Its Normal To Have Questions About Taking Methotrexate Is It Really A Cancer Drug Can You Drink Alcohol Get Answers Here
Check any message board in a rheumatoid arthritis group on social media and theres one topic that pops up in posts constantly. It usually reads like this: My doctor prescribed me methotrexate and Im terrified. Should I take it? Then a stream of about 200 comments follows, about mouth sores and hair falling out and diarrhea, and it scares the beejesus out of you even more.
Taking any new medicine can be intimidating, especially one you might have to take for the rest of your life. Often, our doctors prescribe pills, injections, or infusions weve never heard of, and were either too shy or shocked to ask important questions about what the heck they are and what they might do to our bodies.
For anyone with RA, initiation into the MTX club seems particularly harrowing. I admit that I waited weeks to start taking it when I first got diagnosed with RA. But the truth is, it really wasnt necessary to freak myself out. I wish I had known that but I, too, did not ask for or look for good information to ease my anxiety.
I admit that I waited weeks to start taking it when I first got diagnosed with RA. But the truth is, it really wasnt necessary to freak myself out.
Methotrexate May Interact With Other Medications
Methotrexate self-injectable solution can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.
To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs youre taking. To find out how this drug might interact with something else youre taking, talk to your doctor or pharmacist.
Examples of drugs that can cause interactions with methotrexate are listed below.
Methotrexate And Ra Treatment
RA is an autoimmune disease, which means that it is caused by an abnormal immune response. What does this mean? In a healthy immune system, special cells seek out and destroy harmful germs to prevent infection and disease. But in an autoimmune disease, those same cells attack healthy tissue instead, destroying it in the process.
In RA specifically, immune cells attack the tissues inside the joints. Normally, these tissues are there to help the joints function properly and to protect the joint surfaces from painful and destructive friction. Thats why RA has the clinical manifestations it does when these joint tissues are damaged or destroyed.
Disease-modifying antirheumatic drugs like methotrexate work by targeting the abnormal immune response that causes joint tissue destruction. Among the DMARDs, methotrexate is the one treatment drug which has been around the longest.
One of the primary benefits of methotrexate is that it can be combined with other drugs, including other DMARDs, to provide symptom relief when methotrexate alone isnt enough. It can also be combined with biologics, which are drugs designed to target specific aspects of the abnormal immune response that cause joint destruction to create a more effective treatment regimen.
As a result, doctors can prescribe this drug to patients in a way that allows them to receive a truly customized and personalized treatment plan based specifically on their individual needs , which is the best form of treatment there is.
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How Do I Do The Injection
Why Do I Have To Take Folic Acid Should I Take It On The Same Day As Mtx Or Not
Folic acid is a type of B vitamin. Its currently recommended that all patients on low-dose methotrexate take folic acid to help offset potential side effects that come with taking methotrexate. The most concerning side effect would be any suppression of bone marrow cells, which produce new blood cells.
Some doctors advise that patients skip folic acid the same day or days you take methotrexate, believing it lessens the effects of methotrexate. Other doctors, including Dr. Feldman, think it doesnt matter. I personally dont have a problem with my patients taking folic acid every day, he says. I havent seen any good studies to show that it negates the effects of methotrexate. Though I find that some patients find it hard to remember to exclude it on certain days.
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Will Methotrexate Mess Up My Immune System
Methotrexate tinkers with the immune system, but it doesnt suppress it in the same way that some other RA drugs do. So taking methotrexate is rarely associated with increased infection risk unless youre also taking other medications at the same time, such as glucocorticoids, immunosuppressive disease-modifying antirheumatic drugs , or biologics. There may be slight increase in infection, Dr. Feldman notes, but were talking about a half a cold per year per person.
Doctors may recommend patients with severe infections take a break from methotrexate while they recover, but you can still take it while you have minor infections like an upper respiratory virus or urinary tract infection. However, you should let your rheumatologist know if you have an infection that doesnt get better after a few days, to make sure it doesnt develop into something more serious.
Is Methotrexate A Cancer Drug Why Am I Taking A Pill For Cancer
The distinction between using methotrexate to treat cancer and to treat rheumatoid arthritis is important. Technically speaking, methotrexate is a cancer drug and its used to treat different kinds of cancer, including breast cancer. Thats because methotrexate attacks fast-dividing cells, which include cancer cells.
