Methotrexate and folic acid dosage in RA

[Guest guest]

Susie,

The physician prescribing methotrexate takes into account, among other

things, your diagnosis and the severity of your disease, and should bear in

mind your body weight (they are supposed to when prescribing for children

but may be a bit more lax with adults). In the US, the typical range for

adults with RA is from 7.5 mg to 25 mg per week. Folic acid is recommended

at a dosage of from 1 mg to 5 mg (1000 mcg to 5000 mcg) per day.

http://hopkins-arthritis.org/rheumatoid/rheum_treat.html#meth

http://www.orthop.washington.edu/arthritis/medications/methotrexate/print

http://clinical.caregroup.org/altmed/interactions/Drugs/Methotrexate.htm

Re: [ ] Methotrexate

> Thanks for responding Judy & Joyce.

> I do take the folic acid. I have been on it since about 5 months before

> I started the Methotrexate.

> How do they come to the AMOUNT of METHOTREXATE they give you?

> Do they go by body weight? I weigh 100, maybe it is a little too much I

> am taking?

> Susie

[Guest guest]

,

I should have read my messages before responding to Susie.

The first

5 sites I pulled up all say 20mg is the max, but I see one

of the sites you posted say

25mg is the max. I couldn't find anything about the

relationship of body weight to the mtx dosage. I know they

are supposed to consider body weight, but none of the sites

I

searched mentioned body weight.

a

[ ] Methotrexate and folic acid dosage

in RA

Susie,

The physician prescribing methotrexate takes into account,

among other

things, your diagnosis and the severity of your disease,

and should bear in

mind your body weight (they are supposed to when

prescribing for children

but may be a bit more lax with adults). In the US, the

typical range for

adults with RA is from 7.5 mg to 25 mg per week. Folic

acid is recommended

at a dosage of from 1 mg to 5 mg (1000 mcg to 5000 mcg)

per day.

http://hopkins-arthritis.org/rheumatoid/rheum_treat.html#met

h

http://www.orthop.washington.edu/arthritis/medications/metho

trexate/print

http://clinical.caregroup.org/altmed/interactions/Drugs/Meth

otrexate.htm

Re: [ ] Methotrexate

> Thanks for responding Judy & Joyce.

> I do take the folic acid. I have been on it since about

5 months before

> I started the Methotrexate.

> How do they come to the AMOUNT of METHOTREXATE they give

you?

> Do they go by body weight? I weigh 100, maybe it is a

little too much I

> am taking?

> Susie

[Guest guest]

a,

I've read in several places things like this:

" A safe and effective methotrexate treatment plan must be tailored for each

patient. Factors that must be weighed include renal function, age, and body

weight. "

Source:

http://www.medscape.com/Medscape/Rheumatology/AskExperts/2000/08/RHEU-ae12.html

Below I have included another reference that also mentions body weight as a

consideration when prescribing methotrexate in RA.

Given two people with the very same clinical picture, but one weighs 100

pounds and the other weighs 250, it would be wise for the doctor to consider

body weight before deciding on the dosage of MTX.

I know 25 mg seems high, especially compared to 7.5 mg, but it is still

considered " low dose " methotrexate. I have seen 30 mg mentioned as an upper

limit in more than one place. Here is an example:

http://www.postgradmed.com/issues/1998/02_98/grem.htm

Many clinicians don't want to give more than 15 or 20 mg per week because of

toxicity concerns, but the physician can decide to give more and monitor the

patient very carefully. The chosen dosage will depend on the doctor's

judgment given the patient's clinical status and, later, response to the

MTX.

Although some physicians like to start with the standard 7.5 mg per week and

work up to a higher amount if necessary, there are other strategies.

From the book, " Rheumatoid Arthritis: New Frontiers in Pathogenesis and

Treatment " edited by Firestein, Panayi, and Wollheim (2000, Oxford

University Press):

" Today, MTX treatment can be recommended as single or combination therapy

not only after failure of other DMARDs but as initial treatment in patients

with active disease. MTX can be administered orally or by intramuscular,

intravenous, or subcutaneous injection with doses ranging from 7.5 - 25 mg

once a week. The dose depends on body weight, gender, renal function,

concomitant disease, general health status, and disease activity.

