Methotrexate Change Over

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Dragonfly17
Dragonfly17 Member Posts: 47
edited 28. Feb 2018, 12:09 in Living with Arthritis archive
Need advice: Recently had consultant appointment at which he took me off Hydroxy for 10 days to see if this is what is causing me loose bowel problems (which have been lasting 6 out of 7 days). If this is the cause then I am to start again but take 200 mgs a day instead of 400mgs. He also suggested I stop the mtx orally and change to the subcut pen to help with the nausea (as had been suggested previously but I didn't change as unsure of being able to inject myself). I have recently been considering this change and on reading some other posts it seems that the drug takes time to take effect! Am I right in thinking this and if so why if you are continuing the drug but just administering it different form? If so, then I think I will leave off changing over until I have got used to half dosage of the Hydroxy. Can anyone help me with making my decision, would be very grateful. :? :?

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  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    I have been doing the injections for over seven years (to support my humira injections) and I know it is effective because my bloods are good and the PsA is under control. As the injections avoid the digestion process nausea is unlikely to be a problem and, as one tends to receive a more concentrated 'whack' of the med because of this factor, it could be that a reduced dosage might be an option. As meth is already in your system there won't be any time lag but there might be a more noticeable improvement in your condition. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • Dragonfly17
    Dragonfly17 Member Posts: 47
    edited 30. Nov -1, 00:00
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    Many thanks DD, and yes he did suggest a lower dosage too. As I am still having "twinges" daily in various areas I suppose that is another reason he suggested the change over - as you said it may give me improve my condition. Will contact Rheumy next week to speak with nurse re change over. Thanks once again for helping my decision. :)
  • stickywicket
    stickywicket Member Posts: 27,710
    edited 30. Nov -1, 00:00
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    I hope your 'pen' fears are unfounded and all works well for you.
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • Dragonfly17
    Dragonfly17 Member Posts: 47
    edited 30. Nov -1, 00:00
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    Hi Sticky, it's a combination of two things, 1) I hate those little snicks more than a full blown needle and 2) hate anything to do with my thighs (stems from when a child it was where my mother always smacked me :lol: ), but am willing to give it a try, we'll see how it goes. Hope all is well with you. :D
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    Whilst it's true that with the pen the needle is hidden I know it's going to happen as soon as I press the plunger - and it's done in a trice. I do not feel it happening but I may, occasionally, feel a sting from the jollop. I use my thighs as I reserve the stomach for my humira (a much bigger whack of stuff so I prefer that area because it has fewer pain receptors) but I do not do it standing or sitting as this tenses the thigh muscles. I sit on the bed with my legs out in front, with a pillow under my knees so my thigh muscles are nicely relaxed. I hope you are able to do it, it may be the answer you need: please let us know how you get on. DD

    PS I can still feel the slap of a wet tea towel behind the knees, courtesy of Ma, if she felt I'd overstepped an invisible (to me) line!
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • Dragonfly17
    Dragonfly17 Member Posts: 47
    edited 30. Nov -1, 00:00
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    Well still haven't changed over the pen, rheumy nurses are in short supply at the moment due to illnesses; someone should get back to me on Friday, but will have to wait and see.
    Went back on the hydroxy last Thursday, have to say "tummy" problems have stopped :D But on the minus side getting lots of pains and in some areas I had not had before. I had thought that just 10 days off would not make a difference but not the case, or maybe it's because dosage was halved to 200 mg daily. Really need that chat with rheumy nurse.
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    One of the many arthritic rites of passage is to think that a med isn't doing anything, so we stop it only to discover that it was. Another one is to find that side-effects can dwindle and another is to find that aches and pains crop up in new areas: fun, innit? :wink:

    My meth and humira are delivered by Healthcare at Home, a company my hospital uses. They deliver regular amounts at regular intervals, including sharps etc. Many of us on here are under their 'rule' and I expect that you will be at some point. Have you stopped the tablet meth altogether? I know I should remember but I'm not too bonny, my brain isn't working as it should. :( DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • Dragonfly17
    Dragonfly17 Member Posts: 47
    edited 30. Nov -1, 00:00
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    Hi DD, no I haven't stopped mtx am still taking 25 mg on a Monday, but have to say since stopped hydroxy for 10 days and then continued on reduced dosage the nausea has stopped as well as the tummy probs. So looks like it was the hydroxy causing the them. Now though it seems that reduced hydroxy is not enough to keep pains/stiffness at bay. They are quite bad, especially my knees, feet and hands. Rheumy nurse called back late this afternoon (although I had been told there were none in) but I was in shower and missed the call. Said would call back tomorrow, but have hospital appt at 10.30 for bloods re pre-diabetes so hope they don't call until afternoon.
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    Thank you for the clarification, I appreciate it. It can take some time to find the right combination of meds to make a difference and I hope that happens for you soon. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • Dragonfly17
    Dragonfly17 Member Posts: 47
    edited 30. Nov -1, 00:00
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    Well rheumy nurse got back to me this evening and after discussion she feels the change over to a "pen" will help with my pains which she feels is a result of reducing my hydroxy as requested by my consultant. Now awaiting letter to give me appointment with nurse to show me how to inject myself - probably take a couple of weeks. So things are on the move, just hope she is right cos things are getting really troublesome at the moment.
  • stickywicket
    stickywicket Member Posts: 27,710
    edited 30. Nov -1, 00:00
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    I hope she is too. It's just unfortunate that we all react differently to things so so much is a matter of trial and error.
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • Dragonfly17
    Dragonfly17 Member Posts: 47
    edited 30. Nov -1, 00:00
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    Well went to hospital on Friday and went through procedure for administering the mtx via a "pen". Injected myself and all my fears flew out the winder, didn't even feel it! Still got the foggy feeling few hours later and was very tired the next morning but things got better as Saturday wore on. Seems to be much better, but wont know for a few weeks if it is working okay; back to blood tests every 2 weeks for a while. Still having more pain the all joints, and right knee has been very painful for couple of days, tried to tell rheumy nurse that I think it's down the the decreased dose of hydroxy but she wants me to wait a while to see if the change over to "pen" make a difference !! Not quite sure where she is coming from but can only do as they ask; so it's a waiting game for the moment.
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    I am so pleased that your first self-injection went well, what a boost for your confidence, yes? When doing it at home don't forget to sit on the bed, legs supported but gently straight so your thigh muscles are relaxed to further reduce discomfort. I occasionally feel extra tired a day or so after my injection but that is the only side effect I have and is perfectly manageable. In my case meth has never reduced pain levels (none of the DMARDs or NSAIDs have) but hopefully things will be different for you: I would offer to keep my fingers crossed but as they are currently as flexible as chopsticks I won't.

    I'm due to restart mine at the end of this week, I am very hopeful that it won't trigger another bout of illness. Time will tell. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • dibdab
    dibdab Member Posts: 1,498
    edited 30. Nov -1, 00:00
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    Hi Dragonfly,

    When you use injected methotrexate your body absorbs more than when you take tablets(or at least that's what my rheumy nurse told me) so perhaps she thinks the better absorption will mean your disease is better controlled?

    Often when I change meds/doses the rheumy team offer a steroid jab to damp down the inflammation-I wonder if you could ask about something similar.....it might help whilst stuff settles.

    Deb
  • Dragonfly17
    Dragonfly17 Member Posts: 47
    edited 30. Nov -1, 00:00
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    Thanks for getting back DD and Deb. Things are still very uncomfortable with my knees and hands, seem to have no strength in thumbs and the cold weather doesn't help (we have about 6 inches for snow over night and during today). It's hard to tell if the problems are due to lower dosage in meds, cold weather or a renewed flareup. Was thinking of taking paracetamol but not want to
    started taking painkillers in case I get used to them and then they are of no help when things are very bad! This RA is like wading through treacle. hcold
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    Over my arthritic years I have stopped trying to find the culprit for difficulties, it will do what it will do and very often the cause is something out of my control such as cold or damp weather.

    The use of pain relief is a personal thing, if you are able to manage without then that is a good thing but it does have a valuable role. Paracetamol is an ABC med in that it's available, basic and cheap; it will blunt a small amount of the sharper edges and so make life more comfortable, an emotional and physical benefit which is rare enough in our worlds. It's true that addiction to the stronger meds can become a problem for some but these are prescribed by a GP and if that slide is beginning it will be detected and action will be taken. I don't recall my days when paracetamol was useful, now I take a small daily dose of 30/500 cocodamol to help me get through, sometimes I don't take it if nothing is on the agenda but that doesn't mean I don't need it. I am not concerned about addiction but, thanks to the work I have been doing with my PT, I am beginning to wonder if I could reduce to 18/500 (GP prescribed) or 12/500 (which can be bought OTC). I am in control, not the pain. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
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