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Nausea with methotrexate

Just a short question 😀 my son gets some nausea and tiredness the day after methotrexate tablets , it not very severe. He took 20mg of omeprazole and it seemed to help , is this ok to keep doing ? He doesn’t take omeprazole all the time , maybe he should ?

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Hello weathervane,

According to the drug interaction checker here drugs.com/interactions-chec...

there is an interaction between methotrexate and omeprazole which means you should discuss it with your clinician. Apparently it can potentiate the effects of the methotrexate, increasing blood levels and side effects. I haven't had methotrexate, but find that metoclopramide is a pretty effective anti-nausea drug. And it doesn't appear to have any adverse interactions with methotrexate. But maybe your doctor will be OK with the omeprazole anyway x

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Thanks so much for that advice, gp never mentioned about that , he is on repeat prescription for omeprazole. Would a folic acid help the nausea, he was told to take it the day after the methotrexate, but the nausea is usually settled by then.

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Hi weathervane

Sorry to read your son's nausea problems. When I took MTX I was told to take the folic acid everyday except the dose day and it stopped me having nausea problems. I know the thinking has changed a bit as I took it quite a few years ago now. If it continues or worsens you can have MTX by injection which does help the nausea better whilst drug is better absorbed so can be more effective!.

Hope he has got his shoulder injected and the lesion looked at too. Hope that's helpful. Xx

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Thanks misty 😀 , reading various posts the advice seems to vary . It only lasts a day usually, so not too bad . No word yet about an injection, i will phone secretary again on Monday, she is very hard to get . Hope you are still keeping better xx

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The advice has changed since my time of being on it weathervane so your right to seek Rheumy advice on Monday. Good luck with phoning his secretary. Some are only there if clinics are on which makes it hard.

I've got my leg nerve pain back as had four lovely painfree months!. Feels like the end of the world until I readjust again!. I've got an open appt with the pain clinic so will be phoning her secretary too!. Let me know how you get on. Xx

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Ooh misty, sorry to here that . What do you take for it , is it in your legs or arms ?

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Thanks weathervane, it's my right leg that has nerve damage after an op!. I'm back to lidocaine patches and higher dose co-codamol. Take Gabapentin and Amitriptyline all the time for it and if all else fails I have a morphine patch but that's last resort!. Hope your phone call today went well. Xx

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Thats not good misty, sorry you are in so much pain. When I slipped a disc my lyrica was increased and i was on tramadol, i was anxious about in case i had trouble reducing the lyrica and stopping tramadol, but it was ok . It’s awful relying on painkillers. I hope it settles again soon☹️.

I haven’t got through to anyone yet, i will just keep trying, secretary’s ment to be working today but no answer or message phone. 🤪🤪

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Hope you've been able to speak to someone today weathervane. You'd think they'd have an answerphone!. I've just managed to make a pain appt phone call for mon3rd. So pleased!.

I was lucky like you and don't get withdrawal side effects like some do. These stronger drugs like Tramodol are a worry. Bet your glad you don't need them now. Xx

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Haven’t got anyone yet , might try rheumy Nurse again, though its a new one and she is not as helpful. Nearly took a tramadol today , have painter in snd as moving stuff and have sharp low back pain , put a rub on instead . No moving stuff for me 😫.

Does tramadol have less side effects than morphine patch oe visa versa , never had morphine that i can remember 😀

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Be careful weathervane, hope your back is better tomorrow. Tiring having workmen but worth it when done. Good luck too for hearing from Rheumy nurse. Mine took three working days to contact me. Was worth it as she gave me better news about my bones !. A real boost!.

My old GP said Tramodol was best for short term pain. I've looked both of them up in my drugs book and side effects are similar. Nausea, constipation, drowsiness . The patch gives a slow release relief thru the day better but is best for longer term pain. Hope that's helpful. TAKE CAREXx

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Thanks for that info misty. I am exhausted tonight , no more lifting! If don’t get secretary i will try nurse. Sleep well xx

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Good plan weathervane.fingers tightly crossed. Keep me posted and sleep well too. Xx

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I take folic acid every day except Metho dose day & have had no nausea problems. Would still check with your GP just to be on the safe side.

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Thanks Hazel , i will definitely check about increasing the folic acid to see if that helps him. Reading post , most people take it every day bar methotrexate day .,

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Methotrexate strips our natural folic acid in our gut which leads to nausea. I tried the methotrexate tablets and they caused horrific nausea. Then I switched to the injections and that was better and I landed up taking folic acid about 4 times a week.

I was on omeprozole at the time. Its best to discuss these things with your GP but I didn't have any problems with taking both meds.

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Thanks happytulip , i will check it with gp , before his diagnosis he was on folic acid as his levels were quite low , maybe they have dipped again and he does need to take it every day . I don’t know if his folic acid levels are checked in the methotrexate blood checks .

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They aren't. You need iron studies done, very simple and easy.

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Ok thanks x

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Omeprazole can cause all all sorts of unforeseen problems & really should only be taken as prescribed by the Primary physician prescribing the Mtx.

Your son should speak to his consultant .......if that takes a while to arrange speak to the pharmacist....he will have expert knowledge of what your son should do regarding mixing different drugs.

In the meantime advise him to he drink plenty of water with his Mtx, at least a couple of glasses.