We usually start treatment with a relatively high dose of 15 - 25 mg given

parenterally to exclude the individual differences in bioavailability of

oral medication and to achieve a rapid response; after 6 - 12 weeks, we

switch to oral medication in most patients and adjust the dose according to

efficacy and tolerability. Most rheumatologists prefer to start with lower

oral doses and to increase dosage subsequently. In the case of adverse

events, tolerability can be improved by administering the drug in the evening

or in two equal doses in the morning and evening of the same day, by

changing the route of administration (parenteral versus oral), reducing the

dose, or supplementation of folic acid.... "

As implied by the above passage, there is a difference in bioavailablilty in

the oral versus parenteral form of MTX, so that, too, can influence what the

dosage is chosen to be.

RE: [ ] Methotrexate and folic acid dosage in RA

> ,

> I should have read my messages before responding to Susie.

> The first

> 5 sites I pulled up all say 20mg is the max, but I see one

> of the sites you posted say

> 25mg is the max. I couldn't find anything about the

> relationship of body weight to the mtx dosage. I know they

> are supposed to consider body weight, but none of the sites

> I

> searched mentioned body weight.

> a

[Guest guest]

,

Thanks . I know I've read it somewhere that doses up

to 30mg has been prescribed,

but I didn't have any luck finding that site. I guess some

doctors don't think 25mg is a high dose for someone that is

just 100lbs. But all the sites I read all say the same

thing that the

bleeding should be reported to the doctor immediately.

Maybe just adjusting the dose or

upping the folic acid is all that's needed, especially for

someone that the mtx is working for.

I'll keep this post handy for future reference. I think

it's interesting to see the differences in

opinions between the different rheumatologists and their

choice of treatment.

a

Re: [ ] Methotrexate and folic acid

dosage in RA

a,

I've read in several places things like this:

" A safe and effective methotrexate treatment plan must be

tailored for each

patient. Factors that must be weighed include renal

function, age, and body

weight. "

Source:

http://www.medscape.com/Medscape/Rheumatology/AskExperts/200

0/08/RHEU-ae12.html

Below I have included another reference that also mentions

body weight as a

consideration when prescribing methotrexate in RA.

Given two people with the very same clinical picture, but

one weighs 100

pounds and the other weighs 250, it would be wise for the

doctor to consider

body weight before deciding on the dosage of MTX.

I know 25 mg seems high, especially compared to 7.5 mg,

but it is still

considered " low dose " methotrexate. I have seen 30 mg

mentioned as an upper

limit in more than one place. Here is an example:

http://www.postgradmed.com/issues/1998/02_98/grem.htm

Many clinicians don't want to give more than 15 or 20 mg

per week because of

toxicity concerns, but the physician can decide to give

more and monitor the

patient very carefully. The chosen dosage will depend on

the doctor's

judgment given the patient's clinical status and, later,

response to the

MTX.

Although some physicians like to start with the standard

7.5 mg per week and

work up to a higher amount if necessary, there are other

strategies.

From the book, " Rheumatoid Arthritis: New Frontiers in

Pathogenesis and

Treatment " edited by Firestein, Panayi, and Wollheim

(2000, Oxford

University Press):

" Today, MTX treatment can be recommended as single or

combination therapy

not only after failure of other DMARDs but as initial

treatment in patients

with active disease. MTX can be administered orally or by

intramuscular,

intravenous, or subcutaneous injection with doses ranging

from 7.5 - 25 mg

once a week. The dose depends on body weight, gender,

renal function,

concomitant disease, general health status, and disease

activity.

We usually start treatment with a relatively high dose of

15 - 25 mg given

parenterally to exclude the individual differences in

bioavailability of

oral medication and to achieve a rapid response; after 6 -

12 weeks, we

switch to oral medication in most patients and adjust the

dose according to

efficacy and tolerability. Most rheumatologists prefer to

start with lower

oral doses and to increase dosage subsequently. In the

case of adverse

events, tolerability can be improved by administering the

drug in the evening

or in two equal doses in the morning and evening of the

same day, by

changing the route of administration (parenteral versus

oral), reducing the

dose, or supplementation of folic acid.... "

As implied by the above passage, there is a difference in

bioavailablilty in

the oral versus parenteral form of MTX, so that, too, can

influence what the

dosage is chosen to be.

