Methotrexate And Folic Acid Dose Recommendations
Because of its effectiveness and established safety profile, most patients who have RA take methotrexate at some point for treatment, usually by mouth. The typical dose starts at about 5 mg to 10 mg per week. However, in cases where high-dose oral methotrexate treatment is needed, the dose can be increased to about 25 mg per week, or even higher if necessary.
For patients in whom treatment based side effects become an issue, the proper dose of methotrexate can also be given as an injection under the skin. Sometimes, simply switching the dose delivery method from an oral methotrexate tablet to a methotrexate injection is enough to help. Splitting the dose into two daily doses instead of one single dose may help as well, or you can ask your doctor about anti-nausea medications.
Also, as the University of Michigan reports that methotrexate stops the growth of rapidly dividing cells, such as embryonic, fetal, and early placenta cells. No dose of methotrexate is safe during pregnancy. In fact, doctors often use this drug as a treatment for ectopic pregnancy, a potentially dangerous condition which involves a fertilized egg attaching itself to the fallopian tubes versus the uterus, essentially terminating the fetus.
As far as folic acid is concerned, doses in the range of 5 to 10 mg per week have been shown to reduce methotrexate toxicity. Folinic acid, a healthy form of folate which doesnt require any type of enzyme conversion, can also be found in some natural foods.
Who Needs Biologics For Ra
Methotrexate is usually the first drug that a person will try after getting diagnosed. Typically, biologics are reserved as the next step.
When might a rheumatologist turn to biologic therapy? Here are few reasons.
- Treatment with methotrexate alone isn’t working well enough. This is the most common reason for taking biologics. Your doctor will regularly examine your joints and test your blood for signs of RA. If methotrexate isn’t helping enough, he or she might add a biologic. Studies suggest that the combination of drugs is more powerful than either on their own.
- You have side effects from methotrexate. Some people don’t tolerate methotrexate well. Some health conditions — like liver problems — rule out the use of methotrexate. In these cases, a rheumatologist might move directly to a biologic.
- You are pregnant or want to become pregnant. Women with RA should talk to their doctors if they’re considering pregnancy. Evidence suggests that some — not all — biologics might be safer for pregnant women than methotrexate. However, biologics can pose risks as well.
Ra And Methotrexate: Does Methotrexate Reduce Inflammation
If you have rheumatoid arthritis , youre probably very familiar with the pain and joint swelling that this particular type of arthritis can cause. If youve had it for some time, you may even be experiencing the joint deformities that can occur as RA progresses. As you know, any joint deformity can take a significant toll on your joint function as well as your overall quality of life.
RA usually attacks the joints of the hands and feet first, which means even simple activities like tying a shoe, brushing your teeth, combing your hair, or getting dressed in the morning can become painful enterprises. Leisurely pursuits like gardening or taking long walks may have lost their appeal as well, largely as a result of the pain and inflammation these joint-based movements can trigger.
Although there is currently no cure for RA, there are medications that a doctor can prescribe to slow the progression of joint destruction and deterioration. One of the most popular and also most effective of these is a folate analog called methotrexate . Its a treatment option with one of the longest and most well-established safety profiles of any rheumatoid arthritis drug on the market.
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Can I Get Pregnant Or Breastfeed While Taking Methotrexate
Absolutely not. Methotrexate is toxic to a fetus and can cause congenital mutations, warns Dr. Feldman. Women should wait 90 days after stopping methotrexate to get pregnant. Men, too, should wait 90 days before trying to conceive because methotrexate may affect sperm . Do not breastfeed until the drug is completely out of your system. For more information about managing pregnancy with rheumatoid arthritis, check out our family planning patient guidelines.
Why Is This Medication Prescribed
Methotrexate is used to treat severe psoriasis that cannot be controlled by other treatments. Methotrexate is also used along with rest, physical therapy, and sometimes other medications to treat severe active rheumatoid arthritis that cannot be controlled by certain other medications. Methotrexate is also used to treat certain types of cancer including cancers that begin in the tissues that form around a fertilized egg in the uterus, breast cancer, lung cancer, certain cancers of the head and neck, certain types of lymphoma, and leukemia . Methotrexate is in a class of medications called antimetabolites. Methotrexate treats cancer by slowing the growth of cancer cells. Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming. Methotrexate may treat rheumatoid arthritis by decreasing the activity of the immune system.
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Biologics: Weighing The Benefits And Risks
When you first get diagnosed with RA, you might have doubts about treatment. If you’re only having mild joint pain right now, are the risks of biologics and other DMARDs worth it? Can’t you wait and see how it goes?
But a wait-and-see approach can have serious consequences.
“We know what will happen if we don’t treat someone with rheumatoid arthritis,” says Bingham. “They will get worse.” In some cases, the damage may become so severe that even surgery won’t help.
Matteson compares RA to other chronic conditions like diabetes and high blood pressure. At first, they might not seem like a problem. But untreated, they can lead to serious disease and even early death.
While the side effects from biologics might look scary, Bingham points out that the risks of untreated RA go far beyond achy joints. They include debilitating pain, heart problems, infections, and cancer.
