Re: Methotrexate and Antibiotics

[Guest guest]

Oral antibiotics such as tetracycline, chloramphenicol, and

nonabsorbable broad spectrum antibiotics, may decrease intestinal

absorption of methotrexate or interfere with the enterohepatic

circulation by inhibiting bowel flora and suppressing metabolism of the

drug by bacteria.

Penicillins may reduce the renal clearance of methotrexate; increased

serum concentrations of methotrexate with concomitant hematologic and

gastrointestinal toxicity have been observed with high and low dose

methotrexate. Use of methotrexate with penicillins should be carefully

monitored.

http://www.rxlist.com/cgi/generic/mtx_wcp.htm

http://www.rheumatic.org/mtx.htm

a

On Monday, June 30, 2003, at 08:57 PM, jekee2 wrote:

> I have rheumatoid arthritis and lupus (diagnosed about 5 yrs ago) and

> am

> taking hydroxychloroquine, vioxx, and methotrexate. I cannot use any

> steriods because I'm also bipolar and have gone into mania with

> steroids.

> (lots of meds for the bipolar) I added the methotrexate last fall,

> and it initially

> worked miracles. However, I get sick all the time (two kids who like

> to share

> their germs!) and have to go on antibiotics for numerous viruses that

> progress

> into worse things (pneumonia a few months ago, just getting over ear

> and

> sinus infection now). It takes weeks for me to get over things, and my

> rheumatologist has told me that I can't be on methotrexate when I'm on

> antibiotics. Unfortunately, when I got off my methotrexate my pain and

> exhaustion get much worse on top of trying to fight off infections.

> My sister is

> also on methotrexate, but her doctor never told her about stopping it

> while on

> antiobiotics. I'm to the point where I have to avoid anyone even

> mildly sick,

> which is difficult when I have two children and like to volunteer in

> my six year

> old's class at school. Has anyone had any experiences with this

> methotrexate/antibiotics complication? I'll take any advice! Thanks!

>

>

>

[Guest guest]

Hi! Welcome to the group! Sorry you're having such difficulty.

I believe your physician is wise to be careful about giving you

antibiotics while you are on MTX. Here's and abstract of one case:

http://link.springer-ny.com/link/service/journals/10067/bibs/1020001/10200073.ht\

m

Note that the authors conclude:

" Our case suggests that low-dose MTX may seriously interact with

antibiotics and that these side-effects should always be considered when

RA patients are treated with MTX and antibiotics. "

Here's a more general caution from RxMed on Rheumatrex:

" Oral antibiotics such as tetracycline, chloramphenicol and

nonabsorbable broad spectrum antibiotics, may decrease intestinal

absorption of methotrexate or interfere with enterohepatic circulation

by inhibiting bowel flora and suppressing metabolism of the drug by

bacteria. Trimethoprim/sulfamethoxazole has been reported to increase

bone marrow depression in a few patients receiving methotrexate.

Therefore, caution should be used when NSAIDs, salicylates, and the

aforementioned drugs are administered concomitantly with methotrexate. "

[ ] methotrexate and antibiotics

> I have rheumatoid arthritis and lupus (diagnosed about 5 yrs ago) and

am

> taking hydroxychloroquine, vioxx, and methotrexate. I cannot use any

> steriods because I'm also bipolar and have gone into mania with

steroids.

> (lots of meds for the bipolar) I added the methotrexate last fall,

and it initially

> worked miracles. However, I get sick all the time (two kids who like

to share

> their germs!) and have to go on antibiotics for numerous viruses that

progress

> into worse things (pneumonia a few months ago, just getting over ear

and

> sinus infection now). It takes weeks for me to get over things, and

my

> rheumatologist has told me that I can't be on methotrexate when I'm on

> antibiotics. Unfortunately, when I got off my methotrexate my pain

and

> exhaustion get much worse on top of trying to fight off infections.

