Re: methotrexate and naprosyn or viox

[Guest guest]

In a message dated 4/2/2003 1:05:38 PM Eastern Standard Time,

richarddalaska@... writes:

> Have any of you had problems taking both mtx and naprosyn or mtx with

> viox?

Had no problems with naprosyn, but Vioxx did absolutely nothing for me. Same

way Mobic or Bextra did nothing. Only thing I've found that helps is

Celbrex. *sigh*

Smile,

Becky

[Guest guest]

i've been taking MTX with vioxx from about 5 or 6 months ago. No problem

whatsoever.

Ghaida,,,

[Guest guest]

I take mtx and naproxen (is that the same thing?) for 4 months now. You can't

take anything else containing either aspirin or alcohol - not even cough syrup.

But so far so good.

e

[ ] methotrexate and naprosyn or viox

My rheumy has me on both mtx and naprosyn. The naprosyn label states

that it shoud not be taken by people on methotrexate. The rheumy says

to ignore the warning.

Have any of you had problems taking both mtx and naprosyn or mtx with

viox?

richard

[Guest guest]

I also took Naproxen and MTX together for about 2 years. Never had a problem

with it. You're right. The concern is that you make sure you don't take

anything containing aspirin, and that you don't drink and take any

medications with alcohol in them because the accumulative effect alcohol and

aspirin in combo with naproxen and MTX can cause liver damage.

It is also very important to get regular routine blood work to check blood

counts and kidney and liver function every 4-8 weeks.

Carol in Vancouver, Washington

In a message dated 4/3/03 4:53:27 AM Pacific Standard Time,

avangils@... writes:

> I take mtx and naproxen (is that the same thing?) for 4 months now. You

> can't take anything else containing either aspirin or alcohol - not even

> cough syrup. But so far so good.

> e

> [ ] methotrexate and naprosyn or viox

>

>

> My rheumy has me on both mtx and naprosyn. The naprosyn label states

> that it shoud not be taken by people on methotrexate. The rheumy says

> to ignore the warning.

>

> Have any of you had problems taking both mtx and naprosyn or mtx with

> viox?

>

> richard

>

[Guest guest]

Various rheumatologists have, over the 22 years I have been taking

methotrexate, insisted I try each new NSAID that has come down the

pike, including naproxen sodium and vioxx (all the way back to

indocin, butazolidin, sterazolidin, and all the way up to the COX-2

inhibitors). No rheumatologist has ever cautioned me against an NSAID

and methotrexate concurrently. I have not come across anything in the

literature suggesting such avoidance, either. I think we're on safe

ground there.

Also, I do take, and have taken for several years, at the

prescription of my internist, aspirin daily (while taking MTX). I

don't know that anyone has suggested MTX and aspirin don't go

together, just thought I'd mention I've never been cautioned against

those two together, either.

RE alcohol and MTX: Here's a truly deadly combination. If there are

any members on MTX out there who think a few drinks every now and

then can't hurt--if you don't want to take the advice in this message

string, please talk to a pharmacist or MD BEFORE belting a few back.

D.

> I

> also took Naproxen and MTX together for about 2 years. Never had

> a problem with it. You're right. The concern is that you make

> sure you don't take anything containing aspirin, and that you

> don't drink and take any medications with alcohol in them

> because the accumulative effect alcohol and aspirin in combo

> with naproxen and MTX can cause liver damage.

>

> It is also very important to get regular routine blood work to

> check blood counts and kidney and liver function every 4-8

> weeks.

>

> Carol in Vancouver, Washington

>

=======================================================

Ed. Note: Hi , et. al. The first place I usually look for information about

drugs is http://www.rxlist.com/ It is essentially an on-line PDR. In every case

I've checked, it's information is word-for-word identical to my 1998 PDR. At

RxList.com, the " Warning and Precautions " for MTX appear at:

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

The way I interpret the section under " Drug Interactions " is that NSAIDs

increases the effect of MTX, and that is what makes MTX dangerous to take

concurrently with NSAIDs. The warning applies primarily to those on high doses

of MTX for Osteosarcoma. It seems to me that if a doctor made allowances for the

increased efficacy of MTX due to the concomitant use of NSAIDs, it shouldn't be

a problem - but of course I am not a doctor. Here are the pertinent paragraphs

from the " Drug Interactions " page at:

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

" Drug Interactions "

" Nonsteroidal anti-inflammatory drugs should not be administered prior to or

concomitantly with the high doses of methotrexate used in the treatment of

osteosarcoma. Concomitant administration of some NSAIDs with high dose

methotrexate therapy has been reported to elevate and prolong serum methotrexate

levels, resulting in deaths from severe hematologic and gastrointestinal

toxicity.