But cancer patients take much higher doses of methotrexate for shorter amounts of time than RA patients, says Dr. Feldman. The doses for cancer therapy are actually almost 50 times higher. For RA patients, methotrexate is used in a completely different way.
At these extremely lower doses, methotrexate has a completely different effect on the body. It is a disease-modifying agent that reduces inflammation. I like to say its the difference between swimming in a pool and drinking a glass of water. Both use water but have a different effect, says Dr. Feldman.
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Methotrexates Possible Side Effects
So what are methotrexates possible side effects? The most common negative effects associated with this particular medication are gastrointestinal symptoms like nausea, vomiting, and ulcers . Some doctors have also reported that patients have developed mouth sores, fatigue, headache, dizziness, or shortness of breath. It may cause hair loss as well.
Though the risk is small, methotrexate therapy can also cause liver damage, so patients who take the medication on a regular basis as a form of RA treatment need to have routine blood tests taken by their doctor to make sure their liver remains healthy. To reduce any further risk of liver damage, patients taking methotrexate should also avoid drinking alcohol. If damage is suspected, your doctor may request a liver biopsy.
In a few rare cases, methotrexate has been known to cause lung inflammation or a decrease in white blood cells or platelets, a condition which can lead to bone marrow suppression. According to University of Pittsburg Medical Center , bone marrow suppression occurs when the marrow doesnt make the normal amount of blood cells.
Ultimately, this can instigate other medical conditions such as anemia, leukopenia, neutropenia, or thrombocytopenia says the UPMC. By limiting the likelihood of bone marrow suppression then, youre also reducing your risks of these other conditions. Fortunately, routine blood testing by your doctor can identify these potential issues so they can be stopped before they progress.
Psoriatic Disease: Clinical And Pharmacoeconomic Aspects
There are very few data concerning SC MTX treatment in psoriatic disease. Moreover, no study has compared SC and oral routes of administration for the management of psoriasis.
Based on the results of a systematic review of MTX in psoriasis and expert opinion, the initiation of treatment by oral administration is generally preferred. If the efficacy is not sufficient or gastrointestinal tolerance is poor, the use of SC/intramuscular route at the same dosage is suggested. However, if there is a risk of poor compliance, it has been proposed that treatment can be initiated parenterally.
Nevertheless, it is probable that many dermatologists are not yet familiar with the SC route when prescribing MTX.
A survey examining practice preferences of MTX use among Canadian dermatologists and rheumatologists showed that the latter were more likely than dermatologists to switch to a parenteral route and to use SC injections. The majority of dermatologists and rheumatologists in everyday practice reported the prescription of oral MTX as the initial treatment. Fewer dermatologists declared to perform a subsequent switch to parenteral MTX . SC route was chosen as the modality of MTX parental administration by 63% of dermatologists and 98% of rheumatologists.
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Is Methotrexate Right For You
The reality is that methotrexate can be a very effective treatment option in helping patients reduce the joint damage associated with RA. This, in turn, can reduce pain, improve mobility and function, and increase a patients overall quality of life. Thus, many doctors prescribe the typical dose of methotrexate for RA treatment.
Despite its long history of safety, many patients still worry about the drugs negative side effects. This is likely because theyve heard about the side effects methotrexate can cause in patients with breast cancer or other types of cancer commonly treated by methotrexate.
It is important to keep in mind that these particular patients take very, very high doses of methotrexate much higher than the doses used in RA treatment. Not surprisingly then, their side effects tend to be more prevalent and more severe due to the patient being exposed to higher levels of the drug.
To find out if methotrexate is a good choice for helping you manage your RA, talk to your doctor about whether its the right treatment for you individually. If youre prescribed methotrexate, be sure to take it exactly as the doctor prescribes for maximum treatment benefits with the lowest risk of side effects. If youre unsure what that correct dose is or how to take it, your doctor or pharmacist can answer those types of questions for you.
Bioavailability And Pharmacokinetics Of Sc Mtx Formulation
Orally administered MTX has been found to have a saturable intestinal absorption and nonlinear pharmacokinetics., These features may have a relevant impact on drug bioavailability and clinical efficacy.
