ScreaminMeanie
10-12-2011, 05:04 AM
I've just had some experiences with mtx and antibiotics (besides bactrim), and it was not good!
After getting a cold a month or so ago, it turned into a sinus infection and obviously was not going away on its own. My Rheumy was out of town for two weeks, and none of her colleagues felt comfortable prescribing anything for me, having never seen me. Also, none of them are Rheumatologists - most are orthopedists. My choices were ER or my "regular" doctor. I chose "anything but the ER." ;)
My regular doc offered me a choice of doxycycline and levaquin. Knowing how expensive levaquin is (and not knowing that it is now available in generic form), I chose the doxycycline, 100 mg twice a day for 14 days. After 10 days, I had to stop taking it. I was sick to the point of throwing up, with awful diarrhea, and knowing that any antibiotic can cause pseudomembranous colitis, I stopped taking it and contacted my primary care doc again. He called in the levaquin. I had read that there was a possible bad reaction between levaquin and bactrim, so I stopped taking the bactrim for the 10 days I was on the levaquin. What I hadn't read was that levaquin (all the quinoline antibiotics, in fact) increases serum concentration (and therefore toxicity) of methotrexate. For two days I felt pretty good, then I started feeling nauseated all the time. I did some more reading (this was over a weekend) and found out about the increased toxicity. I had already taken my shot for the week, so there was nothing I could do about reducing my mtx dose, so instead I doubled up on my folic acid until I was done with the levaquin. What a difference! I don't think I would have made it through the full 10 days if I hadn't done this.
The point of all this is......if you're on mtx and you need to take antibiotics (aside from a prophylactic dose of bactrim), please talk to your doctor about the possible interactions and what you can do to minimize the toxicity of mtx (some recommend reducing your mtx dose while on antibiotics). Hope this saves someone else from the 3+ weeks of grief I've just been through.
(Thanks, Trudy, for suggesting I make this a separate thread!)
After getting a cold a month or so ago, it turned into a sinus infection and obviously was not going away on its own. My Rheumy was out of town for two weeks, and none of her colleagues felt comfortable prescribing anything for me, having never seen me. Also, none of them are Rheumatologists - most are orthopedists. My choices were ER or my "regular" doctor. I chose "anything but the ER." ;)
My regular doc offered me a choice of doxycycline and levaquin. Knowing how expensive levaquin is (and not knowing that it is now available in generic form), I chose the doxycycline, 100 mg twice a day for 14 days. After 10 days, I had to stop taking it. I was sick to the point of throwing up, with awful diarrhea, and knowing that any antibiotic can cause pseudomembranous colitis, I stopped taking it and contacted my primary care doc again. He called in the levaquin. I had read that there was a possible bad reaction between levaquin and bactrim, so I stopped taking the bactrim for the 10 days I was on the levaquin. What I hadn't read was that levaquin (all the quinoline antibiotics, in fact) increases serum concentration (and therefore toxicity) of methotrexate. For two days I felt pretty good, then I started feeling nauseated all the time. I did some more reading (this was over a weekend) and found out about the increased toxicity. I had already taken my shot for the week, so there was nothing I could do about reducing my mtx dose, so instead I doubled up on my folic acid until I was done with the levaquin. What a difference! I don't think I would have made it through the full 10 days if I hadn't done this.
The point of all this is......if you're on mtx and you need to take antibiotics (aside from a prophylactic dose of bactrim), please talk to your doctor about the possible interactions and what you can do to minimize the toxicity of mtx (some recommend reducing your mtx dose while on antibiotics). Hope this saves someone else from the 3+ weeks of grief I've just been through.
(Thanks, Trudy, for suggesting I make this a separate thread!)