Sulfasalazine + Methotrexate

donnas

Hello all

Some of you might remember the other week I had a flare up with a big soft tissue swelling on my hand a couple of weeks ago. Well, I got better and then BLAM! Worse again yesterday. I managed to see a rheumatologist while my hand looked like HELLBOY (useless giant red right hand), and he recommended starting methotrexate in addiction to my sulfasalazine. I'm only on a low dose of that and I will be on a low dose of MTX too.


In addition I got a bit jag of kenalog in the bum and my posterior is sore!


Anyone else take this combination? Am apprehensive but know I need to do it. Going out for my chest x-ray soon before I start, and delivering prescription to GP later. Must carry on, I suppose.

Poppyg1rl

Hi Donnas,
Im on 20mg of methotrexate and 4 tabs Sulfasalazine, just started Humira too plus celebrex, folic acid and usual painkillers etc.
It's ok, bit nerve wracking too start with, which is perfectly normal, but I haven't had any problems, be sensible, take it easy and you'll be ok.
Thinking of you hugs x

donnas

hey thanks. I'll be on a lower dose than you. I had such a grotty time on the sulfasalazine I'm scared of anything "stronger". I've been resisting MTX for longer than I can remember, and til recently my doctors agreed, as I just had a a bit of toe and finger pain and the risks outweighed the benefits. But I've been having horrible flareups lately where I've not been able to feed or wash myself properly. Hand is a bit better today thanks to steroids but I feel I'm sitting on a knife edge, waiting for the next flare up.

I knew if I had another flare on sulfa that MTX was going to be the next step, and now that time has come, just three months later.

Deep breaths.

skezier

Hi Donna,

Its a different type of drug so it might not do what the sulfa did to you at a higher dose. Fingers crossed it will help you. I am not on both came off the sulfa cus of a reaction to it and the mtx has been kinda in most ways. Fingers crossed it will work for you. Cris x

dreamdaisy

Hi, I am on both plus a few other things. I have injected meth (it's a lower dose than the tablet form) and have no trouble with it, no side effects to speak of and I have been on six tablets of sulph daily for years. I think that keeps the P bit of my PA at bay, but has never touched the arthritis side of matters, neither has the meth, but that is simply because in my case it was too little too late. If you have caught this early enough you stand a much better chance of success with this combination. I wish you well. DD

tillytop

Hello!

I think the combo of sulph and meth is quite a common one - I have been on both in the past. I know that starting a new drug is scary, I've been at this a long time and I still get very nervous when I start something new. But I try now to approach it with the attitude "I'll give it a try and if it doesn't work/doesn't agree with me, I can stop". From what you have said you are struggling at the moment so you have nothing to lose by trying the meth. And if it doesn't do it for you, there are plently of other meds out there to try.

Really good luck with it and I have everything crossed for you that it helps.

Lots love Tillyxxx

donnas

I'm quietly boggling/chuckling at the abbreviation "meth". That means something completely different to me!

You're right. I can stop if it doesn't work. I'm worried about the work situation though. Can't stop myself feeling like I'm "in trouble" for being ill, as we have a rather threatening policy regarding sickness absence in my place of work. I fell like I can't be off if I have any more horrible side effects and worry about losing my job (was off work loads because I was throwing up on the sulfa).

Anyway. Chest x-ray done, prescription handed in. I'll pick it up tomorrow and start it tomorrow night.

tillytop

Oh yes Donna - and you thought this was an arthritis forum?! We're really "meth drinkers anonymous"!!! I sometimes forget to call it by the proper name when I go to the docs - no wonder he gives me funny looks!

Seriously though, I hope that you get on ok with it. Just a thought given your worries about work - had you considered taking it on Friday evening (assuming you don't work at the weekend)? Not suggesting you will have a prob with it but that would mean that at least you know you can take it without worrying about whether you will be ok for work the next day.

What dose will you be taking to start with?

Will be thinking of you.