The current evidence shows that parenterally administered MTX results in rapid and complete absorption, higher serum levels, and less variable exposure than oral dosing. No statistically significant differences of the relative bioavailability between SC and intramuscular administration of MTX were detected in six patients with RA. Similarly, the equivalence of SC and intramuscular dosing was previously demonstrated in five patients with RA, treated with MTX 12.525 mg weekly, who received two treatments at the same dose, 1 week apart, given in a randomly assigned order. In particular, there were no differences in pharmacokinetic parameters for intramuscular and SC injections. Given the bioequivalence of the two formulations, the SC route has, therefore, been considered a more convenient and less painful way of administering low-dose MTX.
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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
- Bone damage
- Joint deformities
There is no cure for RA, but certain medications like can help slow down how quickly the disease worsens.
Glucocorticoid Use In Rheumatoid Arthritis
The 2015 guidelines recommended low-dose, short-term glucocorticoid use in patients not at target despite treatment with DMARD or biological therapies.2 The 2021 update states that use of long-term glucocorticoids leads to undesirable patient outcomes including osteoporosis, increased risk for infection, and cardiovascular diseases.1 The updated recommendations for glucocorticoid use are provided in Table III.
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Why Inject Methotrexate For Ra
There are 3 main reasons that methotrexate injections may be used instead of oral tablets.
A Strong Dislike For Needles And Injections
There are two things you should know about me: I am a control freak and I hate needles. So, you can guess, when I found out I would have to, routinely, go through blood draws, IVs, and a host of injectable medications for my rheumatoid arthritis, I was horrified.
Adding insult to injury most of these would have to be done by other people.
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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.
What Happens If You Take Methotrexate And Get A Vaccine
Because methotrexate prevents the immune system from having as robust a response to invaders, it can weaken the bodys response to vaccines. This means someone who is on methotrexate and gets a vaccine may not get as much protection from it as someone who is not taking methotrexate.
This was studied a few years ago in a randomized controlled trial of about 300 rheumatoid arthritis patients in South Korea after they received the flu vaccine. Half of the patients were randomized to continue taking their methotrexate as usual after getting the vaccine. The other half stopped taking methotrexate for two weeks after getting the flu vaccine. When researchers measured levels of the patients antibodies to flu virus strains four weeks later, they found that more patients in the group who stopped methotrexate had satisfactory levels of antibodies to at least two of the four flu virus strains in the vaccine than those in the group who kept taking methotrexate .
Antibodies recognize germs and foreign invaders in order to help the body get rid of them before they infect or harm you.
This data has led some rheumatologists to advise patients to skip methotrexate for two weeks after getting a flu vaccine in order to increase the immune systems response to the flu vaccine.
And some rheumatologists are extrapolating data from studies like this to recommend that patients also pause methotrexate after getting a COVID-19 vaccine.
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Getting An Intramuscular Injection For The First Time
The first time I went for this injection, the technician walked me through the medication, possible side effects, and the whole shebang. He then prepped my muscle for the injection. The area he meant to inject was behind my arm and I couldnt quite see properly. Okay, here we go. I dont know what I looked like but, for the first time in eight years, he hesitated and tried to soothe me. Apparently, I looked completely panicked. Something he had never seen from me.
Acr Recommendations For Treating Rheumatoid Arthritis
In the 2021 update, ACR provides either strong or conditional recommendations regarding the treatment of RA. A strong recommendation, for or against, indicates that the benefits clearly outweigh harms , or harms clearly outweigh the benefits of the intervention.1 Conditional recommendations imply that there is uncertainty regarding the benefits and harms of the intervention, either due to low quality evidence or when patient preferences or costs may impact clinical decisions.1
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How And When Is Methotrexate Taken
Methotrexate can be taken as a tablet, liquid or injection.
Methotrexate should be taken on the same day once a week. Youll be given a starting dose of methotrexate while your rheumatologist tries to bring your condition under control, but this might be increased if it isnt helping your symptoms.
Methotrexate tablets come in two strengths: 2.5 mg and 10 mg. To avoid confusion, its recommended you only be given one strength, usually 2.5mg. If you are prescribed both tablet strengths be very careful not to confuse them, as they can look quite similar.
If you are starting methotrexate injections, you’ll usually be given your methotrexate injection by a health professional. They will often show you how to inject yourself using either a syringe or injector pen, so you can do it at home. Let them know if you think you will have difficulty injecting yourself.
You must always wash your hands before and after handling methotrexate.