Methotrexate and painkillers

[Mifford]

So my regular methotrexate query for those with more experience - I'm struggling a bit this evening with really painful tendons/joints especially in my hips and elbows. It's that really annoying pain where no matter what you do you just can't get comfortable and my shoulders are quite sharp pain.

I don't usually take painkillers as there are so few I can have (can't do nsaids for example) but every now and then I reach a limit where I need the relief and tonight is one of those times. As is law of sod though it's evening when I can't get any advice from my docs etc so I turn once again to you lovely people.

I know when I was being taught about the injections I mentioned painkillers and the nurse told me no paracetamol as it acts on the liver as well and that pain is better managed with getting the mtx right so I don't get it so much. Which is all well and good but doesn't help tonight. And daftly I didn't ask what I CAN take if I really need to. Anyone got any advice or know for certain if there's anything I can take that won't cause a problem. I have some nurofen in the cupboard which I can take just 1 tablet as a one off without reacting or I have 5mg diazepam tablets both of which will work to take the edge off but not sure if it's safe to take either. I wish they'd let me have a steroid injection to get rid of the flare and then the mtx would have a better chance too but there's no persuading them unfortunately

Any advice as always greatly appreciated

[Fennella02]

Hi Mifford. I've always been told to stay away from NSAIDs and use paracetamol as the safer alternative. I was also told that there is no interaction with paracetamol and MTX . I always reach for co-codamol for more severe pain and find it very effective, you can buy it OTC . Hope this helps and you feel more comfortable soon xx

[PMRpro]

Too late now - but for next time, if you are in the UK calling 111 should get you that sort of info. A pharmacist is also a good person to ask if you call the duty pharmacy. It is something you should clarify with a rheumy nurse I suppose - and more to the point, something THEY should remember to discuss with you when starting MTX.

But Johns Hopkins website says:

"Methotrexate can be taken with other medications – NSAIDS (Celebrex®, Vioxx®, ibuprofen, naproxen), prednisone, Enbrel, plaquenil. You should not take methotrexate while taking any medicine containing trimethoprim-sulfa (Bactrim®, Sulfatrim®, etc…)."

[happytulip]

That's odd about paracetamol. I am on methotrexate injections and have been advised to take paracetamol 4 times a day, I'm also on oramorph and pregablin. But without regular paracetamol I'd be in a major pickle!

[Mifford]

Thanks everyone. I managed to get hold of the rheumy nurses today and they said paracetamol should be fine when I need it but they would rather I don't take it for too long - it sounds like a combination of letting my liver function get used to the mtx without anything else added to stress it but also for them to be able to tell how the mtx is working for me without painkillers masking anything. I'll be having my follow up beginning of April so I'll take this up with them more then as I think I may have to start looking at taking painkillers with my hips now. I'm hoping the mtx will make it unnecessary and I'm trying to get weight off to help too but I need a backup for when I need it and my tens machine isn't always enough. Paracetamol won't help much but I'm hoping it'll be enough to take the edge off at least.

[SquarePegGuy]

My wife takes Aleve (naproxen) while taking Methotrexate as well as Aspirin to thin the blood.

[Mifford in reply to SquarePegGuy]

I can't take either unfortunately - bad reaction to nsaids and caused a stomach bleed in the past and I've had minor reactions to aspirin but my dad is fully allergic so the docs think my reaction will get stronger each time I take it