mtx question

[Guest guest]

In a message dated 11/29/00 4:39:51 PM Central Standard Time, Ednettieolson

writes:

I am sending this message again because nobody has replied and am still

wondering if anybody has any feedback regarding this message. Thanks

Jeannette

PLEASE READ

<< just got back my lab results from yesterday and my liver enzymes are

elevated again. However, they think it is because I injected MTX on Sunday

and took a lab test on Monday......that was really stupid of me but I forgot.

I have to repeat the test on Friday. My real question, however is, normal

count is 30, mine is 60 something, but when they are looking at dangerously

toxic, they are talking about 900-1000. Why are they even giving any thought

to such a small elevation when I am so far from the dangerous zone it is

almost funny? They would even consider taking me off MTX at a consistent

level of near 60 or above. Any thoughts on the matter?

Jeannette >>

[Guest guest]

Thanks a for the info. I am only on 3mg. or 3/10 injected. It is such a

low low dose. I will find out Monday the results of my lab test tomorrow

because it is being repeated. I certainly hope the level goes down. I am

not particularly interested in trying out a new drug right now. This keeps

happening and we keep going in circles. Up and down and up and down. I am

getting dizzy!!! LOL

Jeannette

[Guest guest]

a:

Yes, I want very much to continue with MTX. Since I have returned home and

am quite rested, I am feeling quite good again. Why try to fix something if

it is not broke? My blood test result tomorrow will be lower; I just know

it. I am willing them to be lower so therefore they will be lower. Amen!!

LOL

Jeannette

[Guest guest]

Jeanette,

I took this out of the American College of Rheumatology guidelines for

monitoring drug therapy:

Methotrexate (MTX). The most serious toxicities of MTX include hepatic

fibrosis (rare) and cirrhosis (rare), pneumonitis (uncommon), and

myelosuppression. Independent risk factors for the development of serious

liver disease (biopsy-proven cirrhosis or clinically evident liver disease

such as ascites, esophageal varices, hepatic encephalopathy, etc.) in

patients with RA include age and duration of therapy, as identified in a

recent case-control study (41). Other potential risk factors for hepatic

toxicity that have been suggested but were not identified in that small RA

cohort study include obesity, diabetes, alcohol intake, and prior history of

hepatitis B or C (41,42).

Prevention of hepatic fibrosis and cirrhosis includes the avoidance of MTX

in patients with liver disease or another important risk factor. In patients

with suspected liver disease, a pretreatment liver biopsy should be

obtained. Prevention also includes advising the patient against alcohol

consumption while taking MTX. Patients should report symptoms of jaundice or

dark urine.

Routine surveillance liver biopsies are not recommended for RA patients

receiving MTX in the recommended doses (43). Liver biopsy is not a

cost-effective means of monitoring, at least for the first 10 years of

therapy in patients with no abnormal ities identified on liver function

tests (44). Liver bi opsy is recommended for patients with liver function

abnormalities that persist during treatment with, or following

discontinuation of, MTX (43).

Risk factors for myelosuppression include the use of antifolate agents such

as trimethoprim, the presence of folate deficiency, and renal insufficiency

(42). Severe myelosuppression is an uncommon complication of low-dose (5-20

mg/week) MTX therapy (42). The rationale for monitoring is to decrease the

incidence and severity of severe myelosuppression and its complications,

such as sepsis, severe anemia, and bleeding. The baseline evaluation

consists of a complete blood cell count (CBC) with differential cell count.

Monitoring consists of a CBC and platelet count performed every 4-8 weeks.

Mean corpuscular volume >100 may indicate folate deficiency and predict

myelosuppression (45). Because the kidneys are the primary route of

excretion of MTX, renal insufficiency may lead to myelosuppressive levels of

the drug. Routine monitoring of renal function every 4-8 weeks is therefore

recommended (46).

Pneumonitis is an uncommon complication of long-term MTX therapy, with a

frequency on the order of 2-6% (42). Precise risk factors for the

development of pneumonitis are unknown. However, patients with preexisting

lung damage have reduced pulmonary reserve and therefore have a greater

likelihood of severe morbidity should this complication occur (47).