" Caution should be used when NSAIDs and salicylates are administered

concomitantly with lower doses of methotrexate. These drugs have been reported

to reduce the tubular secretion of methotrexate in an animal model and may

enhance its toxicity.

" Despite the potential interactions, studies of methotrexate in patients with

rheumatoid arthritis have usually included concurrent use of constant dosage

regimens of NSAIDs, without apparent problems. It should be appreciated,

however, that the doses used in rheumatoid arthritis (7.5 to 15 mg/week) are

somewhat lower than those used in psoriasis and that larger doses could lead to

unexpected toxicity.

" Methotrexate is partially bound to serum albumin, and toxicity may be increased

because of displacement by certain drugs, such as salicylates, phenylbutazone,

phenytoin, and sulfonamides. Renal tubular transport is also diminished by

probenecid; use of methotrexate with this drug should be carefully monitored. "

---

Regarding alcohol and MTX. My rheumatologist is European, and I was astounded

when she once told me that European rheumatologists do not generally warn their

patients about drinking alcoholic beverages while taking MTX. I would be curious

to know what the rheumatologists of our members in other countries advise about

this combination? I have no idea why this is the case, but apparently it's not

considered a " big deal " in Europe. Nonetheless, everyone agrees that both

alcohol and MTX are harmful to the liver. Speaking for myself, I have been a

virtual " teetotaler " since starting MTX and subsequently having switched to

Arava (which has effects similar to MTX), because I would rather be safe than to

be dead.

-- Ron

[Guest guest]

, do you suppose it is Tylenol & MTX that don't mix?

[Editor's Note:

I have never heard that suggested, and--under doctors' (plural) orders,

taken MTX and Tylenol (that is, Tylenol 4) at dosages of up to 25 mg. a week of

MTX AND 20 Tylenol 4 per day. I was a little surprised that docs would

countenance 6000 mg a day of acetominophen; the literature says to stop at 4000

mg. And, of course, both MTX and Tylenol have deleterious effects on the liver.

Thankfully, I'm finally off the Tylenol (switched to Avinza).

In any case, I am not aware of any contraindications with MTX and Tylenol

(absent the high doses of the latter, that is). Have you read or heard anything

in that regard?

D.]

zen124c41 <zen124c41@...> wrote:Various rheumatologists have, over the 22

years I have been taking

methotrexate, insisted I try each new NSAID that has come down the

pike, including naproxen sodium and vioxx (all the way back to

indocin, butazolidin, sterazolidin, and all the way up to the COX-2

inhibitors). No rheumatologist has ever cautioned me against an NSAID

and methotrexate concurrently. I have not come across anything in the

literature suggesting such avoidance, either. I think we're on safe

ground there.

Also, I do take, and have taken for several years, at the

prescription of my internist, aspirin daily (while taking MTX). I

don't know that anyone has suggested MTX and aspirin don't go

together, just thought I'd mention I've never been cautioned against

those two together, either.

RE alcohol and MTX: Here's a truly deadly combination. If there are

any members on MTX out there who think a few drinks every now and

then can't hurt--if you don't want to take the advice in this message

string, please talk to a pharmacist or MD BEFORE belting a few back.

D.

> I

> also took Naproxen and MTX together for about 2 years. Never had

> a problem with it. You're right. The concern is that you make

> sure you don't take anything containing aspirin, and that you

> don't drink and take any medications with alcohol in them

> because the accumulative effect alcohol and aspirin in combo

> with naproxen and MTX can cause liver damage.

>

> It is also very important to get regular routine blood work to

> check blood counts and kidney and liver function every 4-8

> weeks.

>

> Carol in Vancouver, Washington

>

=======================================================

Ed. Note: Hi , et. al. The first place I usually look for information about

drugs is http://www.rxlist.com/ It is essentially an on-line PDR. In every case

I've checked, it's information is word-for-word identical to my 1998 PDR. At

RxList.com, the " Warning and Precautions " for MTX appear at:

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

The way I interpret the section under " Drug Interactions " is that NSAIDs

increases the effect of MTX, and that is what makes MTX dangerous to take

concurrently with NSAIDs. The warning applies primarily to those on high doses

of MTX for Osteosarcoma. It seems to me that if a doctor made allowances for the

increased efficacy of MTX due to the concomitant use of NSAIDs, it shouldn't be

a problem - but of course I am not a doctor. Here are the pertinent paragraphs

from the " Drug Interactions " page at:

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

" Drug Interactions "

" Nonsteroidal anti-inflammatory drugs should not be administered prior to or

concomitantly with the high doses of methotrexate used in the treatment of

osteosarcoma. Concomitant administration of some NSAIDs with high dose

methotrexate therapy has been reported to elevate and prolong serum methotrexate

levels, resulting in deaths from severe hematologic and gastrointestinal

toxicity.