Also taking Folic Acid as prescribed by his consultant helps with nausea.....again do check with consultant if Omeprazole is suitable.

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Thanks for that advice AgedCrone , he is under the combined care of rheumatology, dermatology and gp ! The gp has been in charge of the drugs which caused quite a delay when the dermatologist suggested the methotrexate. It is very difficult getting in touch with any of them , by the time you get past secretaries and receptionists . Still waiting for rheumatologist to get in touch about his shoulder ☹️

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In that case i would definitely have a word with your pharmacist, on more than one occasion GP's have prescribed me contraindicated drugs......luckily I use the same pharmacy all the time & the pharmacist has caught it before I took them.

I think you will find the Consultant prescribes the Mtx, and the GP issues the prescription on the Consutant's instructions. I know my GP couldn't alter the dosage of Mtx without the Consultant's authority.

Luckily I didn't suffer any nausea on Mtx....I was on 6 x5mg FA per week, Mtx does deplete the levels, but I read on here that many do feel sick, but it usually settles down, so try not to worry too much.

I found taking the Mtx in the evening after a meal seemed to solve the only problem I had which was a niggly headache.....but that resolved quite quickly.

Hope you can get some professional clinical advice soon.

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Thanks AgedCrone , your advice is always welcome 😀 The pharmacy i go to is always very helpful, i will have a chat there first . My son is on a 10mg dose but it may have to be increased as I think another lesion in the tissue of his arm is appearing .

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I might be an old Fusspot - but over the years I have found that GPs will rarely admit they don't know much about some AI drugs.....so not wanting to get on the wrong side of them, I always double check elsewhere before questioning a prescription.

Earlier this year it was thought I might have had Drug Induced Lupus(thank goodness I didn't) I ended up seeing a Dermatologist privately because my GP expected me just to "wait & see"! She wasn't the one covered in the most dreadful purple blotches!!

Oh dear......it's bad enough to have these problems oneself, but it must be doubly hard to watch one of your children suffering.

Hope your pharmacist helps.

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Thanks, i also annoy my pharmacist with questions LOL . I hope you are keeping well now , best wishes x

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Hi,

It is not a good idea to take omeprazole or any other PPIs (Proton Pump Inhibitors) unless one has severe oesophageal reflux... It causes a lot of damage long term and once the body becomes used to it it is very difficult to stop it.

Your son should see his GP and ask for some tablets that help with nausea, or better ask to stop using the tablets and have methotrexate injections instead - no nausea then, but I still get nausea with injections, it depends on the person, we are all different.

The injections are not difficult to do, subcutaneous and come prepared in a prefilled pen that you apply to the top of thighs and press down. No problem at all.

Do hope your son finds a way forward.

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Thanks JGBH , i will get my son to stop taking the omeprazole. I don’t know if he would be keen on injections I think he would prefer to see if he can control the nausea. He feels ok today so it only lasts a day.

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If omeprazole is helping it could me a case of gastritis? Could he try gaviscon? Although I get tescos own brand because its cheaper and more effective.

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That’s possible. He is feeling ok today, which seems to be the pattern. I will check with pharmacy first , then with rheumy as he hopefully should have an appointment soon . Thanks for your advice 😀

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Hi

When I hit 15mg MTX in tablet form the nausea hit me big time. I ended up taking folic acid (5mg x 6 days a week) which helped a lot but it was still bad the day after MTX day. I too am now on 20mg MTX but moved across to jabs. After a few weeks nausea issue was gone.

You should not take any antacid around the time you take MTX by mouth. You need to leave at least a 4 hour gap. Coincidentally there are a number of meds that you should not take around the time you take antacids. Of course it does not matter when you take your antacid when you take MTX by jab as the MTX is not going directly into the gut.

I find Omeprazole etc are best taken just before you go to bed.

Joy

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Thanks Joy for advice, hopefully we will have it sorted before next methotrexate on Friday 😀.! Ihope you are feeling better with your regimen now, i wish the doctors provided better guidance !!

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I can recommend 'Queasy Drops', google them, quite expensive as only 21 sweets in each tub around 5.99 each, but they are a natural product that helps me greatly with nausea after my Metho injections each week. They are recommended for chemo treatment for nausea . Hope this helps xx

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Thank you Poshcards , i will look for them ! I could maybe use them myself as well as sometimes have nausea with rituximab infusions. Great information coming through here 😀😀

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Hi, I have been on methotrexate now for 8 months and unfortunately am deteriorating. I have lots of pain, totally tired, immobile, my life is falling to bits to the extent I wish I didn't,t have to live another day. Yesterday I went to see my consultant who took me off methotrexate for yet another drug then decided to tell me my tiredness, lack of energy etc could be due to methotrexate, now she tells me. Too late, my life has fell apart.

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You are obviously feeling very low maalidog , the consultant didn’t think you were going through a flare ? My son wasn’t told that methotrexate can cause tiredness either , his tiredness was put down to rhe lupus . I hope the consultant has come up with an alternative that will suit you better. I have Sjögrens and there have been times when I haven’t been fit to leave my bed because of pain and exhaustion, at the moment things are not too bad and im functioning better. I really hope things improve for you and you can get your life back , everyone is here to support you, best wishes and gentle hugs 🌸🌸

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Thankyou so much for your kind words. Consultant has put me on mycophenolate mofetil.

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🤞🏻New drug works better for you and you get back to yourself x

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