We still don’t have a cure for RA. But biologics offer hope to people who once had no good options.
“Biologics and other DMARDs are more successful than anything we could have imagined 15 years ago,” Bingham tells WebMD. “These treatments have reshaped the face of the disease.”
Clifton Bingham, MD, associate professor of medicine, Johns Hopkins University associate director, Johns Hopkins Arthritis Center, Baltimore.
Eric L. Matteson, MD, chair, department of rheumatology, Mayo Clinic, Rochester, Minn.
Agency for Healthcare Research.
Manage Anemia In Rheumatoid Arthritis Patients
Anemia is the decrease of red blood cells, which are made up of hemoglobin rich in iron and necessary to transport oxygen from the lungs to the rest of the body. In some cases of anemia, patients have sufficient red blood cell count, but the cells lack the sufficient hemoglobin.
Symptoms of anemia include fatigue, weakness, headache, poor concentration, shortness of breath and rapid heartbeat.
Dr. Robert W. Lightfoot, a professor of internal medicine in the division of rheumatology at the University of Kentucky in Lexington, explained why anemia is found in rheumatoid arthritis patients, stating, The most common cause of anemia in RA patients is anemia of chronic illness. Anemia tends to occur in most chronic illnesses, which includes RA.
It is not fully understood why anemia of chronic disease occurs, but it is believed that inflammation commonly found in rheumatoid arthritis contributes to anemia. Inflamed tissues release proteins that affect the bodys ability to use iron and produce red blood cells.
Furthermore, common medications used to treat rheumatoid arthritis can also contribute to anemia by causing chronic irritation and bleeding of the stomach lining.
Managing anemia in rheumatoid arthritis patients is possible by injecting erythropoietin. Dr. Lightfoot explained, It stimulates the bone marrow to produce iron and helps increase the number of red blood cells, but the drug is expensive and the effect is minimal.
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How Do I Take Methotrexate
Methotrexate is typically taken once a week for RA. It is available as both a tablet you take by mouth and as an injection. With the tablets, most people start with one 7.5 mg dose once a week, but your provider may recommend up to a maximum dose of 25 mg once a week depending on how you respond. To reduce the risk of side effects, they may ask you to split the dose into smaller doses that you take throughout the day of the week youre scheduled to take your medication.
If youre using the injection, thats once a week, too. Youll inject the medication either into your muscle or right under your skin, depending on what your provider recommends. The injection is available as either an auto-injector or as a vial. You can find instructions on how to use Rasuvo from the manufacturer here.
In Combination With Other Drugs
Methotrexate is often used with other DMARDs or other medications for pain and inflammation. It has shown to be a great partner. Certain combinations of two or more DMARDsalways with methotrexate as one componentwork better than methotrexate alone. Keep this in mind if you dont respond to methotrexate by itself. You can talk to your doctor about a combination therapy.
Besides the fact that it works for many people, doctors like to use methotrexate because serious side effects are uncommon. But like all medications, methotrexate can cause side effects. Common side effects can include:
- upset stomach
- thinning hair
You may be able to lower your risk of these side effects if you take a folic acid supplement. Ask your doctor if this supplement is right for you.
In rare cases, methotrexate can cause serious side effects. These can include:
- low white blood cell levels
- low red blood cell levels
- low platelet levels
- lung disease
During treatment with methotrexate, your doctor may check your blood cell counts, liver function, and lung function. If you have serious side effects, your doctor may stop your treatment.
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Biologic Therapies And Mtx
The next major advance in RA therapy was the development of targeted biological therapies. By the mid-1990s, there was great enthusiasm for the use of drugs that blocked tumor necrosis factor . As monotherapy, anti-TNF treatment was extremely effective. Studies comparing MTX to anti-TNF therapy were initiated in the late 1990s. The Early Rheumatoid Arthritis study was the first to directly compare an anti-TNF therapy to MTX . In this study of early RA, 632 patients were randomized to receive either etanercept administered 25 mg twice a week as a subcutaneous injection, or oral MTX weekly up to 20 mg per week. During the first 6 months of the study, etanercept achieved a faster and better clinical response than MTX. This was not unexpected because monotherapy studies with etanercept reported clinical responses as soon as 2 weeks after drug initiation. What was surprising was that after 6 months there was no significant clinical difference observed between the patients receiving MTX versus those receiving the anti-TNF therapy. However, etanercept had a much better effect on radiographic progression than that observed with MTX.
The role of MTX in the treatment of RA has now been well established. It has become the standard of care and first-line therapy for patients who have RA. In patients who have an incomplete response on MTX, other drugs are combined with MTX to improve clinical response. MTX has changed the lives of patients with RA!
Before Taking This Medicine
You should not use methotrexate if you are allergic to it. You may not be able to take this medicine if you have:
alcoholism, cirrhosis, or chronic liver disease
low blood cell counts
a weak immune system or bone marrow disorder or
if you are pregnant or breastfeeding.
Methotrexate is sometimes used to treat cancer in people who have a condition listed above. Your doctor will decide if this treatment is right for you.
