UK.

Minocycline is an effective antibiotic widely used in the treatment of

acne vulgaris. We report a previously well 20-year-old woman who

developed liver dysfunction with jaundice and malaise following a 1

year course of minocycline for acne vulgaris. Serum antinuclear

antibody was strongly positive (1 : 2560) and liver transaminases were

grossly deranged. All other causes of liver disease were excluded.

Both the clinical symptoms and laboratory abnormalities resolved

spontaneously on stopping the drug. We review the three different

types of hepatotoxicity associated with minocycline and draw evidence

to support the diagnosis of minocycline-induced autoimmune hepatitis.

This case supports the call to monitor patients on minocycline therapy

for autoimmune disease of the liver and highlights the need for a

multicentre prospective trial of the risks and benefits of long-term

minocycline therapy.

PMID: 18617786

http://www.ncbi.nlm.nih.gov/pubmed/18617786

***********************************

Dig Dis Sci. 2007 Nov;52(11):3242-4. Epub 2007 Apr 3.

Minocycline toxicity requiring liver transplant.

Losanoff JE, Holder-Murray JM, Ahmed EB, Cochrane AB, Testa G, Millis JM.

Department of Surgery, University of Chicago, Chicago, IL, USA.

PMID: 17404879

http://www.ncbi.nlm.nih.gov/pubmed/17404879

************************************

Not an MD

On Fri, Apr 3, 2009 at 9:41 PM, Arshad Amdani <a_amdani2000@...> wrote:

> , I got a question to ask you. Why is that all the GPs or PCPs get

> scared immediately when you mention MTX to them? MTX does pose some unique

> challenges to your liver enzymes since it controls the transportation of

> blood in your body and MTX is very toxic to this organ. Immediately sometime

> after taking MTX your liver enzymes rise up in numeric values which pose a

> threat to your liver and the big problem in getting a Rheumatologist's

> appointment quick enough to check this threat is the biggest challenge

[Guest guest]

HI All,

I was on MXT for nearly 6 years and my liver function tests were abnormally high

for a long period of time. But the liver is a clever organ as it will go back to

normal and repair itself when the cause is taken away. At one time my rheumy

thought I must be a secret drinker because of the results. I don't drink alcohol

and never have done since I was a teenager. I was only on MXT at that time, so

it had to be the cause. With an enlarged liver I was feeling toxic, but when I

came off the MXT, in a very short time, that feeling left. That's why it is so

important to get your blood tested at least every month.

 

I get my bloods done weekly at the moment because I've been put on Enbrel.

 

MXT didn't work for me, but it does for a lot of people and that's one of the

reasons it's prescribed as often as it is, and it's probably the most cost

effective drug given.

 

Best wishes

x

> , I got a question to ask you. Why is that all the GPs or PCPs get

> scared immediately when you mention MTX to them? MTX does pose some unique

> challenges to your liver enzymes since it controls the transportation of

> blood in your body and MTX is very toxic to this organ. Immediately sometime

> after taking MTX your liver enzymes rise up in numeric values which pose a

> threat to your liver and the big problem in getting a Rheumatologist' s

> appointment quick enough to check this threat is the biggest challenge

[Guest guest]

's right. It was actually my PCP who prescribed my MTX for me, not my

Rheumy. I had a really nasty flare after I returned home from my last trip to

the states to see my Rheumy, and I was not scheduled to go back until next month

(I fly to FL 4x a year to see my Rheumy as we don't have on here in the Virgin

Islands). My PCP is doing most of the legwork with my RA with Rheumy having

final say. My PCP is alrady preping my hubby for my next line of treatment as he

he recommending I use Enbrel when I next have to change up my meds. The key is

to finding a PCP/GP who has educated themselves on RA and its treatment. I would

be tearing my hair out if it weren't for my PCP!

 

Betsy