Methotrexate and Omeprazole

[Kami]

Hello! I just found this on the internet and thought I would share. I dont' understand much of it but the last sentence makes sense to me! Any thoughts?
I don't think I will be taking Omeprazole until I can talk to my doctor about it. I was taking it because sometimes I wake up at night with acid reflux.


Abstract

Omeprazole inhibits the gastric hydrogen pump and is an effective treatment for peptic ulcers. Methotrexate is a chemotherapeutic agent that inhibits dihydrofolate reductase and is eliminated by a hydrogen-ion-dependent mechanism in the kidney. We present evidence that omeprazole inhibits methotrexate clearance and may result in potentially toxic methotrexate levels.

Impact of omeprazole on the plasm... [Cancer Chemother Pharmacol. 1993] - PubMed - NCBI (http://www.ncbi.nlm.nih.gov/pubmed/8269594)

[Kami]

Here is one on Prilosec which I think is similar to Omeprazole. Screamin' meanie you aren't taking these together are you? Just thinking of your side effects.

Methotrexate/Proton Pump Inhibitors
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Medical warning:
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Proton pump inhibitors may decrease the ability of your kidneys to remove methotrexate from your body.
What might happen:
The amount of methotrexate in your body may increase, which may cause more serious, potentially life threatening side effects.
What you should do about this interaction:
Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together.Your doctor may want to monitor the amount of methotrexate in your blood, change the dose of your methotrexate, or change your acid medicine. Let your doctor know right away if you develop nausea, stomach pain, yellowing of the eyes or skin, dark urine, fever, fatigue, a persistent sore throat, easy bruising or bleeding, black stools, a change in the amount of urine you pass, skin rash, breathing problems, dry cough, diarrhea, or mouth sores while taking these medicines together.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

webiste:
Interactions between Prilosec Oral and METHOTREXATE (http://www.webmd.com/drugs/drug-7957-Prilosec+Oral.aspx?drugid=7957&drugname=Prilosec+Oral&dmid=2014&dmtitle=PROTON%20PUMP%20INHIBITORS/METHOTREXATE&intrtype=DRUG&pagenumber=9)

[Dryhill]

Thank you for that info Kami. I have been taking Omeprazole because I am on Ctx, but as I am being weaned off Ctx I am taking Methotrexate at the same time.I am at vthe hospital tomorrow for a Ctx infusion so I will query taking Omeprazole.

[pberggren1]

Omeprazole is to protect the stomach from pred.

[Al]

Omeprazole is to protect the stomach from pred.

Omeprazole was prescribed to me despite my CTX being in IV form. I complained to Drac, on the grounds that the ulcer research was inconclusive, so there was no reason to further screw around with body chemistry. He actually agreed....

Al

[Dryhill]

When I was at the hospital today I showed the article to one of the dopctors and she said that was one of the things that they were checking for when I have my fortnightly blood test. So if you are concerned about the effects of Omeprazole and Methotrexate ask for a regular blood test to check on the build up of Methotrexate.

[Thakator]

Thank you, Kami, for posting this information. Even though I don't personally take this drug (I take Prevacid [lansoprazole] instead for the same reasons), your post is a perfect example of why this forum is so vitally helpful for so many of us. It is precisely these types of alerts that help us avoid falling into more pitfalls as we battle the sinkhole of Wegs that's already got us. Ron

[drz]

Thank you, Kami, for posting this information. Even though I don't personally take this drug (I take Prevacid [lansoprazole] instead for the same reasons), your post is a perfect example of why this forum is so vitally helpful for so many of us. It is precisely these types of alerts that help us avoid falling into more pitfalls as we battle the sinkhole of Wegs that's already got us. Ron

Have you taken any of the other similar drugs? My gastroenterologist suggested i try another similar drug since the protonix doesn't seem to working as well lately for me even though there is no big reson to believe one will work much better than another but iknow for me I tried Prilosec and Nexum without much luck before I got some relief from Protonix. Sometimes one does work better for some unknown reasons.

[Sangye]

Very interesting, Kami. I've never seen that info before. Thanks for posting it!

[ScreaminMeanie]

My doc warned me about this when she told me to start taking it, and checks my blood monthly. I suppose now that I'm off pred (and lowering mtx), I should try to get off the omeprazole. Right now I'm waiting to hear back from my doc on my latest bloodwork and hoping that I'll be able to decrease mtx again (to 15mg weekly). I've noticed I am defintely feeling better, the less mtx I have in my system. If all is well on the latest report, I will drop the mtx and start trying to get off omeprazole. It seems to help with the side effects of mtx as well, so I'm not going to rush it.

[Dirty Don]

I am on a double dose of protonix, to relieve the dry cough many of us get...worked for about 3 days, now cough is back. Am reducing pred now as body is reacting well to mtx dosages now. Doc says reduction in mtx may be next...on 6 week checkups. My point is: mtx is so powerful we have to balance against it as it does what it's supposed to do, so we need to be aware and react accordingly...knowledge is power, power is reason to act, we need to keep acting upon this weird little disease! One of the things many people on here are learning is that 'we' must be our own docs also...that is, discuss it, question it, try it, and most of all, make it our own...be patient, persistent, and positive!! Have a good one all!

