What About Avoiding Alcohol If You Have Inflammatory Arthritis Even If You Dont Take Methotrexate
Its a good idea to watch your alcohol intake for other reasons too. For one thing, there are other drugs used to treat arthritis that can potentially cause liver damage, such as azathioprine, leflunomide, sulfasalazine, and certain biologic agents.
Another factor to consider is that alcohol can also lower bone density, and people with rheumatoid arthritis and psoriatic arthritis are already at a higher risk of developing osteoporosis. Excess alcohol intake can disrupt the breakdown and rebuilding of bone tissue.
So, if I need to take methotrexate, can I never imbibe again?
Whether to drink, or how much to drink, calls for a discussion with your doctor about the risks and benefits.
One headline-generating study from 2017 found that the risk of liver damage in people with RA who consumed fewer than 14 units of alcohol a week was no greater than that of people who didnt drink alcohol.
Even though the study states that weekly alcohol consumption of less than 14 units per week does not appear to be associated with an increased risk of liver damage, no alcohol is always better than some alcohol, says Dr. Domingues. Each patient is different from the other and I would always rather be in the safer side when it comes to advising them. Its always about a negotiation with the patient.
He too reminds all patients that no alcohol is always safer than some alcohol though he says I believe the same can be said for milkshakes.
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.
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.
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Who Is Methotrexate For
Methotrexate is for people with moderate to severe psoriasis who have not had a good response from, or are unsuitable for, topical treatments or ultraviolet light therapy.
Methotrexate can also be prescribed for psoriatic arthritis. In this situation, it is known as a Disease Modifying Anti-Rheumatic Drug , meaning it acts on the actual condition itself, rather than just relieve the symptoms.
How Should This Medicine Be Used
Methotrexate comes as a tablet to take by mouth. Your doctor will tell you how often you should take methotrexate. The schedule depends on the condition you have and on how your body responds to the medication.
Your doctor may tell you to take methotrexate on a rotating schedule that alternates several days when you take methotrexate with several days or weeks when you do not take the medication. Follow these directions carefully and ask your doctor or pharmacist if you do not know when to take your medication.
If you are taking methotrexate to treat psoriasis or rheumatoid arthritis, your doctor may tell you to take the medication once a week. Pay close attention to your doctor’s directions. Some people who mistakenly took methotrexate once daily instead of once weekly experienced very severe side effects or died.
Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take methotrexate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
If you are taking methotrexate to treat psoriasis or rheumatoid arthritis, your doctor may start you on a low dose of the medication and gradually increase your dose. Follow these directions carefully.
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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.
Things People Wish They Knew Before Starting Methotrexate
Editors note: This piece is based on the experience of individuals. Please see a doctor before starting or stopping a medication.
Methotrexate is a chemotherapy agent and immunosuppressant drug that interferes with the growth of certain types of cells. It is often used to treat several types of cancer as well as various illnesses, including psoriasis and rheumatoid arthritis. While some experience positive results, others are surprised by the side effects both physical and mental that can accompany the medication.
Although everyone is different and its hard to predict exactly how a drug will affect you individually, it can be helpful to be aware of all the potential side effects before starting a new treatment. So, we asked our Mighty community to share what they wish they knew before starting methotrexate.
Heres what the community told us:
1. Even the smallest dose can still give you the stereotypical chemo symptoms. I thought for sure on 1/16 of a dose I would have no problem, but I could tell the time and day just by how I was feeling at the moment. I didnt realize it would make me so brain-fogged that I would need to warn my employers or workers to let me know of I started acting or speaking strangely.
2. I knew the potential for nausea but it didnt make it any better! Between that, the upset stomach and fatigue, it made it hard to start my mornings.
6. I wouldnt be able to drink alcohol at all, not even on special occasions.
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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.
Should I Worry Because Methotrexate Is A Type Of Chemotherapy
Once called amethopterin, methotrexate was originally used to treat cancer. The dose you take for psoriasis is much lower than those used for people with cancer, however. Doctors also use low-dose methotrexate to treat other diseases that affect the immune system, such as rheumatoid arthritis, Crohnâs disease, and multiple sclerosis.
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Who Should Not Take Methotrexate
- People with active infections should not take methotrexate. You will be tested to check for infections before starting treatment.
- Pregnant women, or people who are trying to conceive a child should not use methotrexate. Both the person taking methotrexate, and their partner, should take contraceptive precautions for up to six months after stopping the treatment. Women should not breast feed whilst on methotrexate.
- People who have conditions that significantly affect the functioning of their liver or kidneys should not take methotrexate.