RE: [ ] Methotrexate and folic acid

dosage in RA

> ,

> I should have read my messages before responding to

Susie.

> The first

> 5 sites I pulled up all say 20mg is the max, but I see

one

> of the sites you posted say

> 25mg is the max. I couldn't find anything about the

> relationship of body weight to the mtx dosage. I know

they

> are supposed to consider body weight, but none of the

sites

> I

> searched mentioned body weight.

> a

[Guest guest]

I called my doctor today about the gums bleeding. They are still seeping

off and on.

Anyway...

They said, " Don't worry...common side effect. You must just be getting a

bug or virus or something. "

And that was that. I tried to question things, but they just blew it

off. Like no big deal. So I just said ok.

So tomorrow I am suppose to let my husband give me my next injection. I

am scared to death. I just don't know what to do.

They never did do an initial chest x-ray. And it has been since first of

September since any blood work. How often are they suppose to check

platelets? Blood?

Susie

a wrote:

> ,

> Thanks . I know I've read it somewhere that doses up

> to 30mg has been prescribed,

> but I didn't have any luck finding that site. I guess some

> doctors don't think 25mg is a high dose for someone that is

> just 100lbs. But all the sites I read all say the same

> thing that the

> bleeding should be reported to the doctor immediately.

> Maybe just adjusting the dose or

> upping the folic acid is all that's needed, especially for

> someone that the mtx is working for.

> I'll keep this post handy for future reference. I think

> it's interesting to see the differences in

> opinions between the different rheumatologists and their

> choice of treatment.

> a

>

> Re: [ ] Methotrexate and folic acid

> dosage in RA

>

>

> a,

>

> I've read in several places things like this:

>

> " A safe and effective methotrexate treatment plan must be

> tailored for each

> patient. Factors that must be weighed include renal

> function, age, and body

> weight. "

>

> Source:

>

> http://www.medscape.com/Medscape/Rheumatology/AskExperts/200

> 0/08/RHEU-ae12.html

>

> Below I have included another reference that also mentions

> body weight as a

> consideration when prescribing methotrexate in RA.

>

> Given two people with the very same clinical picture, but

> one weighs 100

> pounds and the other weighs 250, it would be wise for the

> doctor to consider

> body weight before deciding on the dosage of MTX.

>

> I know 25 mg seems high, especially compared to 7.5 mg,

> but it is still

> considered " low dose " methotrexate. I have seen 30 mg

> mentioned as an upper

> limit in more than one place. Here is an example:

>

> http://www.postgradmed.com/issues/1998/02_98/grem.htm

>

> Many clinicians don't want to give more than 15 or 20 mg

> per week because of

> toxicity concerns, but the physician can decide to give

> more and monitor the

> patient very carefully. The chosen dosage will depend on

> the doctor's

> judgment given the patient's clinical status and, later,

> response to the

> MTX.

>

> Although some physicians like to start with the standard

> 7.5 mg per week and

> work up to a higher amount if necessary, there are other

> strategies.

>

> From the book, " Rheumatoid Arthritis: New Frontiers in

> Pathogenesis and

> Treatment " edited by Firestein, Panayi, and Wollheim

> (2000, Oxford

> University Press):

>

> " Today, MTX treatment can be recommended as single or

> combination therapy

> not only after failure of other DMARDs but as initial

> treatment in patients

> with active disease. MTX can be administered orally or by

> intramuscular,

> intravenous, or subcutaneous injection with doses ranging

> from 7.5 - 25 mg

> once a week. The dose depends on body weight, gender,

> renal function,

> concomitant disease, general health status, and disease

> activity.

>

> We usually start treatment with a relatively high dose of

> 15 - 25 mg given

> parenterally to exclude the individual differences in

> bioavailability of

> oral medication and to achieve a rapid response; after 6 -

> 12 weeks, we

> switch to oral medication in most patients and adjust the

> dose according to

> efficacy and tolerability. Most rheumatologists prefer to

> start with lower

> oral doses and to increase dosage subsequently. In the

> case of adverse

> events, tolerability can be improved by administering the

> drug in the evening

> or in two equal doses in the morning and evening of the

> same day, by

> changing the route of administration (parenteral versus

> oral), reducing the

> dose, or supplementation of folic acid.... "

>

> As implied by the above passage, there is a difference in

> bioavailablilty in

> the oral versus parenteral form of MTX, so that, too, can

> influence what the

> dosage is chosen to be.