" Caution should be used when NSAIDs and salicylates are administered

concomitantly with lower doses of methotrexate. These drugs have been reported

to reduce the tubular secretion of methotrexate in an animal model and may

enhance its toxicity.

" Despite the potential interactions, studies of methotrexate in patients with

rheumatoid arthritis have usually included concurrent use of constant dosage

regimens of NSAIDs, without apparent problems. It should be appreciated,

however, that the doses used in rheumatoid arthritis (7.5 to 15 mg/week) are

somewhat lower than those used in psoriasis and that larger doses could lead to

unexpected toxicity.

" Methotrexate is partially bound to serum albumin, and toxicity may be increased

because of displacement by certain drugs, such as salicylates, phenylbutazone,

phenytoin, and sulfonamides. Renal tubular transport is also diminished by

probenecid; use of methotrexate with this drug should be carefully monitored. "

---

Regarding alcohol and MTX. My rheumatologist is European, and I was astounded

when she once told me that European rheumatologists do not generally warn their

patients about drinking alcoholic beverages while taking MTX. I would be curious

to know what the rheumatologists of our members in other countries advise about

this combination? I have no idea why this is the case, but apparently it's not

considered a " big deal " in Europe. Nonetheless, everyone agrees that both

alcohol and MTX are harmful to the liver. Speaking for myself, I have been a

virtual " teetotaler " since starting MTX and subsequently having switched to

Arava (which has effects similar to MTX), because I would rather be safe than to

be dead.

-- Ron

[Guest guest]

I take MTX, and Naproxen for pain. I recently had a very bad cold and was told I

by my rheumy I could not take cold medicines or anything else containing aspirin

or alcohol; I was able to take Alka seltzer plus which contains acetominophen.

Double checked with the pharmacist who agreed. The naproxen label also states

not to take any aspirin products.

e

Re: [ ] Re: methotrexate and naprosyn or viox

, do you suppose it is Tylenol & MTX that don't mix?

[Editor's Note:

I have never heard that suggested, and--under doctors' (plural) orders,

taken MTX and Tylenol (that is, Tylenol 4) at dosages of up to 25 mg. a week of

MTX AND 20 Tylenol 4 per day. I was a little surprised that docs would

countenance 6000 mg a day of acetominophen; the literature says to stop at 4000

mg. And, of course, both MTX and Tylenol have deleterious effects on the liver.

Thankfully, I'm finally off the Tylenol (switched to Avinza).

In any case, I am not aware of any contraindications with MTX and Tylenol

(absent the high doses of the latter, that is). Have you read or heard anything

in that regard?

D.]

zen124c41 <zen124c41@...> wrote:Various rheumatologists have, over the 22

years I have been taking

methotrexate, insisted I try each new NSAID that has come down the

pike, including naproxen sodium and vioxx (all the way back to

indocin, butazolidin, sterazolidin, and all the way up to the COX-2

inhibitors). No rheumatologist has ever cautioned me against an NSAID

and methotrexate concurrently. I have not come across anything in the

literature suggesting such avoidance, either. I think we're on safe

ground there.

Also, I do take, and have taken for several years, at the

prescription of my internist, aspirin daily (while taking MTX). I

don't know that anyone has suggested MTX and aspirin don't go

together, just thought I'd mention I've never been cautioned against

those two together, either.

RE alcohol and MTX: Here's a truly deadly combination. If there are

any members on MTX out there who think a few drinks every now and

then can't hurt--if you don't want to take the advice in this message

string, please talk to a pharmacist or MD BEFORE belting a few back.

D.

> I

> also took Naproxen and MTX together for about 2 years. Never had

> a problem with it. You're right. The concern is that you make

> sure you don't take anything containing aspirin, and that you

> don't drink and take any medications with alcohol in them

> because the accumulative effect alcohol and aspirin in combo

> with naproxen and MTX can cause liver damage.

>

> It is also very important to get regular routine blood work to

> check blood counts and kidney and liver function every 4-8

> weeks.

