Methotrexate and liver function

Melanie17 · 7. Apr 2016, 19:28

Hello All.Have been taking methotrexate since January and have been pleased with the results.I am a 'pill hater' and was very sceptical about taking this drug(15mg per week) but,after about 6 weeks,I began to notice a significant improvement in my joints and mobility.I have psoriatic arthritis.But.......got a call from the doctor about my last blood test to say that the ALT was 155 and I should stop taking methotrexate and must have a blood test in 14 days.Is this reading really high,and what does it mean please?I would be grateful for any help with this.

dreamdaisy · 8. Apr 2016, 02:58

It's not really high but it's high enough to cause concern. Was it your GP who called or your rheumatology unit? My unit is happy with results up to fifty.

It's good to hear that the meth has been improving matters for you but these setbacks can occur from time to time. Have you been taking any folic acid in between the doses of meth? DD

stickywicket · 8. Apr 2016, 04:40

Lovely to hear that the meth is working but this is why our blood tests are so important because they pick up any potential problems early. It might well be that your liver will settle down again (Hence the repeated blood test) and you'll be able to resume the meth once that happens maybe, as DD has implied, with more folic acid than previously. Just do as the docs are advising and you'll be fine.

trepolpen · 8. Apr 2016, 06:23

hi Melanie , one of the reason for mothly blood test is to check our ALT , which is inflamation of the liver & over 130 & they will stop methotrexate

I been on methotrexate for 18 years , in the past I had problems with raised ALT & had to stop , I was put back on but taking 5mg folic acid six day a week & not had any problems since & my results have been normal , talk to your rheumy nurse/consultant & take their advice , if left unchecked you could end up with liver problems so its good they are doing blood test to protect your health

Melanie17 · 8. Apr 2016, 15:57

Stickywicket,Trepolpen and Dreamdaisy,thank you all!

I am really reassured by your replies.I have been taking folic acid-one tab,I think 5mg,two days after the Methotrexate.But I am only taking folic acid once a week and what Trepolpen has said is really interesting-maybe I will be offered a daily dose of folic acid to rectify the problem.It was my GP who called,told me about this one result and advised me to get advice from my rheumy nurse before taking any more Meth.I reckon it must be the Meth-haven't touched alcohol since I've been on this drug.How high can these ALT readings go to?

dreamdaisy · 9. Apr 2016, 05:17

You're very welcome!

How high can they go? Well, that depends on what's 'wrong'. The highest I reached was in the upper 600s and that was caused by Enbrel (we had to interrupt a week's holiday with an emergency blood test, that's when I fully realised that this dross was not going to leave my side). The odd thing was that I felt perfectly well but within a fortnight my ALT had gone from 16 to 350-ish (done just before we went away) then the emergency test the following week showed it in the 600s. I was also introduced to the wonderful term 'deranged liver' which made me grin but I never once realised that things were not going well - this is why we have to be conscientious about the blood tests.

I remember talking to the liver specialist and he said that if one had a liver disease figures in the low thousands were not unknown. DD

Melanie17 · 10. Apr 2016, 16:35

Am feeling reassured and more knowledgable.I feel that my rheumy nurse does a grand job so far,but there is no room or time to ask lots of pertinent questions.I do understand this-she is concerned about the medical aspect and probably has far too many patients to see.This is where you forumites are little wonders.Whatever I have asked has resulted in really sound advice from 'them who are there'.
Thank you once more.

dreamdaisy · 11. Apr 2016, 14:01

You are more than welcome, I'm sure many of us auto-immuners have experienced similar setbacks so we know our stuff. Please let us know how you get on, OK? I wish you well. DD

pilgrimchris · 12. Apr 2016, 11:47

Hi, I've had similar experiences recently. I started on Mtx back in November and have had to stop for two spells where my blood tests indicated a liver problem. I've started again three weeks ago on 10mg, past a blood test last week and was increased to 15mg.
When I originally started the consultant didn't tell me about folic acid, so I am now taking this on a daily basis. I've also completely stopped drinking alcohol and am drinking a lot of water, especially on the day I take the Mtx. If I pass the next blood test then I'll be increased to 20mg (i've yet to feel any real benefit from the drug, so desperately hoping it will work this time)

dreamdaisy · 13. Apr 2016, 03:15

I hope the FA is helping matters, pilgrimchris. Has your consultant prescribed the folic acid? And I presume you know not to take it on the day you have the meth. DD

