CT SCAN with iodinated radiocontrast

Arthuritis

I have to have a CT coronary artery Scan with iodinated radiocontrast, however I am reading some worrying stuff with regards to MTX interaction with the iodinated contrast used for CT.

Unfortunately I recently had a stroke following some bad news and i think it knocked me out of my remission. I had a contrast scan after a year without MTX for the stroke, but now I need another CT scan with an iodinated contrast, and wondered if annyone has experience with this?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9171540/

Arthuritis

I meant anyone on MTX who has had a CT scan with contrast (not MRI).

Trish9556

@Arthuritis

Afraid i cant assist on the MTX issue for you but I am sorry youre going through tough times at the moment and hope everything looks brighter for you soon.

Love n hugs

Trish Xx

jamieA

Hi @Arthuritis

I'm really sorry to hear of your stroke and hope you recover well. I can't help with your question though reading the National Institutes of Health article is alarming. Is there a possibility the scan could be done without the contrast agent? After I'd had a reaction to a gadolinium contrast agent administered during an MRI of my hand the orthopaedics consultant who'd sent me for the scan appeared to suggest that the scan could have been done without the agent but would have needed to have taken longer. Because the symptoms I had after the reaction to the gadolinium contrast agent I had a CT head scan without contrast as they thought I might have had a brain haemorrhage. They then performed an MRI scan of my head - without contrast - because they thought I might have had a mini stroke.

If I were you I'd want to discuss your options with your consultant making sure he's aware of the drugs you are taking. I know the radiography staff were not aware of the drugs I was taking.

I hope you recover well.

stickywicket

I can understand your çoncern but afraid I'll be of no help.

As you know I've been on meth for years. I had a TIA about 5 years ago. Last year I had both a CT scan (no contrast) and MRI, with contrast, on a hip. No adverse reactions but, in view of @jamieA 's experience, I, too, would want to ask a few questions of the consultant and also ensure those doing the scan werre informed.

I do hope all goes well.

MrDJ

I had a abdo pelvis CT with contrast around 5 weeks ago and no one mentioned anything about stopping my 20mg mtx. i also work in that dept for 43 years and they knew i was on mtx. all your drugs would be in your medical notes so they would soon let you know if you needed to stop any.

mine was injected during the scan while that link discribes a angiogram and then craniotomy surgery with two high doses.

but, and its a big but, there is a lot of difference between various scans so try not to worry and to put your mind at rest you can contact the CT dept to ask any questions or even ask your GP.

Hope you feel better soon.

jamieA

Hi @MrDJ

I have been shocked by the number of medics I've seen in the last 4 years that haven't read my notes or know what drugs I'm on. I'm seen by 5 different groups in the NHS - GP, 2 orthopaedics clinics, cardiology and rheumatology. When I had a heart issue a consultant put me on a drug that should not be taken with NSAIDs. When I later found out about this - from reading my discharge letter - I had a telephone conversation about this with the cardiac consultant where he admitted there was no communication between him and rheumatology. He actually said that in an ideal world there would be but the NHS didn't work like that. I had to talk to my GP pharmacy and rheumatology to discontinue the NSAID prescription. I've had to question a GP regarding why I was left on Omeprazole 7 months after my NSAID was stopped - she said she didn't have time to review my drugs. This despite the fact I'd been diagnosed with anaemia - likely due to the PPI that I didn't need to be taking. I attend two different orthopaedics clinics - one for my hand and one for my knee - and in both I've had to verbally give a list of the drugs I take to the consultant. In the case of the knee consultant he actually started writing the list down on his notepad after offering me NSAIDs that I pointed out I cannot take due to the heart drugs I'm on. For the MRI scan I mentioned in my previous post the nurse who dealt with me waved away the form I'd filled in listing my conditions and drugs I took and asked me verbally - even asking me to spell psoriatic arthritis. At no point did he tell me I would be receiving a contrast agent. I'd asked why he was putting a canula into my arm and he said it was a saline solution to open my veins.

I now keep a notes list on my phone of all my drugs, dosage and frequency and make a point of showing this to any medic I'm being treated by. I also ask for details of any proposed treatments and whether they would be a problem with my drugs.

MrDJ

Hi @jamieA

I know the feeling, thats why i mentioned to talk to ct or gp as well.

The NHS is broken and human error happens everywhere especially in hospitals where everyone is under so much pressure. Its sad that we mostly see a new doc each time who know nothing about you except for the 2 page notes they have in front of them.