>

>

>

> RE: [ ] Methotrexate and folic acid

> dosage in RA

>

>

> > ,

> > I should have read my messages before responding to

> Susie.

> > The first

> > 5 sites I pulled up all say 20mg is the max, but I see

> one

> > of the sites you posted say

> > 25mg is the max. I couldn't find anything about the

> > relationship of body weight to the mtx dosage. I know

> they

> > are supposed to consider body weight, but none of the

> sites

> > I

> > searched mentioned body weight.

> > a

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

According to the American College of Rheumatology, every 4-8

weeks is what

they recommend for patients on mtx.

http://www.rheumatology.org/research/guidelines/ra-drug/ra-d

rug.html

You're within the recommended time. When are you due to go

back? How long

have you been on mtx and at what dose? I don't blame you

for being scared

especially after reading all this information that says that

it's something that the

doctor should be made aware of immediately. I don't know

what to say about

his opinion that it's a common side effect. I'm glad that

you called him. I guess

if it were me, I'd call him back and tell him what I read

and tell him that I'm uncomfortable

about taking the injection without a blood test to check my

platelets. But that's just

what I would do. I don't know your situation or your

relationship with your doctor.

If you're really upset about it, call him back. Remember he

works for you.

a

Re: [ ] Methotrexate and folic acid

> dosage in RA

>

>

> a,

>

> I've read in several places things like this:

>

> " A safe and effective methotrexate treatment plan must

be

> tailored for each

> patient. Factors that must be weighed include renal

> function, age, and body

> weight. "

>

> Source:

>

>

http://www.medscape.com/Medscape/Rheumatology/AskExperts/200

> 0/08/RHEU-ae12.html

>

> Below I have included another reference that also

mentions

> body weight as a

> consideration when prescribing methotrexate in RA.

>

> Given two people with the very same clinical picture,

but

> one weighs 100

> pounds and the other weighs 250, it would be wise for

the

> doctor to consider

> body weight before deciding on the dosage of MTX.

>

> I know 25 mg seems high, especially compared to 7.5

mg,

> but it is still

> considered " low dose " methotrexate. I have seen 30 mg

> mentioned as an upper

> limit in more than one place. Here is an example:

>

> http://www.postgradmed.com/issues/1998/02_98/grem.htm

>

> Many clinicians don't want to give more than 15 or 20

mg

> per week because of

> toxicity concerns, but the physician can decide to

give

> more and monitor the

> patient very carefully. The chosen dosage will depend

on

> the doctor's

> judgment given the patient's clinical status and,

later,

> response to the

> MTX.

>

> Although some physicians like to start with the

standard

> 7.5 mg per week and

> work up to a higher amount if necessary, there are

other

> strategies.

>

> From the book, " Rheumatoid Arthritis: New Frontiers in

> Pathogenesis and

> Treatment " edited by Firestein, Panayi, and Wollheim

> (2000, Oxford

> University Press):

>

> " Today, MTX treatment can be recommended as single or

> combination therapy

> not only after failure of other DMARDs but as initial

> treatment in patients

> with active disease. MTX can be administered orally or

by

> intramuscular,

> intravenous, or subcutaneous injection with doses

ranging

> from 7.5 - 25 mg

> once a week. The dose depends on body weight, gender,

> renal function,

> concomitant disease, general health status, and

disease

> activity.

>

> We usually start treatment with a relatively high dose

of

> 15 - 25 mg given

> parenterally to exclude the individual differences in

> bioavailability of

> oral medication and to achieve a rapid response; after

6 -

> 12 weeks, we

> switch to oral medication in most patients and adjust

the

> dose according to

> efficacy and tolerability. Most rheumatologists prefer

to

> start with lower

> oral doses and to increase dosage subsequently. In the

> case of adverse

> events, tolerability can be improved by administering

the

> drug in the evening

> or in two equal doses in the morning and evening of

the

> same day, by

> changing the route of administration (parenteral

versus

> oral), reducing the

> dose, or supplementation of folic acid.... "

>

> As implied by the above passage, there is a difference

in

> bioavailablilty in

> the oral versus parenteral form of MTX, so that, too,

can

> influence what the

> dosage is chosen to be.