Pneumonitis due to MTX can occur at any time during a course of therapy and

at any dosage. Review of a radiograph obtained within 1 year prior to the

initia tion of MTX therapy is recommended to determine if preexisting lung

disease is present and to provide a baseline for future comparison (42,48).

If evidence of significant lung disease is present, therapy with MTX should

be reconsidered. Monitoring consists of assessing symptoms of pneumonitis,

such as cough, dyspnea on exertion, or shortness of breath, at each followup

visit.

Common but less serious toxicities of MTX include mucositis, mild alopecia,

and GI disturbances, which may be caused by folate depletion (42). These

toxicities are often treated or prevented with the use of folate

supplementation, which should be considered in all patients taking MTX.

Folic acid at a dosage of 1 mg per day or 7 mg once a week is less expensive

and less complicated than the use of folinic acid. Neither low-dose folate

(1 mg per day) nor folinic acid (<=5 mg per week) interferes with the

beneficial effect of MTX (49,50).

Because of the teratogenic potential of MTX, pregnancy should be avoided if

either partner is receiving the drug. Male patients should wait a minimum of

3 months after discontinuation of therapy. Female patients should wait at

least 1 ovulatory cycle after discontinuation of MTX therapy before

attempting conception (51,52).

Recent case reports suggest a possible association between MTX and lymphoma

(53-55). However, a large retrospective study of 16,263 patients with RA

showed no increased risk (56). In that study, only 12 of 39 patients who

developed lymphoma were treated with MTX, and of those, there was no

relationship with cumulative dose or duration of treatment (56). More

studies are required; nevertheless, patients should be advised to report any

lymph node swelling, and the lymph nodes should be routinely examined by the

treating physician.

----- Original Message -----

From: <ednettieolson@...>

< egroups>

Sent: Thursday, November 30, 2000 3:36 PM

Subject: [ ] Fwd: MTX Question

> In a message dated 11/29/00 4:39:51 PM Central Standard Time,

Ednettieolson

> writes:

>

> I am sending this message again because nobody has replied and am still

> wondering if anybody has any feedback regarding this message. Thanks

>

> Jeannette

>

>

> PLEASE READ

>

> << just got back my lab results from yesterday and my liver enzymes are

> elevated again. However, they think it is because I injected MTX on

Sunday

> and took a lab test on Monday......that was really stupid of me but I

forgot.

> I have to repeat the test on Friday. My real question, however is,

normal

> count is 30, mine is 60 something, but when they are looking at

dangerously

> toxic, they are talking about 900-1000. Why are they even giving any

thought

> to such a small elevation when I am so far from the dangerous zone it is

> almost funny? They would even consider taking me off MTX at a consistent

> level of near 60 or above. Any thoughts on the matter?

>

> Jeannette >>

>

>

>

>

[Guest guest]

Jeannete:

I was floored and blown away by the HYPOTEHETICAL and possible reactions to

MTX, and yeah, they are factual, BUT, please do NOT be scared of them, and

afraid to do the MTX as your M..D prescribes. It's a highly, highly, highly

manageable medication.

Jon

----- Original Message -----

From: a <aA@...>

< egroups>

Sent: Thursday, November 30, 2000 4:47 PM

Subject: Re: [ ] Fwd: MTX Question

> Jeanette,

> I took this out of the American College of Rheumatology guidelines for

> monitoring drug therapy:

>

> Methotrexate (MTX). The most serious toxicities of MTX include hepatic

> fibrosis (rare) and cirrhosis (rare), pneumonitis (uncommon), and

> myelosuppression. Independent risk factors for the development of serious

> liver disease (biopsy-proven cirrhosis or clinically evident liver disease

> such as ascites, esophageal varices, hepatic encephalopathy, etc.) in

> patients with RA include age and duration of therapy, as identified in a

> recent case-control study (41). Other potential risk factors for hepatic

> toxicity that have been suggested but were not identified in that small RA

> cohort study include obesity, diabetes, alcohol intake, and prior history

of

> hepatitis B or C (41,42).

>

> Prevention of hepatic fibrosis and cirrhosis includes the avoidance of MTX

> in patients with liver disease or another important risk factor. In

patients

> with suspected liver disease, a pretreatment liver biopsy should be

> obtained. Prevention also includes advising the patient against alcohol

> consumption while taking MTX. Patients should report symptoms of jaundice

or

> dark urine.

