Re: Medication Question...

[Guest guest]

Hi ,

I have been taking MTX for 5 years now. I was told not to take Ibuprofen or

Naproxen. Only Tylenol. I was given Vicodin and never had a problem with it.

I ran out of Tylenol once and decided to take my daughter's Aleve for a headache

and other small pain (I also have fibro) and lo and behold I returned my first

bad liver/blood test. So I quit the Aleve. Tests returned to normal. I also

have IBS, I had a sygmoid colon test this last summer and was told that the IBS

could be a result of the PA or the fibro either one. I always take one of those

stomach acid pills with my MTX. It helps the nausea. I don't usually buy

Prilosec. I only buy OTC like Pepcid AC or generic. I finish it all off with a

piece of chocolate, usually Hershey's. Of course you know by now that everyone

is different and we don't react the same to any of the meds, but I don't know

what

I would have done without the Vicodin for all those 5 years. One reason they

told you not to take it though, is that it is very constipating and if your IBS

is very bad, it could really complicate things. Best of luck with the fatigue,

that is one aspect of these diseases that I have not found an answer for. I

just recently

started sleeping with a C-PAP machine and have been having a really hard time

adjusting to it. I hope that when my sinus problems ease up it will improve my

sleeping enough to give me a little more energy during the day. It is usual for

me to get only 3 or 4 hours sleep a night, and not all at one time. I went to PT

for pain in my lower back one time and could not walk for 2 or 3 days afterward.

Your really sensitive skin could be either disease, but I would lay it to

the fibro. My problem areas at this point in time are both sides of my knees,

my shins and calf muscles. My knees have a discussion between themselves as to

whether they will hold me and let me walk every time I get up out of a chair.

You said it when you said, " Fun, fun! " God bless!

Janet in Ca

[Guest guest]

Hi !

I'm fairly new to PA as well (just dx last fall) but I am also taking MTX and

just upped to 17.5 mg a few days ago and will increase to 20 mg in 2 weeks.

Although being new to the disease and treatment, I also have GERD and was taking

Prilosec OTC due to the PITA of going through the insurance approval for

anything else. My rheumy said that it was fine, although there was so much

breakthrough acid that she got me approved for Nexium and I moved over to it

again last week. I also have prescriptions for Lortab and Hycodan (a codeine

cough syrup) that were written post-dx, and I'm okay to take. Vicodin is just

another name for codeine and tylenol. I take Tylenol for headaches and such and

I don't quite understand why they say no to NSAID painkillers, when I'm taking

Lodine in high doses to help with the inflammation, and under the care of my

rheumy.

I'm interested to hear others responses to this.

[Guest guest]

Hi Ang,

Talk with your Rheumy. I don't know anything about Prilosec, but If

the warnings say no, I wouldn't. Perhaps he can prescribe something

else that might work as well. Also, sometimes the warnings are just

that. 12.5mg is a very small amount, so perhaps your risk of

interaction is not something to worry about. Your Rheumy should know.

Stay Well,

[Guest guest]

Good Morning ,

I think I will send a message over to him and double check. I should

have thought to ask the pharmacy when I picked up the MTX. My brain

has been a little foggy lately : )

Have a great day!

Ang~

[Guest guest]

Hi Janet,

Thanks for the info. I think I'll double check with the pharmacy on

the Prilosec and if it's a problem I'm sure my primary will be

willing to change it to something else. I'm happy to hear that the

Vicodin hasn't been a problem for you. I haven't taken it yet but...

there are some days that are a real challenge just to get up and get

motivated because of the pain. Now I know I can take one if needed. I

was laid off of my job in October right when the symptoms were

getting worse and maybe it was a blessing in disguise. At least I

don't have to get up at the crack of dawn and can take a nap when I

need to. Hoping that I will be feeling better by the time a new job

offer comes along.