>

>

>

> RE: [ ] Methotrexate and folic acid

> dosage in RA

>

>

> > ,

> > I should have read my messages before responding to

> Susie.

> > The first

> > 5 sites I pulled up all say 20mg is the max, but I

see

> one

> > of the sites you posted say

> > 25mg is the max. I couldn't find anything about the

> > relationship of body weight to the mtx dosage. I

know

> they

> > are supposed to consider body weight, but none of

the

> sites

> > I

> > searched mentioned body weight.

> > a

>

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

I have been on it for 6 doses now. It's 0.5cc week.

I asked about blood, she told me I didn't need that until the end of

November.

That is when I am " suppose " to go back. They were so Insistant that I

just HAD to stay on the Methotrexate. That " You are really bad off, and

we need to get you out of this pain. " And that I needed to stay on it.

My doctor is very closed mouthed. I think he thinks he shouldn't tell

what he thinks. It is as if it is HIS ILLNESS, not mine! Well, he can

have it!

I finally (after a year and a half) pinned him down a few weeks ago and

asked WHAT was the diagnoses. He said, really passive... " Oh...it's

just ENTHESOPATHY. " I questioned further, and asked what that was. (I

knew already, from reading, but " asked " anyway!)

He said, " ENTHESOPATH is just one of the symptoms of THE

SPONDYLOARTHROPATHIES. "

I asked him WHICH one. (I knew this was the seronegative.) He evaded me

and went out of room, saying he would be back in a minute. When he came

back he explained about tendon bone ligiments. And I kept pressing him

about the BACK pain and stiffness. (I can no longer bend my lower spine.

So painful I LITERALLY want to die. No joke) He said that he knew how

bad it was, but that for " what I had " , they needed to stay away from

opoid (sp?) meds as long as possible.

Duhhhhhhhhhh... I wanted to say I would be DEAD before he " thought " it

was time!

Anyway... he never would say " which " one in the group of

Spondyloarthropathies.

So take your pick on my diagnosis...

This is the SPONDYARTHROPATHIES:

Ankylosing Spondylitis

Reactive arthritis

Reiter Syndrome

Enteropathic Arthritis

Psoriatic spondyloarthropathy

**

The protacol for METHOTREXATE is when ALL other RA meds have been tried.

He never " tried " me on any others! Just one day they called after some

blood tests I had and said I needed to start the METHOTREXATE &

Sulfazdine(sp???)

And all of sudden he says that the FIBROMYALGIA has seemed to have

" dissappeared " . And now says, " The pain if from SOMETHING ELSE. " And

again... he won't say WHICH one.

The little Chiropractor I use to go to, told me that I MAY be showing

signs of the ANKYLOSING SPONDYLITIS. The way my bones looked That was

over a year ago, before I ever went to this RA doctor I am going to. I

haven't been back to the Chiro, it was just Too painful for

minipulation.

My body is quite a mess right now. And am in too much pain tonight to

really care if the METHOTREXATE " does me in " at this point!

(joke...haha. Yea, right.)

On a lighter note... these bleeding gums...well, PERFECT HALLOWEEN

atmosphere here! I could be a Vampire.

Susie

> According to the American College of Rheumatology, every 4-8

> weeks is what

> they recommend for patients on mtx.

> http://www.rheumatology.org/research/guidelines/ra-drug/ra-d

> rug.html

>

> You're within the recommended time. When are you due to go

> back? How long

> have you been on mtx and at what dose? I don't blame you

> for being scared

> especially after reading all this information that says that

> it's something that the

> doctor should be made aware of immediately. I don't know

> what to say about

> his opinion that it's a common side effect. I'm glad that

> you called him. I guess

> if it were me, I'd call him back and tell him what I read

> and tell him that I'm uncomfortable

> about taking the injection without a blood test to check my

> platelets. But that's just

> what I would do. I don't know your situation or your

> relationship with your doctor.

> If you're really upset about it, call him back. Remember he

> works for you.