To make sure this medicine is safe for you, tell your doctor if you have ever had:
liver problems, especially fluid in your stomach
Tell your doctor if you are pregnant or plan to become pregnant. Methotrexate may cause injury or death to an unborn baby and should not be used during pregnancy to treat arthritis or psoriasis. However, methotrexate is sometimes used to treat cancer during pregnancy.
Methotrexate can harm an unborn baby if the mother or the father is using this medicine.
If you are a woman, you may need to have a negative pregnancy test before starting this treatment. Use effective birth control to prevent pregnancy while you are using methotrexate and for at least 6 months after your last dose.
If you are a man, use effective birth control if your sex partner is able to get pregnant. Keep using birth control for at least 3 months after your last dose.
Tell your doctor right away if a pregnancy occurs while either the mother or the father is using methotrexate.
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What Other Information Should I Know
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Methotrexate Initially Not A Drug For Ra
Although methotrexate has been proven as a great treatment option for RA, that isnt why this drug was created. In fact, methotrexate was initially introduced in the 1940s as a cancer treatment drug. Doctors prescribed it to provide relief for patients with different types of cancers, such as non-hodgkin lymphoma and breast cancer.
Methotrexate works by interfering with cancer cells ability to absorb and use folate. Folate is a form of vitamin B thats necessary for cell survival, but methotrexate has the effect of partially inhibiting dihydrofolate reductase within the cancerous cells.
Then in the 1970s, the Food and Drug Administration approved methotrexate for psoriasis according to the National Psoriasis Foundation. Psoriasis afflicts roughly 7.5 million people and involves itchy, inflamed skin. Fortunately for its sufferers, numerous studies have backed using methotrexate as a suitable psoriasis treatment option. For example, one 26-year retrospective study found that low-dose MTX is an effective therapy for severe forms of psoriasis.
Not only is methotrexate beneficial for people with psoriasis, its also helpful for those diagnosed with psoriatic arthritis. This type of arthritis is different than RA in that psoriasis generally precedes issues in the joints. In some cases though, no psoriasis-type symptoms exist at all.
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What Is Rheumatoid Arthritis
In rheumatoid arthritis , your immune system recognizes your joints as foreign to your body and attacks the fluid inside them, called the synovium. This can affect people in different ways, depending on how severe the disease has gotten. RA can cause:
Inflammation, redness, and swelling
There is no cure for RA, but certain medications like can help slow down how quickly the disease worsens.
What Is Seronegative Inammatory Arthritis And How Effective Is Methotrexate In Treating It
Q) Ive recently been diagnosed with seronegative inammatory arthritis and have been put on methotrexate. Could you please tell me what seronegative inammatory arthritis is, and what is the long-term prognosis? Im 65 years of age and healthy, apart from this problem. How different is it from other forms of arthritis? How successful is methotrexate?
Vic Sibson, Broadstairs, Kent 2008
A) Arthritis can be generally divided into seropositive and seronegative this refers to the presence in the blood of an antibody called rheumatoid factor. About 70 per cent of people with rheumatoid arthritis are seropositive. So seronegative rheumatoid arthritis occurs and this may be the diagnosis in your case. I say may be because theres a group of disorders generally called seronegative spondyloarthropathy and these include ankylosing spondylitis, psoriatic arthritis and reactive arthritis. My guess is that you havent got one of these conditions. Seronegative rheumatoid arthritis can be just the same as seropositive rheumatoid arthritis although on the whole it has a better outlook. If you dont feel the doctor has the time to explain things to you, try asking to see another member of the rheumatology team a nurse, physiotherapist or occupational therapist, or all three!
This answer was provided by Dr Philip Helliwell in 2008, and was correct at the time of publication.
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What Are Standard Dosages For Methotrexate
Most people with RA begin with a 7.5 milligram dose of methotrexate tablets taken once a week. Over time, if that is not enough to help, your doctor will increase your dosage, perhaps to 20 milligram.
It is extremely important to understand that the drug is taken once weekly, not once each day, Tenpas says, noting that mistaking this dosage has led to toxicity in some patients.
Methotrexate can also be given by injection. People can give the methotrexate shot to themselves using an auto-injector. Taking the drug this way allows more of it to get into your system without increasing unwanted side effects.
Starting dosages for the injected drug are generally similar as for the oral version.
Cautions With Other Medicines
There are many medicines that affect the way methotrexate works.
Children taking methotrexate must not have a “live” flu vaccine . Adults are given an “inactivated” flu vaccine and this usually does not cause problems with methotrexate.
Tell your doctor if you’re taking these medicines before you start methotrexate:
- non-steroidal anti-inflammatories like ibuprofen, or cough and cold remedies containing NSAIDs
- co-trimoxazole,trimethoprimor other antibiotics for bacterial infections
- medicines that make you pee more , such asindapamide andbendroflumethiazide
- epilepsy medicines such asphenytoinorlevetiracetam
- theophylline, a medicine used to treat asthma
- medicines used to treat indigestion, such asomeprazole
- folic acid or vitamin supplements that contain folic acid this is because your doctor may prescribe folic acid to take with your methotrexate
These are not all the medicines that may affect methotrexate.
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