RE: Guidelines for Skipping A Dose

October 8, 2001

Georgina,

Abbie was told to skip a dose of mtx with a sinus infection. It had to do with the fact that the antibiotic was doing what the mtx would and too much would be like overkill on her white cells (or something like that). The doctor wasn't too concerned one way or the other, but said it would probably be a good idea. She has had infections in the past and not skipped, so I don't know why she did this time except that I raised the question. A nurse had warned me that if she ran a fever or was on an antibiotic I should question it. I understand as little about this as I did before. Hopefully someone else can explain it better.

Christy

October 8, 2001

Hi Georgina,

Jordan started on MTX the early part of March. The only thing that

his rheumy said was that it was a good thing that he'd had the

chicken pox (over 5000 on his body the december before). They said

that if your child HASN'T had them or the vaccine, and if they are in

contact with them, to discontinue the MTX immediately and call the

rheumy. Luckily we didn't have that problem, he just seems to have a

cold every time I turn around.

We go back to the rheumy Nov 6 for his checkup, hopefully all will

still be fine then. Will keep you updated.

Take Care

Lori - Jordan's mom 5 -systemic

> Hi,

>

> One of my questions in the messages that I never got to post (!!!!)

was

> asking about the guidelines for skipping a dose of a regular med. As

> often as I've read that our children may sometimes need to skip a

dose

> of a med (like MTX) when they are sick, we've never had to do so.

Last

> week I left a message for the rheumatologist, saying that Josh was

put

> on an antibiotic (Cephalexin) for 10 days and I wondered if that

meant

> we should forego his MTX that week. The nurse phoned back with a

message

> that the doctor said to go right ahead with it, as planned. I think

> that's only the second time I had concerns about whether he may have

> been too sick to take his MTX. Both times the doctor said to go

ahead

> and give it to him.

>

> Does anybody here know more about the recommended guidelines? Have

> children here had to postpone a dose of a med (methotrexate, or some

> other med like Enbrel or something) because of an infection? What

are

> the indications for doing this?

>

> Thanks, in advance,

> Georgina

> (, age 12, systemic)

>

> PS ... I wish I could remember some of my other questions. I'm sure

I

> will eventually

October 8, 2001

Haven't had to skip because of sickness, but did have to skip because of

surgery.

Meghann had to skip her dose before and her dose after surgery on MTX and

skip her daily doses of sulindac (clinoril) for a week before and a week

after.

Surgery was to her elbow.

Sharon and Meghann

JRA and PRS

Guidelines for Skipping A Dose

> Hi,

>

> One of my questions in the messages that I never got to post (!!!!) was

> asking about the guidelines for skipping a dose of a regular med. As

> often as I've read that our children may sometimes need to skip a dose

> of a med (like MTX) when they are sick, we've never had to do so. Last

> week I left a message for the rheumatologist, saying that Josh was put

> on an antibiotic (Cephalexin) for 10 days and I wondered if that meant

> we should forego his MTX that week. The nurse phoned back with a message

> that the doctor said to go right ahead with it, as planned. I think

> that's only the second time I had concerns about whether he may have

> been too sick to take his MTX. Both times the doctor said to go ahead

> and give it to him.

>

> Does anybody here know more about the recommended guidelines? Have

> children here had to postpone a dose of a med (methotrexate, or some

> other med like Enbrel or something) because of an infection? What are

> the indications for doing this?

>

> Thanks, in advance,

> Georgina

> (, age 12, systemic)

>

> PS ... I wish I could remember some of my other questions. I'm sure I

> will eventually

>

> For links to websites about arthritis and JRA, visit:

> http://www.geocities.com/Heartland/Village/8414/Links.html

>

October 8, 2001

Our daughter just started mtx last week. She sees a dr at Seattle

Childrens. The dr gave us these instructions:

DO NOT take the antibiotics SEPTRA or BACTRIM. All other antibiotics

are okay.

Please get a flu shot every year while taking the medication.

DO NOT take if you have a fever greater than 101 F.

DO NOT take if you have chickenpox.

He ran a chicken pox titer because we don't know if she is immune. If

not if she has obvious exposure she will have to come in for

immunoglobulin. (theu gave other instructions too but those are the

do

nots.)

Hope that is helpful. And when in doubt call your dr.

--e

October 9, 2001

Georgina

the only time i was told to not give doese of certain meds were

with prednisone and one of her inhalers the antibotics are given to her with

any infection as precaution even with a ingrown toenail or finger nail

something minor as that could lead to something worser

as with any new medication i always check them out and talk with the pharmacy

with any reactions i need to notice

you cant be cautioned enough though

i have been told on her medication on a scale which to give her under the

pain scale

my brother in law takes dilantin (seizure med) and has been on and off of

antibotics

the one you mentioned hes on now and has been for a week or more

so far hes doing good on it without any side effects

Robbin

October 9, 2001

Georgina, when was really sick in february, I recall the doctor telling me to hold off on the MTX because it would help prolong the illness. I think I held off for 4 or 5 days. It didn't do anything bad, she had such a bad cold, it didn't matter. I also recall that is when they stopped the Cyclosporine too. If he isn't too sick, I'd give it to him, but if he is really ill, I'd hold off.