> a

>

> Re: [ ] Methotrexate and folic acid

> > dosage in RA

> >

> >

> > a,

> >

> > I've read in several places things like this:

> >

> > " A safe and effective methotrexate treatment plan must

> be

> > tailored for each

> > patient. Factors that must be weighed include renal

> > function, age, and body

> > weight. "

> >

> > Source:

> >

> >

> http://www.medscape.com/Medscape/Rheumatology/AskExperts/200

> > 0/08/RHEU-ae12.html

> >

> > Below I have included another reference that also

> mentions

> > body weight as a

> > consideration when prescribing methotrexate in RA.

> >

> > Given two people with the very same clinical picture,

> but

> > one weighs 100

> > pounds and the other weighs 250, it would be wise for

> the

> > doctor to consider

> > body weight before deciding on the dosage of MTX.

> >

> > I know 25 mg seems high, especially compared to 7.5

> mg,

> > but it is still

> > considered " low dose " methotrexate. I have seen 30 mg

> > mentioned as an upper

> > limit in more than one place. Here is an example:

> >

> > http://www.postgradmed.com/issues/1998/02_98/grem.htm

> >

> > Many clinicians don't want to give more than 15 or 20

> mg

> > per week because of

> > toxicity concerns, but the physician can decide to

> give

> > more and monitor the

> > patient very carefully. The chosen dosage will depend

> on

> > the doctor's

> > judgment given the patient's clinical status and,

> later,

> > response to the

> > MTX.

> >

> > Although some physicians like to start with the

> standard

> > 7.5 mg per week and

> > work up to a higher amount if necessary, there are

> other

> > strategies.

> >

> > From the book, " Rheumatoid Arthritis: New Frontiers in

> > Pathogenesis and

> > Treatment " edited by Firestein, Panayi, and Wollheim

> > (2000, Oxford

> > University Press):

> >

> > " Today, MTX treatment can be recommended as single or

> > combination therapy

> > not only after failure of other DMARDs but as initial

> > treatment in patients

> > with active disease. MTX can be administered orally or

> by

> > intramuscular,

> > intravenous, or subcutaneous injection with doses

> ranging

> > from 7.5 - 25 mg

> > once a week. The dose depends on body weight, gender,

> > renal function,

> > concomitant disease, general health status, and

> disease

> > activity.

> >

> > We usually start treatment with a relatively high dose

> of

> > 15 - 25 mg given

> > parenterally to exclude the individual differences in

> > bioavailability of

> > oral medication and to achieve a rapid response; after

> 6 -

> > 12 weeks, we

> > switch to oral medication in most patients and adjust

> the

> > dose according to

> > efficacy and tolerability. Most rheumatologists prefer

> to

> > start with lower

> > oral doses and to increase dosage subsequently. In the

> > case of adverse

> > events, tolerability can be improved by administering

> the

> > drug in the evening

> > or in two equal doses in the morning and evening of

> the

> > same day, by

> > changing the route of administration (parenteral

> versus

> > oral), reducing the

> > dose, or supplementation of folic acid.... "

> >

> > As implied by the above passage, there is a difference

> in

> > bioavailablilty in

> > the oral versus parenteral form of MTX, so that, too,

> can

> > influence what the

> > dosage is chosen to be.

> >

> >

> >

> > RE: [ ] Methotrexate and folic acid

> > dosage in RA

> >

> >

> > > ,

> > > I should have read my messages before responding to

> > Susie.

> > > The first

> > > 5 sites I pulled up all say 20mg is the max, but I

> see

> > one

> > > of the sites you posted say

> > > 25mg is the max. I couldn't find anything about the

> > > relationship of body weight to the mtx dosage. I

> know

> > they

> > > are supposed to consider body weight, but none of

> the

> > sites

> > > I

> > > searched mentioned body weight.

> > > a

> >

> >

> >

> >

> >

> >

> >

> >

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[Guest guest]

I'd be pretty upset too Susie. You have a right to know

what the doctor

thinks is wrong and what treatments are available. Your

doctor sounds

like the one I dumped a few months ago. He didn't like me

asking questions.

These rheumatic diseases are to serious to have a doctor

that you can't

communicate with.

As far as mtx being used when other meds fail, that is

becoming old school.