Love Tilly xxx

donnas

I will start with three tablets - is that 7.5mg?

My social life is as precious to me as remaining in employment. I don't want a ruined weekend either! Maybe it'll just make me sleepy and I can doze through Friday...

When do you take it? Morning/evening. Three tablets at the same time or throughout the day? Hoping my friendly pharmacist will fill me in.



p.s. I was thinking of crystal meth! I now feel like a deviant. Not for the first time I'm sure.

dreamdaisy

When I was on the tablets I took them all at the same time, first thing in the morning. I stopped those after a while as I developed a rash on my forearams. I now do the injection first thing in the morning but I am very rarely troubled by any side effects from meth and the morning thing is just habit. 7.5 is a very small dose and hopefully won't cause you any trouble - remember that side effects are not guaranteed but you do have to be warned about them.

Come what we laughingly call the 'summer' make sure that you use a decent sunscreen as meth can affect how your skin reacts to sunlight. You need to keep well-protected. DD

km89

Hi,

I'm on methotrexate and sulphasalazine too. When I first started taking methotrexate my rheumatologist told me that taking your weekly dose at night is best so you can 'sleep through' any nausea or anything that you might initially get. Has worked for me!

Hope you get on ok with it

Katie

starspangle

Hi all what an interesting post!
I am in the same situation at the moment, my hands and the pain have rapidly deteriorated over the past few months and the psoriasis has popped up in more places.

I always thought it was sulfa or meth..I had no idea you could take them together.
I have taken sulfa for many years and it often aggrivates my digestion.

Saw the GP last night and he suggested bringing forward my rheumy appt as they had mentioned in a letter to him that meth may be the next option if things got worse.
DD was the rash completely different from the P? I am beginning to think all my itching may be something else as the steroid creams (used very sparingly) have made it more red and itchy.
Good luck with it all Donnas let us know how things get on.
Thanks for the info on this post.

ironic

Hi Donna,
Good luck with the mtx. I take mine in the evening too with a large glass of water. Have you been given Folic acid to take 3 days later? The pharmacy will go through things with you. It might be best if you avoid alcohol for a while just until you have had a couple of blood tests done.
Fingers crossed you will feel the benefits soon.
Lv, Ix

Good luck to you too Starspangle, I hope you get your appointment soon.

donnas

Hiya starspangle!

I have necked my first dose. Am I cured yet?

The rheumatologist explained it all to me. I take my folic acid on Sunday. I've just been reading that you can't take NSAIDS with MTX, or vitamins with folic acid! I'm buggered! As a vegan I need my vitamins, oh dear me. And I have a headache most of my life which I take nurofen meltlets for half of the time. I better wave them goodbye. The pharmacist didn't say much but now I'm just hoping hoping hoping it all goes ok.

If I feel ok I'm going away to stay with friends this weekend. They will distract me and look after me a bit.

Like you, starspangle, I thought it was one of the other, not both! This is a new thing for me completely.

donnas

Again, OH BUGGER. I take esomeprazole for stomach problems. I have just checked drug interactions online and have found out that there is an interaction between methotrexaate and omeprazole. I guess I'm phoning the pharmacy in the morning then. Bugger. My guts are going to be unhappy without the esomeprazolebut I don't want poisoned.

dreamdaisy

I take both of them, have done for more than two years now and have had no problems. According to half of the meds I take I shouldn't be taking the other half and vice versa. I don't think you need to worry or panic, I think that side effects leaflets and interraction info have a habit of over-stating matters, I suspect purely to forestall any legal action. One of the reasons we are so closely monitored is to deal with any serious ill-effects. I am sure you will be fine.