Melanie17 · 13. Apr 2016, 19:54

Hi Pilgrimchris,
It's not nice that you started on Methotrexate back in November,and have not yet had any benefit from this drug.Have you queried this?I started on Meth in January,and admittedly it took about five weeks to take effect.The aches and pains gradually disappeared and I know it was the Meth because now that I have stopped it due to a liver function test showing an ALT of 155,the aches and pains are returning.I am no expert,but I have read that Meth can take up to 8 weeks to 'kick in',but in your case it's over 4 months.I say this because Meth just didn't work at all for a friend of mine with RA.Simply didn't work at all for her and she was then given a different drug.I suggest that you ask why it has not helped so far,and maybe suggest that it never will?My ALT is now at 52 after stopping the Meth.Rheumy nurse phoned and told me to start it again and I will,but I don't like the idea of taking a drug in the knowledge that it can do this to my liver

Melanie17 · 13. Apr 2016, 19:58

Pilgrimchris-forgot to mention.My dose of Meth has been 15mg throughout so this drug really can work at this dosage.

dreamdaisy · 14. Apr 2016, 04:11

It is very much a case of trial-and-error with our meds and it can take some juggling with the dosage to find the useful level - sometimes more than one medication is required, most of us on here take at least two meds.

The whole point of the regular bloods is to monitor how the body is coping, I am very fortunate in that I have no real problems with the meth but I need that plus humira and sulphasalazine to control my disease activity. Auto-immune arthritis is a powerful beast and needs powerful meds to subdue it. DD

trepolpen · 14. Apr 2016, 04:30

hi Melanie , its good your ALT has come down , did you ask about increasing folic acid , if not I would phone your rheumy nurse & ask to take 5mg six days a week

when I started 18 years ago one of the nurses was telling a bold man that he would not lose his hair on meth , was funny when she realised what she was saying , but meth can cause side effects like hair thinning & increasing folic acid will help & stopped the problems I had with raised ALT , like DD said its one of the drugs I take alone with Sulpha , rituximab & predisolone to treat RA

pilgrimchris · 14. Apr 2016, 08:58

dreamdaisy wrote:

I hope the FA is helping matters, pilgrimchris. Has your consultant prescribed the folic acid? And I presume you know not to take it on the day you have the meth. DD

Well, its over the counter FA but the consultant said this was fine.

pilgrimchris · 14. Apr 2016, 09:04

Melanie17 wrote:

Hi Pilgrimchris,
It's not nice that you started on Methotrexate back in November,and have not yet had any benefit from this drug.Have you queried this?I started on Meth in January,and admittedly it took about five weeks to take effect.The aches and pains gradually disappeared and I know it was the Meth because now that I have stopped it due to a liver function test showing an ALT of 155,the aches and pains are returning.I am no expert,but I have read that Meth can take up to 8 weeks to 'kick in',but in your case it's over 4 months.I say this because Meth just didn't work at all for a friend of mine with RA.Simply didn't work at all for her and she was then given a different drug.I suggest that you ask why it has not helped so far,and maybe suggest that it never will?My ALT is now at 52 after stopping the Meth.Rheumy nurse phoned and told me to start it again and I will,but I don't like the idea of taking a drug in the knowledge that it can do this to my liver

I started the MTX mid-Nov after a failed attempt on Sulfasalazine. I probably did 6 weeks at 15mg before failing a blood test for liver function. Through January to late March i was either on 10mg or not on the drug. It definitely had an impact as i started to develop psoriasis quite badly in my ears after a couple of weeks off (which I hadn't really had before). I've now been on 10mg for two weeks, followed by a successful blood test and am due to take my second week at 15mg on friday. If i pass a blood test next week then I'm to increase to 20mg.
I think the consultant just felt that i hadn't been at a high enough dose for long enough to see any benefit. Plus I don't think i was drinking enough water and taking enough FA to keep my liver happy.
I'm pretty desperate for it to work by July as I start a new job then and can afford to be in the state I currently am. Fingers crossed

dreamdaisy · 14. Apr 2016, 11:10

Hello again pilgrimchris. I might be wrong but I recall reading somewhere that prescribed FA is stronger than the stuff bought OTC - that might be worth investigating. I too began with sulph but that made no difference to anything so tablet meth was introduced to run alongside the sulph. After three months I developed meth rash hence (after a long break and taking other meds) the switch to the injected version. I've been taking sulph since 2002. I was initially classed as being an auto-immune inflammatory arthritic around 2002/3 but when a bout of pustular psoriasis occurred on my palms and soles in 2006 I was re-classed as having PsA: the label changed but the meds did not.