I had a colonoscopy this last summer as well. I had been having

increasing problems in that area and there was concern that it was

more than just IBS. Fortunately it wasn't, so I just keep taking the

Bentyl when needed.They never said anything about it being associated

with the Fibro though...hmmm.

I hear ya when you say your knees have a discussion. My knees seem to

be conversing with my hips and back, lol!

Hope you start to get some better sleep soon. Even with the Elavil

at night I still wake up several times and stare at the ceiling while

listening to my husband snore...I don't know how he doesn't wake

himself up... seriously.

Take Care and Thanks again, Ang~

[Guest guest]

,

Thank you for taking the time to answer my questions : ) Do you find that you

feel tired and even a little nausea the next day after taking the MTX? Sounds

like I'm on a pretty low dose compared to some of you and just wondering how

much worse the side effects are for those taking higher doses. I'd like to

think this will help at 12.5mg but want to be prepared for having to increase.

It's only been 2 weeks on this medication but so far I've had no relief and

instead have more pain in more places ....is this typical?

Ang~

[Guest guest]

I've only been on the MTX myself about 10 weeks. I had gotten to a 15 mg

dose, and at my 4 week check last week, my rheumy increased it to 17.5 for

the next 2 weeks due to an increase in pain, and then I'll be moving to 20

mg. Actually, I am tired for a couple days after my weekly dose, and I'm

tired a little longer after an increase. I also have a little bit of nausea

the day after I take my dose. Both of these experiences are not uncommon,

according to my rheumy. As your body adjusts to your dose, it's likely that

it will get better or go away. As my rheumy says, some nausea is okay, but I

m to call if I'm severely nauseated or worse. That would likely mean that I

m not tolerating the MTX and that a change might be in order.

I know you said you've only been on MTX for 2 weeks - give it longer, as it

takes a while to take effect. My rheumy said that it can take 6 weeks to

kick in. I started seeing a difference at about 4 weeks. Where I was in more

pain up until last week, just upping the dose a little has begun to counter

that. The only thing that I don't like about MTX is that I can't do alcohol

Not that I'm a drinker, but I do enjoy a couple glasses of wine from time

to time, and when I play bunco with my bunco group. My rheumy thinks it's

okay to have a drink every now and then, but she says that she would rather

me limit it to one drink every 6 weeks - which I think is the amount of time

it takes for liver cells to turn over....

Good luck!

[Guest guest]

, by all means call the doctor who prescribed the MTX right

away and ask about taking Prilosec or something similar with MTX.

You do not want to aggravate your GERD by totally discontinuing your

treatment! MTX itself causes reflux, so you most likely need to take

something for it. I took Zantac while taking MTX; it was prescribed

by my rheumy when I called to complain of nausea from the MTX. She

explained that the nausea was likely really reflux from the MTX.

Sure enough, taking Zantac the day before and after my MTX dose cured

the relux/nausea.

Just call your doctor's office and ask to speak with his nurse. Tell

her your question and have her call you back with the doctor's

reply. Never hesitate to call the doctor with questions like this -

questions about meds or med combinations, questions about new or

worsening symptoms, questions about flares, etc. It is no good to

wait until your next appointment. Things can get out of hand very

quickly. Best to call right away with ANY concern.

Your pharmacist is also a very good source of info about which meds

can be taken together. However, I like to go directly to my doctor

with these questions.

best,

sherry z

[Guest guest]

Ang, yes it's common for it to take a while for MTX to build up in your

system and begin to show results. It can take 2-3 months for

significant improvement, although many people get relief more quickly.

The fatigue and nausea are normal as well. Either Benadryl or a reflux

med taken the day before and after the MTX helps many people. The

Benadryl, though, might increase the fatigue and drowsiness. I took

Zantac OTC and it stopped my nausea and it didn't get get any worse as

I increased the dose. Best to ask your own doctor what to take - call

him, don't wait for the next appointment - why suffer needlessly?