Pat

October 9, 2001

Dear Georgina,

Kate's currently on Ibuprofen and Enbrel--and when she has a very bad

cold or sinus cold etc... her dr. will pull her off the Enbrel due to

the fact that Enbrel users are more prone to upper respitory

infections--so if they have one it could make it worse--(pneaumonia and

bronchitis being the scare) She was also pulled off it for 10 days

recently when chickenpox went through her school--just to be on the safe

side. She's been pulled off all meds prior to and after a colonoscopy,

sigmoidoscopy and flexoidoscopy (stomach problems) due to the increased

risk of infection and or bleeding. Was also pulled of Methotrexate (was

taking it at that time) and Naprosyn when she had to have a 2 hour

dental procedure done--in outpatient surgery. I think maybe it's all a

matter or what the dr. thinks--but if you read the risk warnings I think

sometimes it's not a bad idea to pull them at times depending on the

situation etc...

and Kate--(7 poly and avn of hips)

P.S.

Kate goes for more x-rays this week on her hips--dr. not sure what's

up--thinking more avascular necrosis problem acting up. So saying a lot

of prayers as we don't want her to have to have hip surgery.

October 9, 2001

Hi Georgina:

I guess the 'skipping a dose' issue is another one of those calls that different doctors differ on. Mickey has had her mtx suspended 3 times now, for 3 or 4 weeks each time, because of exposure to chicken pox. Each time she had to have a shot of something to boost her immune system (can't think of the name right now) - and each time they took her off the mtx to allow her immune system to fight the (possible) chicken pox. We finally missed one exposure, I guess, and she ended up with chicken pox... and was on acyclovir to fight it. It all turned out okay and we were very relieved she'd finally had them (with no terrible complications) and we could stop acting the the Centre for Disease Control/Chicken Pox, in our town!!!!! : )

Anyway, that's the only times Mickey's docs' took her off the mtx, so again, I guess its an individual call by different doctors.

Lynn

From: Georgina <gmckin@...>

Reply-

Date: Mon, 08 Oct 2001 13:11:04 -1000

a JRA List < >

Subject: Guidelines for Skipping A Dose

Hi,

One of my questions in the messages that I never got to post (!!!!) was

asking about the guidelines for skipping a dose of a regular med. As

often as I've read that our children may sometimes need to skip a dose

of a med (like MTX) when they are sick, we've never had to do so. Last

week I left a message for the rheumatologist, saying that Josh was put

on an antibiotic (Cephalexin) for 10 days and I wondered if that meant

we should forego his MTX that week. The nurse phoned back with a message

that the doctor said to go right ahead with it, as planned. I think

that's only the second time I had concerns about whether he may have

been too sick to take his MTX. Both times the doctor said to go ahead

and give it to him.

Does anybody here know more about the recommended guidelines? Have

children here had to postpone a dose of a med (methotrexate, or some

other med like Enbrel or something) because of an infection? What are

the indications for doing this?

Thanks, in advance,

Georgina

(, age 12, systemic)

PS ... I wish I could remember some of my other questions. I'm sure I

will eventually

October 10, 2001

Georgina, The doctors that Tabitha has had and plus the one now has never

stopped her mtx..when she was sick with anything..even way back when she had

chicken pox. The only thing that they do watch is if she has a sinus

infection and prescribes meds. to take care of it before she gets her

remicade...now i remember when she was going to get surgery i to stop

certain meds like a week before the surgery. But other than that no time.

But maybe with sys. jra..it is different..and like everyone says every

doctor is different...wish we could eventually get to a place where everyone

agrees on what is best..lol.

take care

karen (tabitha..poly)

From: Lynn Young <llyoung@...>

Reply-

< >

Subject: Re: Guidelines for Skipping A Dose

Date: Tue, 09 Oct 2001 21:03:53 -0400

Hi Georgina:

I guess the 'skipping a dose' issue is another one of those calls that

different doctors differ on. Mickey has had her mtx suspended 3 times now,

for 3 or 4 weeks each time, because of exposure to chicken pox. Each time

she had to have a shot of something to boost her immune system (can't think

of the name right now) - and each time they took her off the mtx to allow

her immune system to fight the (possible) chicken pox. We finally missed one

exposure, I guess, and she ended up with chicken pox... and was on acyclovir

to fight it. It all turned out okay and we were very relieved she'd finally

had them (with no terrible complications) and we could stop acting the the

Centre for Disease Control/Chicken Pox, in our town!!!!! : )

Anyway, that's the only times Mickey's docs' took her off the mtx, so again,

I guess its an individual call by different doctors.