(my rant) The management seem to be more interested in everyone doing their appraisal and 40+ online training modules every year. an hour to read the bumf and then the 20 question quiz, fail 2 questions and you fail the quiz and have to go through the whole thing again and for my department who has 360 staff thats a lot of hours wasted when its clearly shown that mistakes are still happening and still all those hours lost sitting on a computer. Ive seen one person sit there for 6 hours and still fail even though they asked people walking past to answer the question for them and then still fail. when they finally passed everyone clapped. 10 minutes later i asked them 3 questions they had just answered and they failed each one. (rant over).

(back on track) ive had similar in the last few months where i had a cancer scare which after test came back all clear except for nsaid eating away in my gut. Told to stop froben anti inflamatory tablet after taking them for 38 years but not given any other drug except paracetamol. pointless when im already on codein and morphine but still in a lot of pain. New consultant fresh out of qualifying in rhumatology and she has refered me to a pain clinic back in may. phoned them 3 weeks ago and letter was still sitting on hosp comp waiting for one button to be pressed to approve it then it gets sent out. still not heard anything so 2 days ago rang gp and he said oh we received the referal the day i rang rhumy but a copy had not been sent to me. gp then sends me a copy and letter states hospital on other side of London but not to call until after 17th August if i had not heard anything.That is then to make the appointment for 3-6 moths later. the system is well and truly broken.

So as you say, its always worth bringing up what meds you are on just in case it has been overlooked. most appointment letters should state please bring a list of meds you are taking with you to appts.

Trish9556

@jamieA

I had to tell a young registrar post hip surgery in May that he was prescribing me the wrong drugs, ones i couldn't, and wouldnt take. Nothing as serious as yours, basic inhalers instead of my strong ones, immediate removal of my tramadol and other painkillers and anti inflammatories which i cant even use as a cream, let alone as pills, but they woukd have made me ill.. He got cross when i told him this and when i showed him it in my notes. My surgeon was furious with him. It is a good job i had an epidural otherwise i would have been too dopey to notice.

I always keep the latest page two etc if my repeat prescription form that the chemist gives me on my person...just in case i need to give ut to anyone and a word document on my laptop with my complete medical history on, although you can also download this from patient access etc.

I hope you're keeping as well as you can be?

Trish xx

Arthuritis

@Trish9556 @MrDJ @stickywicket @jamieA The sheer shambles and arrogance running the NHS really is astounding… the laughable part is that I am on the patient feedback group on ideas to improve safety, and toxic drug contraindications was something i identified as the BIGGEST risk and EASIEST to fix, as someone said here, their consultant was not aware or too busy to review the medication history, but you DON’T need a consultant or even a human for that. A computer already checks ALL UK prescriptions against the GMC database for authorisation to prescribe and log how many times anything is prescribed. It is a very simple step to check with the BNF what drug interactions are contradicted, and if done retrospectively, the morbidity & mortality avoidance benefit of such a system. But it’s not done. Because it’s invisible. No photo op. So no funding. I put thus forward to the patient safety group… usual nhs lip service resp. « Lessons will be learned”. No they won’t. They never have.

Thank you all for your thoughts though. Much appreciated. Cardiologist wants me to take the CTCA test and said because i hesitated previously 6 years ago (over unexplained risks) they won’t ever treat me if i didn’t take the test. Surely can’t be legal to put a patient already stressed over a barrel like that.

Arthuritis

BTW i had already been prescribed contraindicated penicillin antibiotics while on 25mg MTX, and penicillin like PPI, prevents MTX clearance and it made me horribly horribly sick. All i got in response was a shoulder shrug & “we are only human and too busy. mistakes will be made”.

Trish9556

@Arthuritis

49 years ago i was put on a combination of 14 different drugs at least three times a day. These ranged from phenobarbitone to anti convulsants painkillers and everything else. I lost three stone in month and woke one morning not being able to stand walk talk or see properly. Three days later after increased phenobarbitone i was seen by my consultant and immediately admitted, taken off all meds and told i was lucky to be alive. I would've died within three days. I spent six weeks in hospital learning how to do stuff like walking again. You didnt complain to the nhs then.

Its depressing to know after all this time they still dont listen and learn.

Trish xx

Trish9556

@Arthuritis

Why cant they run an allergy test on the dyes? Surely they can do a basic patch test before you have the scan and dye?

Trish xx

Arthuritis

@Trish9556 Unfortunately it’s not an allergy but a drug interaction. The contrast when combined with MTX in the reported case effectively poisoned the patient, and such things are only detected when reported and medics are paying attention. Contrast agents are fine in most cases, but they have been known to cause serious problems but most hospitals don’t pay attention because they have not yet been sued over harm caused, and even after, the lesson is quickly forgotten.

stickywicket

I simply googled 'interaction methotrexate and iodinated contrast' and found enough stuff to make me feel that, if it were me having it,, I'd want a good chat with my consultant after printing off some of what's written.

I wish you well, in every sense.