>

> Routine surveillance liver biopsies are not recommended for RA patients

> receiving MTX in the recommended doses (43). Liver biopsy is not a

> cost-effective means of monitoring, at least for the first 10 years of

> therapy in patients with no abnormal ities identified on liver function

> tests (44). Liver bi opsy is recommended for patients with liver function

> abnormalities that persist during treatment with, or following

> discontinuation of, MTX (43).

>

> Risk factors for myelosuppression include the use of antifolate agents

such

> as trimethoprim, the presence of folate deficiency, and renal

insufficiency

> (42). Severe myelosuppression is an uncommon complication of low-dose

(5-20

> mg/week) MTX therapy (42). The rationale for monitoring is to decrease the

> incidence and severity of severe myelosuppression and its complications,

> such as sepsis, severe anemia, and bleeding. The baseline evaluation

> consists of a complete blood cell count (CBC) with differential cell

count.

> Monitoring consists of a CBC and platelet count performed every 4-8 weeks.

> Mean corpuscular volume >100 may indicate folate deficiency and predict

> myelosuppression (45). Because the kidneys are the primary route of

> excretion of MTX, renal insufficiency may lead to myelosuppressive levels

of

> the drug. Routine monitoring of renal function every 4-8 weeks is

therefore

> recommended (46).

>

> Pneumonitis is an uncommon complication of long-term MTX therapy, with a

> frequency on the order of 2-6% (42). Precise risk factors for the

> development of pneumonitis are unknown. However, patients with preexisting

> lung damage have reduced pulmonary reserve and therefore have a greater

> likelihood of severe morbidity should this complication occur (47).

> Pneumonitis due to MTX can occur at any time during a course of therapy

and

> at any dosage. Review of a radiograph obtained within 1 year prior to the

> initia tion of MTX therapy is recommended to determine if preexisting lung

> disease is present and to provide a baseline for future comparison

(42,48).

> If evidence of significant lung disease is present, therapy with MTX

should

> be reconsidered. Monitoring consists of assessing symptoms of pneumonitis,

> such as cough, dyspnea on exertion, or shortness of breath, at each

followup

> visit.

>

> Common but less serious toxicities of MTX include mucositis, mild

alopecia,

> and GI disturbances, which may be caused by folate depletion (42). These

> toxicities are often treated or prevented with the use of folate

> supplementation, which should be considered in all patients taking MTX.

> Folic acid at a dosage of 1 mg per day or 7 mg once a week is less

expensive

> and less complicated than the use of folinic acid. Neither low-dose folate

> (1 mg per day) nor folinic acid (<=5 mg per week) interferes with the

> beneficial effect of MTX (49,50).

>

> Because of the teratogenic potential of MTX, pregnancy should be avoided

if

> either partner is receiving the drug. Male patients should wait a minimum

of

> 3 months after discontinuation of therapy. Female patients should wait at

> least 1 ovulatory cycle after discontinuation of MTX therapy before

> attempting conception (51,52).

>

> Recent case reports suggest a possible association between MTX and

lymphoma

> (53-55). However, a large retrospective study of 16,263 patients with RA

> showed no increased risk (56). In that study, only 12 of 39 patients who

> developed lymphoma were treated with MTX, and of those, there was no

> relationship with cumulative dose or duration of treatment (56). More

> studies are required; nevertheless, patients should be advised to report

any

> lymph node swelling, and the lymph nodes should be routinely examined by

the

> treating physician.

>

>

>

> ----- Original Message -----

> From: <ednettieolson@...>

> < egroups>

> Sent: Thursday, November 30, 2000 3:36 PM

> Subject: [ ] Fwd: MTX Question

>

>

> > In a message dated 11/29/00 4:39:51 PM Central Standard Time,

> Ednettieolson

> > writes:

> >

> > I am sending this message again because nobody has replied and am still

> > wondering if anybody has any feedback regarding this message. Thanks

> >

> > Jeannette

> >

> >

> > PLEASE READ

> >

> > << just got back my lab results from yesterday and my liver enzymes are

> > elevated again. However, they think it is because I injected MTX on

> Sunday

> > and took a lab test on Monday......that was really stupid of me but I

> forgot.