My sister is

> also on methotrexate, but her doctor never told her about stopping it

while on

> antiobiotics. I'm to the point where I have to avoid anyone even

mildly sick,

> which is difficult when I have two children and like to volunteer in

my six year

> old's class at school. Has anyone had any experiences with this

> methotrexate/antibiotics complication? I'll take any advice! Thanks!

[Guest guest]

i have had minor bladder infections and taken antibiotics with my mtx. knock

on wood i don't get as sick as i did on enbrel or remicade. good luck. kathy

in il

[Guest guest]

Dear Paige- MTX suppresses your immune system making you much more susceptible to things like strep. If the RD is prescribing augmentin its to counteract the negative effect of taking mtx. Strep is a very very serious problem when you are healthy let alone immunosuppressed. If she is prescribing as a precaution, just ask her if its safe. You can ask her why they warn of a drug interaction. Happy Holidays, Deborah

On 12/21/06, Paige <paigec38@...> wrote:

Good morning:Both my children have strep throat and I woke up yesterday with symptoms. I saw my family doctor and told her all the medications that I'm on, including injectable methotrexate. She prescribed me Augmentin which is in the Penicillin family, although she doesn't think I have Strep Throat. She did so as a precaution with the holidays coming up, etc.I ran the drug interactions and saw that one should not take antibiotics with methotrexate, specifically those of the Penicillin class. I'm going to call my rheumatologist today, but please share your experiences or thoughts......

[Guest guest]

wow I've never heard of that ...I just took antibiotics too for a severe sinus infection and I still took my methotrexate. You'll have to let us know what your doc says. Paige <paigec38@...> wrote: Good morning:Both my children have strep throat and I woke up yesterday with symptoms. I saw my family doctor and told her all the medications that I'm on, including injectable methotrexate. She prescribed me Augmentin which is in the Penicillin family, although she

doesn't think I have Strep Throat. She did so as a precaution with the holidays coming up, etc.I ran the drug interactions and saw that one should not take antibiotics with methotrexate, specifically those of the Penicillin class. I'm going to call my rheumatologist today, but please share your experiences or thoughts...... __________________________________________________

[Guest guest]

That was the first thing my Rheumy told me

when the possibility came about me getting MTX. Apparently there have

been one or several cases here in Switzerland where people nearly

died with that combination. I do not remember what kind of antibiotics he

was talking about but he was very serious about it. I went onto Enbrel so

that didn’t concern me anymore. Just thought I share.

Happy holidays,

From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of

Sent: Sonntag, 24. Dezember 2006

07:34

Rheumatoid Arthritis

Subject: Re:

Methotrexate and Antibiotics

wow I've never heard of that ...I just took antibiotics too for a

severe sinus infection and I still took my methotrexate. You'll have to let us

know what your doc says.

Paige <paigec38 >

wrote:

Good morning:

Both my children have strep throat and I woke up yesterday with symptoms. I saw

my family

doctor and told her all the medications that I'm on, including injectable

methotrexate. She

prescribed me Augmentin which is in the Penicillin family, although she doesn't

think I have

Strep Throat. She did so as a precaution with the holidays coming up, etc.

I ran the drug interactions and saw that one should not take antibiotics with

methotrexate,

specifically those of the Penicillin class. I'm going to call my rheumatologist

today, but

please share your experiences or thoughts......

__________________________________________________

[Guest guest]

I've had sinus infections and was given amoxicillin (sp) with MTX. I called my rd's office and they told me to skip the next dose of mtx and take the next one. The antibiotic was for 10 days so I only missed one week of MTX. Whenever I have a cold I have to skip humira. Doing that right now grrrr.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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Paige <paigec38 > wrote:

Good morning:Both my children have strep throat and I woke up yesterday with symptoms. I saw my family doctor and told her all the medications that I'm on, including injectable methotrexate. She prescribed me Augmentin which is in the Penicillin family, although she doesn't think I have Strep Throat. She did so as a precaution with the holidays coming up, etc.I ran the drug interactions and saw that one should not take antibiotics with methotrexate, specifically those of the Penicillin class. I'm going to call my rheumatologist today, but please share your experiences or thoughts......

..