Stopping Methotrexate

[stephwest]

Hi All. I have not been on for a few months trying to forget GPA :rolleyes1:
I tapered down and off Pred 4 months ago with no signs of inflammation. I am now only taking MTX at 15mg once a week with some folic acid.
I know all about tapering off pred (I reduced it at 1mg a month and zero for 4 months).
What is the best way to stop Methotrexate which is a horrible drug on stomachs and bones and muscles, not read much on gradual reduction or stopping cold turkey and if signs of inflammation do occur do you throw a load of MTX and PRED down your throat again and how long does it take to work.
Any ideas
All Best
SW

[annekat]

Nice to hear from you again, Stephen. Good questions. I'm also on 15mg. MTX and have heard that is the lowest effective dose. So I don't know what would happen if you tried to taper it, or if that would be sort of like going off it. I haven't heard that there are withdrawal symptoms, except maybe the possibility of a flare if your body wasn't ready to quit. That might not happen right away. I'd suspect if the flare was mild to moderate they would put you back on some pred in addition to reinstating the MTX. I think pred works faster than MTX and would reduce the flare symptoms a lot sooner if you had stopped both meds. That's what I surmise, anyway. The part I'm unsure of is whether tapering the MTX to get off it would make any sense or if you would just stop.

This caught my eye because I am or will be in a similar situation, on the same dose of MTX. But I'm still on 12 mg. pred due to some mild flares and other issues in the last couple years. So I'm thinking ahead to the future. Congrats on getting off the pred, and I sure hope you don't ever have to go back on it. And if you could get off the MTX, too, that would be great! Best of luck!

[Pete]

Hello Stephen!

I asked the same question of my doc at Cleveland Clinic. She said that 15 mg/wk is the lowest effective dose. She went on to say that those who go off mtx without any other maintenance meds have a 40% chance of a flare within a year.

I went off mtx in August, but had four infusions of rituximab immediately following. So far, so good. The main reason I went off mtx is that the side effects were increasing and starting to interfere with my life activities. I was to the point where I was kinda wiped out for 2-3 days following each week's dose.

[mishb]

Hi Stephen, well done with the pred reduction.

Methotrexate can be stopped without a taper, it is fine, however stopping gives a greater risk of a flare, as Pete said.

Methotrexate does not build up in the system, it only lasts for 7 days.

I am due to have a nose operation sometime before March, and my Rheumy advised that I could stop taking MTX for a few weeks, without it causing an issue.

[stephwest]

Hi. Is there anybody out there that has stopped pred for 4-5 months (after every day for 2.5 years) with no flare apparent and is still on MTX at15mg per week and what are they going to do re getting off all meds.
MTX even at 15mg has bad side effects over long term on muscles and bones.
What advice is there !!!!
Thanks
S