> > I have to repeat the test on Friday. My real question, however is,

> normal

> > count is 30, mine is 60 something, but when they are looking at

> dangerously

> > toxic, they are talking about 900-1000. Why are they even giving any

> thought

> > to such a small elevation when I am so far from the dangerous zone it is

> > almost funny? They would even consider taking me off MTX at a

consistent

> > level of near 60 or above. Any thoughts on the matter?

> >

> > Jeannette >>

> >

> >

> >

> >

[Guest guest]

You're welcome Jeanette. I was looking for the actual lab values, but this

was the best I could come up with. Hopefully since it is only slightly

elevated, you can continue with it.

a

----- Original Message -----

From: <ednettieolson@...>

< egroups>

Sent: Thursday, November 30, 2000 6:09 PM

Subject: Re: [ ] Fwd: MTX Question

> Thanks a for the info. I am only on 3mg. or 3/10 injected. It is

such a

> low low dose. I will find out Monday the results of my lab test tomorrow

> because it is being repeated. I certainly hope the level goes down. I am

> not particularly interested in trying out a new drug right now. This

keeps

> happening and we keep going in circles. Up and down and up and down. I

am

> getting dizzy!!! LOL

>

> Jeannette

>

[Guest guest]

Good attitude! I'll send some will your way!

----- Original Message -----

From: <ednettieolson@...>

< egroups>

Sent: Thursday, November 30, 2000 8:08 PM

Subject: Re: [ ] Fwd: MTX Question

> a:

>

> Yes, I want very much to continue with MTX. Since I have returned home

and

> am quite rested, I am feeling quite good again. Why try to fix something

if

> it is not broke? My blood test result tomorrow will be lower; I just know

> it. I am willing them to be lower so therefore they will be lower.

Amen!!

> LOL

>

> Jeannette

[Guest guest]

a, I started at 7.5mg and at present take 15mg...I have been as low as

2(2.5) and as high as 8(2.5).I didnt know about folic acid until I started

having mouth sores ...and on that I have gone tween 1mg aday to up to 6 mg.I

have never had a chest xray b4 starting on any of my meds but I have had

bouts of pleurisy off and on for last few yrs.I know I pull (like sprain) my

chest muscles a lot from a car accident 20 yrs ago so when I get a cold ,

allergies, etc, have to be careful.I have blood work done every 6 weeks for

MTX and truthfully I never see any difference in me on the day I do

MTX...guess I am lucky there? Judy in AZ

[Guest guest]

jesse use to get achey after he took the mtx by injection. he now takes it in

pill form which has been much better for him. don't know if this will help

but wanted to share it with you.

shelly

[Guest guest]

15 mg orally or by injection, a? How much folic acid was recommended and

how often? Is the patient taking any other meds? What are the diagnoses of

the patient?

----- Original Message -----

From: " a " <paula54@...>

< >

Sent: Sunday, April 01, 2001 12:44 PM

Subject: [ ] MTX question

> Hi everyone. I have a question from a new member that hasn't yet

introduced themself concerning MTX. This person just started last week on a

dose of 15mg. It caused the joints to hurt worse for several hours after

taking it. The doctor did NOT give this person folic acid, nor did he

order a chest x-ray in spite of chest pains, prior to beginning on the mtx.

At my suggestion, the doctor was called and folic acid was prescribed, but

the doctor neglected to let this person know that it shouldn't be taken on

MTX day. grrrrrrrrrrrrrrrrrr.....

> I'd really like to do some cursing now, but I'll contain myself. The

normal starting dose for mtx is between 7.5-10 mg. Has anyone here started

on 15mg? The biggest concern is that after the second dose, the joint pain

again increased. Has anyone had this happen? Thanks for any input.

> a

[Guest guest]

a,

I was started on a high dose. I also have never been told not to take my

folic acid on mtx days. I take 2 mgs daily so I take it twice on mtx day.

I've never had my joints hurt any worse on mtx days though. Good luck to our

new member. Tery - FL

[Guest guest]

a,

I was never told not to take my folic acid on methotrexate day. Can you

explain!

I had Hugh probs with nausea for several months after mtrx day but is better.

I have the mouth sores now. Last week was so bad I couldn't stand to eat.