>

> Carol in Vancouver, Washington

>

=======================================================

Ed. Note: Hi , et. al. The first place I usually look for information

about drugs is http://www.rxlist.com/ It is essentially an on-line PDR. In

every case I've checked, it's information is word-for-word identical to my 1998

PDR. At RxList.com, the " Warning and Precautions " for MTX appear at:

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

The way I interpret the section under " Drug Interactions " is that NSAIDs

increases the effect of MTX, and that is what makes MTX dangerous to take

concurrently with NSAIDs. The warning applies primarily to those on high doses

of MTX for Osteosarcoma. It seems to me that if a doctor made allowances for the

increased efficacy of MTX due to the concomitant use of NSAIDs, it shouldn't be

a problem - but of course I am not a doctor. Here are the pertinent paragraphs

from the " Drug Interactions " page at:

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

" Drug Interactions "

" Nonsteroidal anti-inflammatory drugs should not be administered prior to or

concomitantly with the high doses of methotrexate used in the treatment of

osteosarcoma. Concomitant administration of some NSAIDs with high dose

methotrexate therapy has been reported to elevate and prolong serum methotrexate

levels, resulting in deaths from severe hematologic and gastrointestinal

toxicity.

" Caution should be used when NSAIDs and salicylates are administered

concomitantly with lower doses of methotrexate. These drugs have been reported

to reduce the tubular secretion of methotrexate in an animal model and may

enhance its toxicity.

" Despite the potential interactions, studies of methotrexate in patients with

rheumatoid arthritis have usually included concurrent use of constant dosage

regimens of NSAIDs, without apparent problems. It should be appreciated,

however, that the doses used in rheumatoid arthritis (7.5 to 15 mg/week) are

somewhat lower than those used in psoriasis and that larger doses could lead to

unexpected toxicity.

" Methotrexate is partially bound to serum albumin, and toxicity may be

increased because of displacement by certain drugs, such as salicylates,

phenylbutazone, phenytoin, and sulfonamides. Renal tubular transport is also

diminished by probenecid; use of methotrexate with this drug should be carefully

monitored. "

---

Regarding alcohol and MTX. My rheumatologist is European, and I was astounded

when she once told me that European rheumatologists do not generally warn their

patients about drinking alcoholic beverages while taking MTX. I would be curious

to know what the rheumatologists of our members in other countries advise about

this combination? I have no idea why this is the case, but apparently it's not

considered a " big deal " in Europe. Nonetheless, everyone agrees that both

alcohol and MTX are harmful to the liver. Speaking for myself, I have been a

virtual " teetotaler " since starting MTX and subsequently having switched to

Arava (which has effects similar to MTX), because I would rather be safe than to

be dead.

-- Ron

[Guest guest]

,

I took MTX with Naprosyn (Naproxen) for over 16 years without any

noticeable liver effects. I tried Vioxx for a short while but it just

didn't work, nor did Celebrex (which also had bad side effects). The

COX II inhibitor that really worked for me is Arcoxia (etoricoxib),

but I'm not sure if it's approved for use in the USA yet.

You do have to watch out for gastro-intestinal bleeding with Naprosyn

and most early NSAIDs and it might be smart to take a proton pump

inhibitor with it (my GP has me on Lanzoprazole) to guard the

stomach. COX II inhibitors are reckoned to be much safer on the

stomach.

Mike from Wiltshire, UK

[Editor's note:

Mike (and other interested members),

Arcoxia's FDA application was withdrawn in March 2002, in order to conduct

further research and demonstrate broader efficacy, ostensibly to make it a more

useful (i.e., profitable, market-share grabbing) competitor against Pharmacia's

Bextra and Celebrex (Merck also has Vioxx in its stables). At last report, Merck

expeted to resubmit Arcoxia to the FDA later this year.

The II inhibitors are gentler on the stomach than the older NSAIDs

(Indocin, et al)--in MOST, but not all, patients.

D.

> My rheumy has me on both mtx and naprosyn. The naprosyn label

states

> that it shoud not be taken by people on methotrexate. The rheumy

says

> to ignore the warning.

>

> Have any of you had problems taking both mtx and naprosyn or mtx

with

> viox?

>

> richard

[Guest guest]

> ,

> ...

> You do have to watch out for gastro-intestinal bleeding with

> Naprosyn and most early NSAIDs and it might be smart to take a

> proton pump inhibitor with it (my GP has me on Lanzoprazole) to

> guard the stomach. ...

>

> Mike from Wiltshire, UK

I have always taken Cytotec (Misoprostol) along with Naproxen to help

protect my stomach. Cytotec has both antisecretory (inhibiting

gastric acid secretion) and mucosal protective properties. See:

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

-- Ron