- People who drink a lot of alcohol should not take methotrexate. In most cases, alcohol should be avoided whilst taking methotrexate. Your Dermatologist or Rheumatologist will discuss this with you, if relevant.
Is There A Risk If The Father Is On Methotrexate
For many years men were advised not to father children while they were on methotrexate and for at least 3 months afterwards because methotrexate had been reported to cause a reduction in sperm count. The current expert view is that the risks are very low, and this precautionary approach is not necessary.
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Some Side Effects Can Be Serious If You Experience Any Of These Symptoms Or Those Listed In The Important Warning Section Call Your Doctor Immediately:
- blurred vision or sudden loss of vision
- seizures
- weakness or difficulty moving one or both sides of the body
- loss of consciousness
Methotrexate may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
Stopping Methotrexate For One Week Vs Two Weeks
The reason the ACR guidance recommends holding for one week versus the two-week period used in the South Korean study has to do with scheduling issues related to the two-dose vaccines from Pfizer and Moderna. If you were to stop taking methotrexate for two weeks after each vaccine dose, you would be off the medication much longer than if you were getting just a one-dose vaccine. Skipping methotrexate for one week instead of two might be a happy medium that may allow patients to have a stronger immune response without as much of a risk of flaring.
If you get a single-dose vaccine from Johnson & Johnson, the ACR guidance suggests holding methotrexate for two weeks afterward.
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Treatment Of Psoriasis: An Algorithm
ASHA G. PARDASANI, M.D., STEVEN R. FELDMAN, M.D., PH.D., and ADELE R. CLARK, P.A.-C., Wake Forest University School of Medicine, Winston-Salem, North Carolina
Am Fam Physician. 2000 Feb 1 61:725-733.
See related patient information handout on psoriasis, written by the authors of this article.
Psoriasis is characterized by red, thickened plaques with a silvery scale. The lesions vary in size and degree of inflammation. Psoriasis is categorized as localized or generalized, based on the severity of the disease and its overall impact on the patients quality of life and well-being. Patient education about the disease and the treatment options is important. Medical treatment for localized psoriasis begins with a combination of topical corticosteroids and coal tar or calcipotriene. For lesions that are difficult to control with initial therapy, anthralin or tazarotene may be tried. The primary goal of therapy is to maintain control of the lesions. Cure is seldom achieved. If control becomes difficult or if psoriasis is generalized, the patient may benefit from phototherapy, systemic therapy and referral to a physician who specializes in the treatment of psoriasis.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
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What Kind Of Efficacy Can Physicians Expect With Methotrexate Monotherapy
Dr. Leonardi cited the results of the European randomized, open-label RESTORE-1 trial as being consistent with his own extensive clinical experience: a week-16 PASI 75 response rate of 42% with methotrexate, compared with 78% for infliximab .
Of course, some patients cant receive a biologic agent because of their age, lack of insurance coverage, or medical contraindications.
I use methotrexate a lot in Medicare patients, where, with Part D, its hard to get access to biologics without really good coinsurance. I think all of us who prescribe biologics understand that, he observed.
In pediatric patients with extensive psoriasis, he turns to methotrexate as first-line systemic therapy. After 3 months, if the young patient hasnt responded satisfactorily, Dr. Leonardi asks the insurance company for access to a biologic agent and usually gets it.
Methotrexate really shines in combination with a biologic agent. It inhibits formation of antibiologic antibodies, an important cause of loss of effectiveness of monoclonal antibody therapy.
In one study, 28% of patients on adalimumab developed antiadalimumab antibodies during the first 3 years of therapy. These patients were more likely to drop out of therapy for lack of effectiveness.
The Dangers Of Daily Dosing
A study published in the Medical Journal of Australia detailed more than a decades worth of Australian data on methotrexate, looking at cases where people had accidentally taken methotrexate daily instead of weekly.
Taking methotrexate for as little as three days in a row is enough to cause serious consequences, including sepsis and death. Note that this is different to high-dose methotrexate in chemotherapy, where rescue therapy is used to prevent toxicity.
Since 2000, at least eight Australians have died and many more have been hospitalised after taking too much methotrexate. Methotrexate use is increasing, which has corresponded with an increase in accidental daily dosing reported to Australian Poisons Information Centres.
Given that most medicines are taken daily, these potentially fatal mistakes can be easy to make. Methotrexate is effective and safe if used correctly. Changes in packaging and labelling, and alerts in prescribing and dispensing software used by doctors and pharmacists, could help prevent overdosing.
If you have questions about your methotrexate treatment, speak with your doctor or pharmacist. For advice about dosing errors with methotrexate or any other medicine, contact the Poisons Information Centre, 13 11 26 , Australia-wide.
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