Side effect of methotrexate?

[Tim Roberts]

Jan: I have been taking methotrexate for about 7 months now since my diagnosis with wegener's in August of 2009. I have almost completed my whole prednisone regime as I am down to 5 mg per day and hopefully off by about April 1st. To be honest, the side effects of the prednisone have been much more difficult than the methotrexate.

I take methotrexate weekly and am on 17.5 mg per week. I notice that when I take it, the day I take it (Tuesdays) it almost acts as a stimulant as I don't ever sleep well that evening. The next day I feel a little "off" - just a little more tired than normal and just not quite as good as I normally do. By Thursday, however, that feeling is gone so it is just basically Wednesdays that I feel some of the side effects but actually very minimal.

What helps me the most is exercise as I either walk or run six days a week for anywher from 2 1/2 miles to 4 miles. I usually just walk on Wednesdays (my crappy day) but otherwise the prednisone and methotrexate let me do my routine the rest of the week. My rheumatologist indicated that I can do whatever I feel up to and this has helped me more than anything both mentally and physically.

I hope this helps and best of luck to you and certainly if you have more questions, don't hesitate to ask. I have learned much from all of the folks on this site that are much more experienced with this disease than I am and they are truly wonderful.

Tim

[moyan]

Hi all you who know: Seeing the internist tomorrow and I wonder, can my difficulty to breathe have anything to do with 2 years of pred? Lung doc found an obstruction between my neck and my tummy but no explanation. I asked for a puffer and got advair, don't know if it works, but take it
In 2 years pred was down from 60 to 15!
Moyan

[Sangye]

Have you had lung involvement, Moyan? Also, I'm totally forgetting what drugs you're on other than pred. When I was first on ctx, I had increased difficulty breathing within 6 months. As soon as we stopped it (couple months later) my breathing improved a bit. I later learned that ctx is particularly toxic to the lungs.

Do you practice taking deep breaths throughout the day? That helps a lot.

[jeriorleans]

A.J starts on Methotrexate this Friday. His last cytoxan dose is tommorrow. His doctor said the Folic Acid was to keep him from getting sores in his mouth. He is starting on 20 mg and then in 2 weeks he moves up to 25 mg. (he is 190 pounds). He is still on 10 mg predisone, every other day. His doctor told him to take it right before he goes to bed so that if there is any nausea he will hopefully sleep through it.

[katwoman]

Hi Jan, I am on 20mg of methotrexate, about a month into i developed mouth ulcers and was prescribed folic acid - as Sangye said its because it depletes it from your system.

I beg to differ that your doctor said it was for nausea, sometimes in the fluster of the doctors visit it is possible to mis-understand, I have a copy of 'patient information on methotrexate; they advise taking folic acid for the side affects of developing mouth ulcers and antinausea tablets if needed'. One of the previous threads that was going, alot of people advised me on ginger in some form or another (hhmm I remember someone said they ate ginger biscuits..yum) I got ginger tablets (which are for car sickness) that really helped, but I find I don't really have much side affect these days other then a little off in the stomach.

[JanW]

Thanks for that. Yes, doc wants to check for mouth sores every two weeks, and yes, there have been blind studies done within the last couple of years that show that folic acid is just as effect against nausea as other, more expensive anti-nausea meds, which is why hee prescribes it (this I confirmed looking at the studies on the Internet).

I'm going to take it today (10 mgs); will let you all know how I do on it.

[moyan]

Sangye Never had lung involvement, shortness started a year after chemo was finished. Now on immunosuppressant. Just started noserince, curious if that might help.

[Sangye]

How is your overall muscle tone? Pred causes muscle wasting. The intercostal muscles (between your ribs) are very small and atrophy quickly. That can limit ribcage expansion, causing you to feel short of breath.

Also, check to see if your abdominal muscles are functioning properly. When you breathe in deeply, your abdomen should expand. This reflects diaphragm action-- the primary muscle involved in breathing.

[moyan]

How is your overall muscle tone? Pred causes muscle wasting. The intercostal muscles (between your ribs) are very small and atrophy quickly. That can limit ribcage expansion, causing you to feel short of breath.

Also, check to see if your abdominal muscles are functioning properly. When you breathe in deeply, your abdomen should expand. This reflects diaphragm action-- the primary muscle involved in breathing.

Thank you, Sangye. Intercostal muscles sounds just right. Will have physio lady give me some excercises. Doc app. was for good and maybe bad: Taper the pred accordding to my/your plan,slowly. Foot might haqve infection in the bone and if so more have to be taken off. Just left it for now, looks sort of good

[JanW]

So far so good -- haven't noticed anything except some light nausea about a half hour after dosing that went away within an hour. Also got my lung CT back today and all's clear, so am excited about that as well.