Methotrexate and other medications

Airwave!

I’m just waiting for a Methotrexate prescription to arrive and have been reading the VA pamphlet and note that Omeprazole should be avoided. Any suggestions for other non reactive substances to ask for?

I realise that it shouldn’t be up to the patient but since I now know I like to be prepared.

it’s a grin, honest!

stickywicket

????

I've been taking both for over 20 years, Airwave. No problems. Why not check with the pharmacist?

Airwave!

I will when get the methotrexate, perhaps the pharmacy can shed some light on the warning?

it’s a grin, honest!

frogmorton

A lot of us take both Airwave.

I only recently found out that there is a warning myself. Wonder if it's recently been added to the information or whether it's at the Dr's discretion?

Take care

Toni x

jamieA

Hi @Airwave!

From what I've read previously the warning about taking MTX and omeprazole was regarding high levels of MTX for the likes of cancer treatment - more than 10 times the max level for inflammatory arthritis. The protective lining the PPI creates reduces the clearance of MTX leading to a build up of MTX in the system.

When I was taking omeprazole I was diagnosed with pernicious anaemia and that was put down to omepazole stopping the absorbtion of vitamins - particularly B12 but also B9 and D3. This was picked up during my 3 monthly MTX blood tests - I think in part that's what they are for.

Arthuritis

@jamieA @Airwave! @stickywicket The warnings regarding MTX & other drugs, including penicillin based drugs and PPIs depend on the MTX dosage and your ability to clear it. The latter varies with each individual and age, but matters more when you are an edge case, as I was at 25mg/week MTX. The penicillin based antibiotic prevented the MTX from being cleared, so each week I was effectively accumulating more, and the effect persists for weeks after, making me horribly nauseous and unable to think clearly enough to perform any work tasks. There is a BNF contraindication warning, but few GPs check before prescribing (I have raised this here before). The NHS automated prescription could easily do this more reliably than any human doc, but that safety net isn’t there. (That IT project need is too “behind the scenes”, low budget with no career advancement, no photo op so nobody is pursuing it or sponsoring it, unlike the £10bn write off for NPfIT NHS IT project, also why there is no universal booking system etc the list goes on). I believe the PPI interaction is similar, and inhibits clearance of MTX from blood. Acid is needed to absorb certain nutrients, eg B9 I think, so any antacid will reduce absorption. Your gp might prescribe an antihistamine, which can reduce stomach acid without causing problems with MTX. However a lot depends on your dosage and your ability to clear MTX. If memory serves, think @stickywicket is on 10mg/week? and otherwise healthy so had better prospects of escaping the MTX interaction than I did. The memory still fills me with dread, and frustration that highly restrictive NICE rules didn’t protect me from that, and the gp only shrugged and said they’d never seen it before or noticed it in the BNF.

As we say here, you need to be your own health advocate, well done for checking!

More here.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3336837/

Welsh1

Have been told I can take lansoprazole on 15mg of Methotrexate also on Hydroxychloroquine max dose not taking ppis at the moment as its a juggling act with timing 4 hours after Hydroxychloroquine. They are cautious on vitamins not prescribed by themselves too and advised not too take iprofen and Naproxen. NO herbal supplements either apparently.