Re the headaches: could the neurofen be the culprit? I have heard of it causing such problems, it's just a thought. DD

donnas

Ah no, I have an ill fitting jaw and a bone out of place in my neck - BLAM headaches. I only take nurofen when the cocodamol doesn't work.

p.s. I haven't turned blue and expired yet. Yippee!!!

donnas

Side effect 1 = insomnia. At least I'm used to that one, but it's been absent in my life for so long I feel rattled.

dreamdaisy

Side-effects are listed because should any turn up then the chances are they are related to the meds. I have just gone through my humira leaflet and ticked 6 out of a list of 128. Just because they are there does not mean you will have them. I always blithely assume that none will turn up, and most of the time they don't. I am sure you will be fine but if not then contact your GP or the rheumatology team for advice. Take care. DD

tillytop

Hi Donna

There are other stomach protectors - I take Lanzoprazole alongside mtx etc - so you should be able to get alternative if it turns out yours doesn't mix with the mtx. I am not aware of the mtx causing insomnia - I don't sleep well but I think, for me, the prednisolone is the main culprit.

Love Tilly xxx

starspangle

Thanx for all your wishes here. But thanx donnas for initiating it.

I read all the replies to Donnas and my jaw was dropping re the stomach protector etc., Rheummmy getting back to me Tues re the appt, but as the days go by the pain worsens and so the info re not using NSAIs concerns me ....is that always the case??? very confused now :shock: and need to be armed with queries and questions when I get the appt.
More able to keep up to date now as off on annual leave for a week or so 8)
good luck again Donnas

donnas

Thanks all. I'm ok for now. Have needed heavy duty stomach meds fir many years due to NSAID damage. Will check with GP/nurse/pharmacist soon.

donnas

Psyching myself up for week two tomorrow. Thinking I might take my mtx earlier in the day to avoid the insomnia I had last week. Might not work, but hey.

dreamdaisy

What an interesting choice of words. You are making this a really big thing, aren't you? Do you think it possible that you could try to afford it less prominence and importance, I honestly don't think this is helping you. The dose you are on is relatively small, yes there are side effects, the prospect of taking it is unsettling and some do find it much harder to tolerate than others but it seems to me that you are focusing exclusively on the negative sides and ignoring the potential positive. What if it works? What if it helps, your RA is eased, the pain lessens - it is within the realms of the possible. I know it is unwise to get one's hopes up too far but some positivity can help matters.

I have been on meth for years and can report very little trouble with side effects, which is similar to the effect it has had on my arthritis. I remember starting with sulph and thinking 'This is it! I am mended!' I remember adding in the meth thinking 'This is it now! I am mended!' I thought that when I tried the cyclosporin (oooo I got hairy on that!) and now I don't bother thinking the mended thoughts as I know that is akin to the Holy Grail or finding hen's teeth. Meth has helped a fair few on here and I hope it does so for you. My fingers are firmly crossed on your behalf. DD

skezier

Hi Donna,

Flower it's always worrying after you have rad the leaflet but they have to say every little thing reported and are you on esomeprazole? That's a recent one for me but would now fight to keep it as its so much better.

There are a few tablets they say you shouldn't take with it but I seem to be and kinda hope the doc's know what they are doing.

I moved on to the mtx jabs after the mtx hurt my stomach as well. I do mine in the evening and was on 25 mg tablets now 20 ml jabs. Its been kind to me in jab form, it wasn't really in tablet form but it only made me feel sick for a few weeks at the lower doses and with luck it will be kind to you and more importantly work.

Try not to worry and just see how it goes. For me it's been so much kinder than the sulfa but I reacted to that but was kept on it even though till it got really bad reactions.

Hang in there and fingers crossed it will hep you. Cris x

donnas

I have a chequered history with strong drugs I'm afraid. Months and months of vomiting and serious nausea on sulfasalazine, permanent gastritis due to NSAID damage, can't take hydroxychloroquine due to retinal scarring. I think it's only natural to be apprehensive!

I'm on esomeprazole so that's fine but will make an appointment to speak with my doctor about the supplement thing, I don't like being without vitamin insurance. Spoke to a lovely pharmacist today who said the main thing to be careful about was NSAIDS, so that's bearable. And I have B12 so am slightly less concerned about vitamin deficiency.