A little worried about my treatment

Hi,

I am a little unsure about my treatment.
I started methotrexate 15mg once a week yesterday and they also want me to use septra DS(sulfatrim/trimeth DS) 160mg to take every 2days. After a few research i found that they recommend to avoid to take these 2 medications because Sulfonamides (septra) may decrease the renal clearance of methotrexate. Serum levels of free methotrexate and the risk of bone marrow suppression may be increased. Sulfonamides may also displace methotrexate from plasma protein binding sites, which may further increase serum methotrexate levels and the risk of toxicity. Methotrexate toxicity has also been reported in patients receiving low weekly doses.
I want to wait until monday to talk to my rheuma before i start the septra. I am starting blood works every months to keep tracking my WBC's because of that mix of meds.
I just want to know if anybody used these meds together.

Jeff, I've been reading a lot about this on another WG forum lately. I'm sure someone will be along to advise soon. Why are you taking the Bactrim. I am on mtx (17.5 mg) weekly, and have been since last spring, but have never taken bactrim. I know that people take it as a precaution when taking ctx, but am unsure of other uses.

And yes, your doc has to stay on top of those liver enzymes when you are on mtx. I started with bi-monthly blood work for the first few months at full dose.

Hi JanW,

Thanks for the reply.
The purpose of taking Septra DS is because MTX can cause pneunonitis and Septra is an antibacterial agent used to prevent and treat a variety of
bacterial infections, including PCP (Pneumoxystis carinii pneumonia).
I am just starting these meds and i will have blood work monthly starting tomorrow.
But it is kinda scary to take both especially when you read about this blend.

Jeff,
Following this thread from the other site.... It sounds as though you may be either recently diagnosed, or experiencing a flare after a hiatus? When initially diagnosed (primary symptoms were pulmonary,) my daughter was place on methotrexate, septra, and prednisone for a brief period. When it became clear that her pulmonary lesions were not responding, she was very quickly given the choice of additional treatment with Cytoxin or Ritxuin as induction therapy (she chose Rituxin). Once pulmonary lesions cleared, she was maintained with methotrexate, bactrum and her prednisone was then gradually reduced. Methotrexate was eventually eliminated, as she flared while on it about 10 months after her initial Rituxin infusions. She is not currently on 'maintenance drugs,' with the exception of Septra DS

All through out treatment, and continuing through current date, her blood studies are monitored, including CD19/20 (rituxin effectiveness), CBC, SED rate, ESR, liver enzymes, and many more for any abnormalities. We copy her Vasculitis expert at Mayo, Rochester regarding blood and CT chest and sinuses.

Septra is prescribed prophylactically to prevent pneumonia (PCP) and has proved possible antiinflammatory effects as well. It is generally well tolerated, except for those with sulphur allergies, to my knowledge.

Let us know what you find out from your doc on Monday......these drugs are not minor things, and methotrexate combined with septra is not on the strong end of usual cocktails for this crowd. All the drugs can have serious side-effects, and being aware of what to be on the lookout for is knowledge and power. I hope it will not deviate you from strong action against this disease though, (sometimes it needs a really serious kick inorder to get things in order,) as the disease will win. Good luck!

Thanks for your info Palmyra,

To answer your question i was diagnosed in january 2010 so it is my first year anniversary... in one year i had 2 flares ,my last one was recently in december.
In my case it is all in the upper trac (orbital pseudo-tumor, hearing loss, etc)
Same as your daughter, i will reduce the prednisone and eventually the mtx (hopefully).
I will let you know about my discussion with my doc on monday for sure.

Hi Jeff,

Please feel free to email me at [email protected] so that if you like, we can get together as I'm a Calgarian as well. I have been on Methotrexate, Septra & Prednisone for over a year now (the Septra since Oct 2007) and the as mentioned by the other posts, I don't think this is a lethal combination of drugs. I know that you have to be careful of the Amoxicillian family of antibiotics with Methotrexate but the Septra is going to help those of us that have the Wegener's in our upper respitory area so that we don't get any kind of ENT infection. Remember, being immune suppressed, getting sick is not what we want, any infection can flare up the Wegener's at any time. You should go with what you feel you are comfortable in taking, but you don't want to be sick from Wegener's too long and permanently lose any of your vision or hearing!

I have found that being on Methotrexate, I am usually anemic so I take iron supplements (maybe being a female too doesn't help), and you have to make sure to get your monthly blood and pee work done to make sure your liver and kidneys levels are not toxic. I am actually on 25mg/week of Metho and I take the Septra 3x/week. To date, for how long I was on chemo or have been on Metho, I haven't had any ENT infections requiring any other antibiotics other than Septra.

Good luck and please feel free to contact me via email as well.

Gurinder

Reviving this old thread because I've just had some experiences with mtx and other antibiotics, 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 primary care physician 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.

Wow, what a mess! Good for you for doing that research and taking matters into your own hands. Glad you didn't damage your liver.