AP and MTX

[Guest guest]

Hi all,

There is a lot of talk about the dmards and biologic drugs here. I

found this artcie very enlightening.

Its on rheumatic.org and written by Janine.

Marge

ANTIBIOTIC THERAPY AND METHOTREXATE

For a patient taking methotrexate, it is best to discontinue the

methotrexate before starting antibiotics as these two drugs work at

cross purposes.

Tetracyclines destroy bowel flora which are needed to break down the

methotrexate. This may result in increased free methotrexate

concentrations. The toxic side effects of methotrexate may be

increased if this drug is combined with certain drugs such as

tetracyclines. These drugs may inhibit the elimination of

methotrexate and may allow a build up in the bladder and kidneys

which increases the chance of toxic side effects.

The use of NSAIDS (aspirins, etc.) can increase toxicity as well, so

caution should be exercised when these two kinds of drugs are used in

combination in prolonged treatment plans such as those used in

treating RA patients.

Before starting antibiotics, the patient should be checked for

inflammation (SED rate), anemia, and liver function and a complete

blood count should be done to make sure there is no drug toxicity.

Because the methotrexate is eliminated through the kidneys and liver,

a drug build up may cause a problem, especially in patients whose

kidney and or liver function is already impaired. These problems may

not show up right away.

After a period of time (called a washout period), the antibiotics can

be started.The doctor may choose to start with a course of

intravenous clindamycin and then add oral tetracycline or start with

the orals alone. If flares become a problem, the dose should be

lowered, and prednisone (less than 10mg.) used to control

inflammation. As the flares are brought under control, the antibiotic

dose can be raised to the level recommended for this protocol.

Sources:

AHFS Drug information 1994, pgs. 666-67

Physicians' Desk Reference, 1991, pgs. 1185-1188.

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[Guest guest]

Hi,

Yes you can take methotrexate with AP until you are feeling better. You can

even take a small amount to cortisone to help you thru this.

What are you taking Minocin or minocycline? Is there a possibility you could

get your doctor to do Clindamycin IV's? How cooperative is your doctor?

Go to

http://rheumatic.org/support.htm there are a lot of stories and some

Articles that might be of help.

You have only been on antibiotics for a short time.don't give up!

I am sure there will be a lot of other people with help on this site for

you. Best of luck and give the kids a hug!

Cooky

Hi I was dx with RA in Jan 09, started sulfasalazine, dropped it and was on

AP in March. Prior to AP, I was 90% functinal but after startind was down to

30%. I'm herxing or disease progressing real bad that I have to quite my job

due to difficulties with daily activities. My rheumy talked me over starting

MTX or I'll be crippled with bone damaged pretty soon which I think I'm

pretty much in that situation. Although I know DMARD work contraindicated

with AP, thinking that I have to take care of my 2 kids, I might have to

make a dicision somehow. Are there anyone on this site ever dealt with

situation like this and do whatever they can to be physically functional

while on AP. Your opinion are appreciated as I'm in a crossroad of decision.

Thank you

DV1121

[Guest guest]

Hi ,

I truly don't think you will have problems with 100mgm Minocin but go slow.

I wish I would have. I went into it @200mgm MWF right away! I always

suggest do only the M & F for 2 weeks before adding the Wednesday. Switch to

Minocin as soon as you can. You will be amazed at the difference.

AP is different for everyone. You will enjoy reading all the stories.

Don't give up. AP is so much better than being on those new drugs that only

will kill you sooner than later. I'm retired and usually here so if you have

questions..

Best of luck.

cooky

From: rheumatic [mailto:rheumatic ] On Behalf

Of davidcheesm

Sent: Saturday, May 09, 2009 6:34 PM

rheumatic

Subject: rheumatic Re: AP and MTX

Hi Cookie

Thanks for replying & the hug for my kids. I'm actually on minocycline 100

mg/daily but intend to switch to minocin 50mg MWF to keep the herx at

tolerable level. Also taking Naproxen (NSAID) to keep myself functional

otherwise it will be too painful to do anything.

My AP doc is an intergrative MD who does not give IV's. I'm in NY & might

have to travel in order to get AP docs who do IV's.

My rheumy was mad at me for not taking the MTX as had prescribed back in

March. At that time, I was not as bad so was thinking of giving the

antibiotic & my immune system a chance to do it's job. Guess I'm not as

lucky as those who got quick responseS but I have faith in AP & will stick

with it down the road. Just have to go alittle beyond AP this time.

[Guest guest]

,

If you are herxing too much, reduce the dosage of Mino. I started 100mg

brand Minocin MWF I got worse for about 4 months before seeing a slight

improvement, that continued. Some people can tolerate only very little to

start. Maybe someone on this list has experience and can share about this.

I hope you are feeling better soon.

Take care,

Ute

At 01:29 PM 5/9/2009, you wrote:

>Hi I was dx with RA in Jan 09, started sulfasalazine, dropped it and was

>on AP in March. Prior to AP, I was 90% functinal but after startind was

>down to 30%. I'm herxing or disease progressing real bad that I have to

>quite my job due to difficulties with daily activities. My rheumy talked

>me over starting MTX or I'll be crippled with bone damaged pretty soon

>which I think I'm pretty much in that situation. Although I know DMARD

>work contraindicated with AP, thinking that I have to take care of my 2

>kids, I might have to make a dicision somehow. Are there anyone on this

>site ever dealt with situation like this and do whatever they can to be

>physically functional while on AP. Your opinion are appreciated as I'm in

>a crossroad of decision.

[Guest guest]

HI ,

So sorry about your situation, I was in the same boat, if it weren't for my kids

I would have been bed-ridden. Only by shear will power and the need to care for

my kids did I painfully struggle to get thru a day. I started MTX and found out

about AP about 1 year later. I've had a bit of luck with both but I'm not

exactly a poster person for either. With both of theses and other drugs I am

about 50% of what I use to be. I really have nothing to offer but best wishes.

Sue

---- davidcheesm <davidcheesm@...> wrote:

> Hi I was dx with RA in Jan 09, started sulfasalazine, dropped it and was on AP

in March. Prior to AP, I was 90% functinal but after startind was down to 30%.

I'm herxing or disease progressing real bad that I have to quite my job due to

difficulties with daily activities. My rheumy talked me over starting MTX or

I'll be crippled with bone damaged pretty soon which I think I'm pretty much in

that situation. Although I know DMARD work contraindicated with AP, thinking

that I have to take care of my 2 kids, I might have to make a dicision somehow.

Are there anyone on this site ever dealt with situation like this and do

whatever they can to be physically functional while on AP. Your opinion are

appreciated as I'm in a crossroad of decision.

>

> Thank you

>

> DV1121

>