[Kami]

When I was first admitted to the hospital and they were trying to diagnose me I had several teams of doctors, and med students, more people then I could keep up with and I was very sick so it wasn't easy but one thing I remember them telling me over and over was "You have to be in charge of your own health." They meant to pay attention and ask all the questions I wanted. I found that very refreshing that they wanted my input, and after 2 years, they still do. My doctor always lets me help decide what to do next (at least he makes it seem that way) :)

[freakyschizogirl]

My Mum is back on the MTX - she had been on it a few years ago but it did nothing for her RA and was put on other things. She had bad reactions to it - extreme nausea and was bed ridden for a few days after taking it.

She never took any acid blockers but since I found out about them she asked for them too. On Thursday night I heard a loud thud and expexted it to be my dog - it was my Mum who had fallen out of bed. I turned her light on and she was so pale - she had grey lips and hands, was very disorientated, a pounding headache and nausea. Scared the life outta me.

I told my mum about this thread and that MTX and Omeprazole interact so she went to see her doctor. She told the doctor and she said she wished they were kept up to date with these things - I said to my mum well the info is out there - all she has to do is to look. Even my pharmacist had warned me about possile interactions months ago.

Needless to say I'm not impressed. Doctor told my mum to stop the Omeprazole.

Thanks guys for posting this info!

[gunnyl]

It's important to know that not all Ant-Acids are created equal. A year before getting diagnosed with Wegeners I had a Hiatal Hernia repair called a Nissin Wrap. Omeprazole blocks the production of stomach acid as where pepsid AC mitigates it. If you go cold turkey off of Omeprazole your stomach will go into hyper acid production and you will suffer the consequences. Ulcers and so on. My Surgeon weened me off of Omeprazole and put Pepsid in it's place. Made me take pepsid for 3 months after weening me off of Omeprazole and then weened me off the Pepsid so I could stop the antacids altogether. Then along comes Wegeners and Cytoxan so I'm on Pepsid again. I refused to let them put me on Omeprazole and if you want to come off of it make sure you consult a doctor and do it the right way.

[elephant]

How did you wean off Omeprazole? Did you take it every other day?

[gunnyl]

I don't remember the schedule exactly but something like that. I would consult a Gastroenterologist or in my case I had a surgeon who was wicked knowledgeable about the differences in the medications. I remember he told me never to go cold turkey off the Omeprazole, Protonix, Prilosec or any of that particular type of med. He lowered my dosage then staggered the days and eventually replaced it with Pepsid for 3 full months before I was able to come off the pepsid. So now I take Famotadine which is the generic for Pepsid to counter the Cytoxan. I refused to go back on the others and explained to my Rheumy why. She agreed!

[Al]

I don't remember the schedule exactly but something like that. I would consult a Gastroenterologist or in my case I had a surgeon who was wicked knowledgeable about the differences in the medications. I remember he told me never to go cold turkey off the Omeprazole, Protonix, Prilosec or any of that particular type of med. He lowered my dosage then staggered the days and eventually replaced it with Pepsid for 3 full months before I was able to come off the pepsid. So now I take Famotadine which is the generic for Pepsid to counter the Cytoxan. I refused to go back on the others and explained to my Rheumy why. She agreed!

Good for you, Gunny!

Al

[Sangye]

I've been on Protonix a few times while on high dose pred and didn't have any trouble stopping cold turkey. (I took 40 mg once a day) I understand the doctor's reasoning and believe it to be valid. I just want to say that not everyone is doomed to a prolonged taper if they use Protonix.

Protonix was the only one that worked for me while I was on pred.

[Dirty Don]

No, not everyone gets 'tapered' all the time. It's best to see if one needs it initially, let a reaction occur if necessary, then deal with it...

I take protonix both from recent surgery and WG...seems to work for stomach...although the double dose right now is aimed at reducing my 'dry cough'. It isn't working real well, so may go to Prilosec, we'll see.

[ScreaminMeanie]

It's important to know that not all Ant-Acids are created equal. A year before getting diagnosed with Wegeners I had a Hiatal Hernia repair called a Nissin Wrap. Omeprazole blocks the production of stomach acid as where pepsid AC mitigates it. If you go cold turkey off of Omeprazole your stomach will go into hyper acid production and you will suffer the consequences. Ulcers and so on. My Surgeon weened me off of Omeprazole and put Pepsid in it's place. Made me take pepsid for 3 months after weening me off of Omeprazole and then weened me off the Pepsid so I could stop the antacids altogether. Then along comes Wegeners and Cytoxan so I'm on Pepsid again. I refused to let them put me on Omeprazole and if you want to come off of it make sure you consult a doctor and do it the right way.

This is very good to know. Thanks for posting.