I have no doubt that the double-act of sulph and meth keep my skin generally clear of psoriasis but I have on-going patches breaking through on the backs of my hands and, currently, a weeping patch in the pinna on the left side (the right cleared up a few weeks ago).

I guess that different rheumatologists have different approaches to our conditions. My consultant is adamant that OTC FA is not sufficient for the likes of us, whereas the OTC kind is fine for ladies in that 'delicate condition'.

My hospital is a teaching one and I often wonder if that makes a difference to the attention patients receive: it shouldn't but it could. DD

trepolpen · 14. Apr 2016, 16:48

pilgrimchris wrote:

dreamdaisy wrote:

I hope the FA is helping matters, pilgrimchris. Has your consultant prescribed the folic acid? And I presume you know not to take it on the day you have the meth. DD

Well, its over the counter FA but the consultant said this was fine.

hi Chris , the over the counter FA is about the 12th the strenght of the 5mg supplied on presciption , know you should always take your consultants advice if you are having problems I would ask to get FA on prescription

Melanie17 · 14. Apr 2016, 18:24

My rheumy has told me to start MetH again at 15mg(I stopped Meth due to an ALT of 155)My latest ALT is 52 so I can start it again.I asked about folic acid(I take 5mg every 7 days)-whether I could take it daily.My rheumy said that I didn't need to,as the Meth wasn't causing side effects!She must,of course,mean side effects other that liver function,side effects such as hair loss etc.So that's her opinion-I don't need it,even with the previously raised ALT of 155.

It has been mentioned that Meth should be taken with lots of water :hammock: Silly me-I never thought of that.Any other advice on taking it please?

Out of interest,is there any other soul out there who,like me,has a diagnosis of psoriatic arthritis,without a single trace of psoriasis anywhere on the body?

pilgrimchris · 15. Apr 2016, 03:19

Melanie17 wrote:

My rheumy has told me to start MetH again at 15mg(I stopped Meth due to an ALT of 155)My latest ALT is 52 so I can start it again.I asked about folic acid(I take 5mg every 7 days)-whether I could take it daily.My rheumy said that I didn't need to,as the Meth wasn't causing side effects!She must,of course,mean side effects other that liver function,side effects such as hair loss etc.So that's her opinion-I don't need it,even with the previously raised ALT of 155.

It has been mentioned that Meth should be taken with lots of water :hammock: Silly me-I never thought of that.Any other advice on taking it please?

Out of interest,is there any other soul out there who,like me,has a diagnosis of psoriatic arthritis,without a single trace of psoriasis anywhere on the body?

I'm just drinking a lot of water, especially on the day i take the Meth plus zero alcohol, lots of fruit and veg.

Until recently i thought i had PsA without the psoriasis but i've had problems with what must be psoriasis in my ears only (dry, itchy etc). The Meth has helped a lot (when i stopped recently for three weeks it came back with avengence).

dreamdaisy · 15. Apr 2016, 03:36

When I began with my left knee inflating like a balloon, back in April 1997, my scalp was riddled with what I now know to be plaque psoriasis but that cleared completely after a fortnight in Italy, in the September of that year. I began sulph in February 2002 with no diagnosis - and no psoriasis. Come October 2006 I had a bout of what I learned was pustular psoriasis on my palms and soles, now I have a touch of the plaques here and there. I am sure that the sulph and meth keep me mostly clear. I have FA 5mg tablets but often forget to take it because it's only once a week.

it is not unknown to be diagnosed with PsA despite the lack of P. It is supposed to begin in the smaller joints of the body such as fingers and toes, and the inflammation that comes with it differs from that caused by RA, I think ours occurs more in the entheses (I think that's the right word!) Mine didn't obey the niceties and started in a major joint. It is also a sero-negative auto-immune, again making it harder to diagnose. DD

stickywicket · 15. Apr 2016, 04:34

Melanie17 wrote:

It has been mentioned that Meth should be taken with lots of water :hammock: Silly me-I never thought of that.Any other advice on taking it please?

I think most meds should be taken with a fair amount of liquid and, for those of us with dodgy stomachs, a small amount of food, too. I've always believed, rightly or wrongly, that drinking plenty of innocuous stuff – ie water, sometimes cunningly disguised as tea

- is a good idea for anyone on meds so as to keep the kidneys well flushed out. I was told, when diagnosed, aged 15, that an added potential extra with being diagnosed young is kidney problems. I've not had any.

Methotrexate and liver function

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