Flare fevers

seemed to make it feel worse. This mega-flare is finally winding down. A

new twisted finger is the result. Also, can you tell me why every doctor

just wants to pour the antidepressants down my throat. They are rx for

sleep. Both the reg doc and the rheumy have tried to get me to take

trazodone in the last few months. The side affects are horrible!!! I would

rather not sleep and hurt than take such a toxic med. Are there better

choices that I might suggest? I take cyclobenzaprine and

sometimes lorazapam for sleep. Pain can out distance those.

Thanks,

[Guest guest]

a: I started out on the 15 mg and have been on it for about six yrs now.

I also started taking folic acid after I noticed some slight hair loss. My

dr. did not say anything about not taking it when taking the mtx. I talked

with a pharmacist friend this weekend and he is going to bring me a paper

regarding mtx and side effects which he found on the computer, (he can't

remember where). When I get it I will post it. I have not had any side

effects except every now and then it makes me throw up the weekends I take

it. It was every weekend for about six months, then it comes every now and

then. Can't figure it out.

Jan

[Guest guest]

I have never had the joint pain with the Methotrexate. I was wondering though

about the Folic Acid. I take mine every day of the week, including the day I

take the Methotrexate. I have a very good rheumatologist. Could this advice have

changed?

Kim Meyers

Purchase AVON online!

http://www.youravon.com/kmeyers/

passcode=Avon

(you will be prompted for this when registering)

740-452-4697

______________________________________________________

Get Paid... With Your Free Email at

http://www.zwallet.com/index.html?user=kmeyers

[Guest guest]

Sorry, I was behind on my email when I asked the question. I see that the

question has already been answered.

Thanks,

Kim M

______________________________________________________

Get Paid... With Your Free Email at

http://www.zwallet.com/index.html?user=kmeyers

[Guest guest]

My cold is pretty much gone except for a nagging cough. I have very little

chest congestion, but one of those " back of the throat tickle " coughs. I know

mtx can cause lung problems. What do I need to watch for with this cough so I

know if it is developing into something I need to see the Dr. about?

Sharon

[Guest guest]

Sharon,

What you need to watch for is a change in the color of your mucus. If you are coughing up stuff and it is either green or yellow, better call. ~Sharon Wertz <sbwertz@...> wrote:

My cold is pretty much gone except for a nagging cough. I have very little chest congestion, but one of those "back of the throat tickle" coughs. I know mtx can cause lung problems. What do I need to watch for with this cough so I know if it is developing into something I need to see the Dr. about?Sharon__________________________________________________

[Guest guest]

If it hurts to take a deep breath, call your doctor.

You don't want bronchitis and/or pneumonia from the cold.

Hugs, Jacy

~Treat your neighbor as you wish to be treated, the rest is commentary.

jacymail@...IM: jacygal - ICQ: 96949087www.geocities.com/mtn_rose

Want a signature like this?

----- Original Message -----

From: Sharon Wertz

Rheumatoid Arthritis

Sent: Wednesday, December 22, 2004 08:20

Subject: mtx question

My cold is pretty much gone except for a nagging cough. I have very little chest congestion, but one of those "back of the throat tickle" coughs. I know mtx can cause lung problems. What do I need to watch for with this cough so I know if it is developing into something I need to see the Dr. about?Sharon

[Guest guest]

,

I have never really skipped my MTX. I know if one is sick, they are

not suppose to take it. Have you thought about taking it Friday night,

and then by Monday morning you should feel better?

I take mine on Saturday night, that gives me a chance to rest up.

Good luck, Tawny

> Is it okay to skip a weeks' dose of methotrexate? Has anyone done

this

> and had adverse reaction(s)? I'm a teacher, school starts this

week,

> and I don't have a minute to spare........much less a day or two to

be

> fighting extreme sleepiness and fatigue.

>

[Guest guest]

I skipped a week during June because I was travelling and needed all

my energy.I did just fine.

- In , " lisake40 " <lisaestill@s...> wrote:

> Is it okay to skip a weeks' dose of methotrexate? Has anyone done

this

> and had adverse reaction(s)? I'm a teacher, school starts this

week,

> and I don't have a minute to spare........much less a day or two to

be

> fighting extreme sleepiness and fatigue.

>