The only thing that helped my fatigue was sleep and time. I was going

to bed at 7 or 8 o'clock many days, and taking as much nap as I could

whenever I could. Some Saturdays I would literally sleep all

afternoon, have dinner and go right to bed for the night. Over time,

though, the fatigue and drowsiness decreased on its own for me. I

think that as the disease itself got under control, I got my energy

back. Whenever I increased the dose, I had a short out of overwhelming

fatigue the first week or two. Then I would get back to normal.

best regards,

sherry z

[Guest guest]

I was disappointed about the " No Alcohol " factor as well, kind of felt like, one

more thing in my life I have no control over. I don't drink often but do enjoy

the occasional margaritas on a girl's night out. My rheumy says one drink a

month and sip it slowly...

Ang

[Guest guest]

Hi;

It's best to check with your doc, but I can say that my Rheum

prescribed Prilosec and Zantac with my injectable methotrexate.

Good luck;

Jill

[Guest guest]

Hi ,

I am glad I could help. One other thing I would like to add though,

if your husband snores as bad as you say, please have him go have

a sleep study done for sleep apnea. It is one of the symptoms and

sleep apnea can cause heart problems as well as many other problems

if not taken care of.

Hope your health is getting better.

God bless,

Janet in Ca

[Guest guest]

Lexicomp (the hospital's pharmacy computer where I work) has the

following to say about interactions between GE reflux medications

such as Prevacid, Omeprazole, Nexium, etc and Methotrexate:

" The reflux medications above can increase the length of time it

takes your body to clear the Methotrexate, Therefore the risk of

having side effects of Methotrexate can be increased. Formerly

Methotrexate-stable patients may develop elevation of liver enzymes

or changes in their CBC such as thrombocytopenia when a reflux

medication such as the above is added to their regimen. THE RISK IS

MUCH LESS WHEN THE LOWER (ANTIRHEUMATIC) DOSES OF METHOTREXATE ARE

TAKEN. "

Lexicomp classifies the interaction risk between the two as class C

which is considered a moderate risk.

Looking up the interactions between NSAID's (such as Ibuprofen,

Naproxen, etc) provided the following information:

" NSAID's can increase the length of time it takes Methotrexate to

clear your system. This seems to occur because renal perfusion is

decreased thus limiting the kidney's ability to excrete the drugs.

As soon as one day after combining an NSAID with Methotrexate,

patients have exhibited elevated renal function laboratory values

and there have also been reports of acute renal failure. The risks

and benefits should be weighed; if it is necessary to take NSAID's

with Methotrexate, kidney lab values especially the serum creatinine

should be closely monitored. Renal complications have been

attributed 38-40 % of the time with ibuprofen " ***note to all: this

was the highest incidence of reports, there were reports with others

such as naproxen and indocin but they were less.......between 15-30%

*****; " there seem to be fewer side effects associated when

combining COX-2 NSAID's with Methotrexate. THE RISKS ARE MUCH LESS

WITH THE LOWER (ANTIRHEUMATIC) DOSES OF METHOTREXATE. "

Lexicomp characterizes the interaction between NSAID's and

Methotrexate as class D or severe.

[Guest guest]

Thank you for all the information. It makes me feel better taking

the Prilosec and not worry about it anymore : ) It sure helps with

the acid but I still get nausea for several days after taking the

MTX..yuck

[Guest guest]

,

I have been on MTX 7 weeks and I started out the same as you. The

nausea has gotten better, I still get that way sometimes but not as

bad. My dose is a little higher 20mg. I take my dose late on my

Friday which is actually Thursday, got to love shift work. It seems

to help with the nausea, laying still helps lol. I am more tired now

than with the first doses but it gets better after a couple of days

which is why I take it at the end of the week, it is easier to nap on

my weekends. It has almost cleared my skin totally but the pain is

much worse now than before, and yes more places. I am not sure why

but I will ask my rheumy when I finally get to see him, there is more

demand than supply in the Atlanta area. I am not sure if this is

typical but I am glad I am not the only one.