RE: MTX questions: How much is enough? How long does it take?

August 19, 2001

Hi john

I have been on MTX for nearly three years, and on either Enbrel or Remicade

for the last two years. I have always had to take steroids with these. I am

now at 8mg Medrol (=10mg Prednisone), have had my first 4 Remicade infusions

and take .8cc MTX per week injection. When it was only MTX and the Steroids,

I could lower the steroids by raising the MTX....however this proved to be an

intolerable tradeoff as the MTX makes me soooo sick and sleepy that I would

rather have the steroids raised a couple of mg and be able to tolerate the

level of MTX in my body. I did manage, for a few months (during my 'healthy

time' every spring) to stop the mtx and only take enbrel and medrol. This

only lasted until the next flare came along and the dragon forced me to

start taking it again. And, in my experience of being on and off mtx, I

think you notice improvements much faster when it is already in your system

and you just change doseage. I'll be interested to see if others share this

experience. I wish you good luck and better health.

Stay healthy

August 19, 2001

,

When my daughter (12, systemic jra) started on mtx about 18 months ago, she

moved up quickly. Every month the rhuemy upped it until she was at about

18-20 mg. He slowly brought her pred down at the same time. Last October she

flared and we switched her to a ped rheumy who was a little more aggressive.

He upped her to 25 mg and 2 months later to 25 mg sub q. Since she was

started on mtx right away along with celebrex and folic acid, I really don't

have a feel for how well it does. She is now also on planquenel and has since

upped her celebrex, but is doin well. She is as low on the prednisone as she

has ever been (10 mg every other day). So we are crossing our fingers. I do

think that changing the mtx to sub q made a difference though. Not to mention

the side effects. Now she gets a bad taste in her mouth after we give her the

shot, but no more terrible nausea.

Hope somewhere in this rambling I was able to help.

Christy (mom to Abbie, 12 systemic)

August 19, 2001

My Rheumy started my cocktail 1st w/Pred & Placqunil. After 3 Months, that

didn't work, he added MTX. He started @ 15mg oral, once a week. He told me that

it takes anywhere from 3 to 6 months to see any results. Every time he upped the

dosage, it was a wait & see for 3 months. I finally ended up with 20mg of MTX.

My Pred was down & up & down. Depending upon how my fevers were. I was under

control w/ pred & started dropping, then I developed Paricaditinis (sp).

Hospitalized, than up the Pred to 60 for a short period. Then started the slow

decent. Now my pred is at 4.0 (YEAH!!!) and have dropped my MTX to 17.5. He said

to check my Sed rate after 30 days. if all is well, he could drop MTX again.

meanwhile he is

still very slowly dropping my pred by ½ every 3 weeks. (It was every 2 weeks

prior to MTX drop) On my last visit my Sed rate was about 6 (YEAH). I can only

hope that this can go on.

Hope this helps

Sanford

Cannon wrote:

> Hi All - -

>

> (1) For those on MTX, or a combination of MTX and other anti-inflammatory

drugs, how do you know when you have reached the correct dose of MTX? For

example, 7.5 mg. per week of MTX might work if you were also taking 15 mg. per

day of Prednisone. But it might take 15 mg. per week of MTX to get your

Prednisone down to 5 or less mg. per day. Do you just have to keep

experimenting with amounts until you get to a tolerable combination?

>

> (2) If you have been on MTX for a while, and then you increase your dose,

does it take many weeks for the increase to have an impact (like when you start

out on MTX)? Or does the effect come sooner because you have already had MTX in

your system for a while?

>

> Any wisdom will be greatly appreciated. Thanks, Cannon

johncann@... Front Royal, VA

>

August 19, 2001

Hi, .

Unfortunately, each of are somewhat unique in our symptoms and responses to

medications. MTX efficacy varies depending on many factors.

In reply to your question:

< (2) " If you have been on MTX for a while, and then you increase your

dose, does it take many weeks for the increase to have an impact (like when

you start out on MTX)? Or does the effect come sooner because you have

already had MTX in your system for a while? " >

In my case, it takes 3-4 weeks for me to notice a change in symptoms with a

change in MTX dose, up or down ( after I had taken it for a few years). I

knew I reached an effective dose when my symptoms improved, and my sed rate

declined. And then my the dose was increased slowly until no there was no

noticeable change in my symptoms. I now take 30 mg. MTX.

7.5mg did not help me whatsoever. I did not notice a change in symptoms

until I was at 17.5 mg/wk. At that point, the fevers and rash declined in

intensity and frequency.

-Brent

MTX questions: How much is enough? How long

does it take?

Hi All - -

(1) For those on MTX, or a combination of MTX and other anti-inflammatory

drugs, how do you know when you have reached the correct dose of MTX? For

example, 7.5 mg. per week of MTX might work if you were also taking 15 mg.

per day of Prednisone. But it might take 15 mg. per week of MTX to get your

Prednisone down to 5 or less mg. per day. Do you just have to keep

experimenting with amounts until you get to a tolerable combination?

(2) If you have been on MTX for a while, and then you increase your dose,

does it take many weeks for the increase to have an impact (like when you

start out on MTX)? Or does the effect come sooner because you have already

had MTX in your system for a while?

Any wisdom will be greatly appreciated. Thanks, Cannon

johncann@... Front Royal, VA

August 20, 2001