It used to be that they treated rheumatic diseases slowly

and with the least

toxic meds. Now that they have found that the diseases are

causing damage

early into the diagnosis, it is common to bring out the big

guns early. Mtx is

the most widely used, and may be the best med for you. BUT

when you are

showing side effects after starting at a high dose, I would

think that the doctor would

cut you back to a dose that you could tolerate, and let your

body adjust to it and THEN

increase it. I'm really surprised that he didn't at least

order a blood test as a precaution.

Mouth sores are very common with mtx, but I've never heard

anyone say their gums

were bleeding. Do you have any bruising?

a

Re: [ ] Methotrexate and folic

acid

> > dosage in RA

> >

> >

> > a,

> >

> > I've read in several places things like this:

> >

> > " A safe and effective methotrexate treatment plan

must

> be

> > tailored for each

> > patient. Factors that must be weighed include

renal

> > function, age, and body

> > weight. "

> >

> > Source:

> >

> >

>

http://www.medscape.com/Medscape/Rheumatology/AskExperts/200

> > 0/08/RHEU-ae12.html

> >

> > Below I have included another reference that also

> mentions

> > body weight as a

> > consideration when prescribing methotrexate in RA.

> >

> > Given two people with the very same clinical

picture,

> but

> > one weighs 100

> > pounds and the other weighs 250, it would be wise

for

> the

> > doctor to consider

> > body weight before deciding on the dosage of MTX.

> >

> > I know 25 mg seems high, especially compared to

7.5

> mg,

> > but it is still

> > considered " low dose " methotrexate. I have seen 30

mg

> > mentioned as an upper

> > limit in more than one place. Here is an example:

> >

> >

http://www.postgradmed.com/issues/1998/02_98/grem.htm

> >

> > Many clinicians don't want to give more than 15 or

20

> mg

> > per week because of

> > toxicity concerns, but the physician can decide to

> give

> > more and monitor the

> > patient very carefully. The chosen dosage will

depend

> on

> > the doctor's

> > judgment given the patient's clinical status and,

> later,

> > response to the

> > MTX.

> >

> > Although some physicians like to start with the

> standard

> > 7.5 mg per week and

> > work up to a higher amount if necessary, there are

> other

> > strategies.

> >

> > From the book, " Rheumatoid Arthritis: New

Frontiers in

> > Pathogenesis and

> > Treatment " edited by Firestein, Panayi, and

Wollheim

> > (2000, Oxford

> > University Press):

> >

> > " Today, MTX treatment can be recommended as single

or

> > combination therapy

> > not only after failure of other DMARDs but as

initial

> > treatment in patients

> > with active disease. MTX can be administered

orally or

> by

> > intramuscular,

> > intravenous, or subcutaneous injection with doses

> ranging

> > from 7.5 - 25 mg

> > once a week. The dose depends on body weight,

gender,

> > renal function,

> > concomitant disease, general health status, and

> disease

> > activity.

> >

> > We usually start treatment with a relatively high

dose

> of

> > 15 - 25 mg given

> > parenterally to exclude the individual differences

in

> > bioavailability of

> > oral medication and to achieve a rapid response;

after

> 6 -

> > 12 weeks, we

> > switch to oral medication in most patients and

adjust

> the

> > dose according to

> > efficacy and tolerability. Most rheumatologists

prefer

> to

> > start with lower

> > oral doses and to increase dosage subsequently. In

the

> > case of adverse

> > events, tolerability can be improved by

administering

> the

> > drug in the evening

> > or in two equal doses in the morning and evening

of

> the

> > same day, by

> > changing the route of administration (parenteral

> versus

> > oral), reducing the

> > dose, or supplementation of folic acid.... "

> >

> > As implied by the above passage, there is a

difference

> in

> > bioavailablilty in

> > the oral versus parenteral form of MTX, so that,

too,

> can

> > influence what the

> > dosage is chosen to be.

> >

> >

> >

> > RE: [ ] Methotrexate and folic

acid

> > dosage in RA

> >

> >

> > > ,

> > > I should have read my messages before responding

to

> > Susie.

> > > The first

> > > 5 sites I pulled up all say 20mg is the max, but

I

> see

> > one

> > > of the sites you posted say

> > > 25mg is the max. I couldn't find anything about

the

> > > relationship of body weight to the mtx dosage.

I

> know

> > they

> > > are supposed to consider body weight, but none

of

> the

> > sites

> > > I

> > > searched mentioned body weight.

> > > a

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >