Methotrexate

Hello everyone

I am a student nurse, and have become interested in methotrexate. I have noticed that some of you here are taking it, presumably for your asthma - however, in my (brief thus far) research I have only found it used for cancer/lymphoma, severe psoriasis, and severe active rheumatoid arthritis. Am I correct in thinking that some of you guys take it for asthma? Can anyone give me any details on this, e.g. it's action, i.e. what it does to treat asthma, route, side effects etc?

Feel free to PM me if you'd rather not share this info with everyone, and any information you choose to give me will be kept strictly confidential, however I am not after the most personal details, mostly if I have just got the right end of the stick! Also I hope any pharmacists/doctors/qualified nurses can jump to my aid here!

Am purely asking for personal interest as I seem to have exhausted the BNF and it hasn't answered my question as to whether methotrexate is used for asthma at all!

Many thanks in advance

Emz

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Hello Emz,

I’ve put together information about methotrexate as explained to me by professor of allergy and respiratory medicine and consultant respiratory pharmacist.

Methotrexate is unlicensed to treat asthma. In fact if a respiratory con/prof recommends this drug your GP could refuse to prescribe it.

As you you say this drug has a history of treating other conditions. It's also been around for a long time so the side effects are well known.

However methotrexate is also used to treat asthma but only under specialist guidance and advice plus a very strict - weekly –check upon side effects relating to key organs such as the liver for the metabolism of this drug and effects upon the liver itself plus other systems within the body for example the potential to damage red blood cells, which is ameliorated to a certain extent by taking folic acid. Methotrexate is prescribed at very low doses for asthma, 15mgs per week average, similar to other inflammatory conditions such as rheumatoid arthritis and psoriasis.

For some asthmatics this drug works. They – the asthma docs – don’t understand the precise mechanism for any improvement although the effects of methotrexate upon the immune system have been well documented. My personal perspective ( I’m trying this drug for the second time - first time not for asthma or for the other conditions you mentioned and at a higher dose) is that methotrexate could act as a steroid sparing agent concerning well known side effects of pred taken for a prolonged period of time.

So far ( over a month) I’ve noticed a slight improvement in lung function via pf’s. Blood tests are OK although an average of three months is needed to record any sort of trend concerning improved lung function and reduced inflammation. More fortunately I don’t seem to be experiencing the side effects that happened last time, and have just started sleeping through the night without asthma symptoms waking me up. A record after four years of broken sleep. Still early days or a coincidence though.

I’ve included a web ref for more detailed information about this and other alternative drugs which have and are still being used but only under specialist supervision.

Good luck with your nursing studies and career.

Mia xxx

chestjournal.org/content/12...

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Hi em

Ive recently had to stop methotrexate after nearly 4yrs on it for severe asthma and it was used almost as last thing to try. I was started on it due to being so steroid dependent and on such high doses. It was hoped initially that it would help to reduce these with it being a steroid sparing agent and reduce inflamation too therefore reducing symptoms. I was initially started on a small dose and they built it up gradually and i had wkly then fortnightly and then monthy blood tests to check my liver function and other things.

I had awful headaches when first started it and also sickness feeling after taking it but did ease after few months and took anti sick tabs too.

In first couple yrs being on it i did get pred down to 13mg, lowest ever and spirom etc improved along with night symptoms etc.

But in last yr or so i have been getting more and more severe infections including pneumonia and pleurisy etc and they thought this could well be due to the methotexate lowering immunity as well as the ever increasing doses of pred added with it. It seemed to also be affecting my blood, lfts where starting to rise more and i think something about my white cell count.

Anyway cos of this and the increased infections etc that is why ive had to stop it. Since stopping it in oct ive not had as many infecs and bloods norm again but asthma symptoms been more all over inclu 2 bad hosp admissions but dont know if thats just coincidence and may well have happened anyway esp with the winter we 've had.

Hope that helps a little for you.

Sarah

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Thanks

Dear Sarah and Mia

Thank you for your very helpful replies, I do get the feeling that this is a last resort drug, and that the side effects, especially immune system compromise, are a very limiting factor.

Kit-kat: Thank you for your pm, my computer is being silly and wont let me reply (thought I tried to send one and you may get a reply, who knows?!)

Hope everyone is well as can be, and thanks again for helping me out!

Emz