Ibuprofen with methotrexate and azathioprine

[cakerbaker]

Hi all, I was wondering if anyone can help me. I am on methotrexate and reducing the azathioprine for my lupus. The trouble is I was told by the pharmacist she wouldn't give me ibuprofen as I was on the methotrexate. My rheumatologist said it was OK to take both so now I am confused. Is it safe or not? I am having a symptom flare and got a massive headache caused I think by sleeping awkwardly and paracetamol isn't helping and I can't take codeine. Is anyone able to help please? Thank you. 😊

[CarolMcl]

Hi, I questioned that too and was advised by rheumatologist that it's perfectly safe. I've been taking it for a few years now with no ill effects 🌹

[cakerbaker in reply to CarolMcl]

Carol you are a lifesaver. Thank you so much 🙏 x happy Easter

[CarolMcl in reply to cakerbaker]

Happy Easter 🐰🐣🐰

[Feelgoodbooks]

The pharmacist said that because according to the BNF (British National Formulary) there is an interaction between Ibuprofen and Methotrexate. I've copied and pasted what it says. I hope this helps

IbuprofenIbuprofen is predicted to increase the risk of toxicity when given with Methotrexate. Manufacturer advises monitor. Severe Study

Both Methotrexate and Ibuprofen can increase the risk of nephrotoxicity.

[PMRpro]

A more detailed description of the interaction says

"Ibuprofen may increase the blood levels and side effects of methotrexate. You may be more likely to experience this interaction if you have kidney disease or are receiving a high dose of methotrexate. The risk may be less if you are using methotrexate once a week to treat certain forms of arthritis. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor immediately if you develop symptoms of potentially serious side effects of methotrexate such as mouth ulcers or sores; vomiting; diarrhea; rash; loss of appetite; joint pain or swelling; yellow discoloration of skin and eyes; dark urine; shortness of breath; dry cough; paleness; dizziness or fainting; unusual bruising or bleeding; seizures; infection; and flu-like symptoms (fever, chills, body aches, sore throat, muscle weakness). It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor."

drugs.com/drug-interactions....

I am surprised they are so dismissive!!! But then - they aren't taking it are they

[cakerbaker]

Ni PMRPro - no they aren't indeed. Thanks for the advice. I am new to methotrexate and do have a sore mouth but it is also very dry at times so think I need my HbA1c checking too. Kidneys are fine as far as I am aware so I am hopefully ok to use occasionally. I have been on the MTX for 8 weeks but no blood tests due for another 4 weeks - I don't know if that's normal as up until now I have been having them weekly. I will try and get hold of them this week to discuss.

[Poshcards]

Saw my Rheumy last November and she said Ibuprofen is a big, no, no, because I am on high dose Methotrexate! x

[citygirl1234]

Hi, I had this dilemma last year when I had a wisdom tooth infection. My rheumatologist said hard no to taking ibuprofen when I was on methotrexate as it’s a “red” drug interaction, though he did say I could take it while he paused the methotrexate. My best friend’s a clinical pharmacist so I also asked her for her take as a clinical pharmacist: she said in general they would say no, but they would potentially let a doctor override the red interaction for a rheumatology weekly methotrexate dose if there was additional monitoring (e.g. bloods and urinalysis) in place while you were on both. That would be for the doctor to make the case to the pharmacist as an exception though.

Maybe the doctor was confusing the methotrexate with the azathioprine which is generally ok to take with ibuprofen? Or just having a long day? Good catch by the pharmacist. Hope the headache’s gone!

Here’s the page in the BNF that the pharmacist and rheumatologist should be looking at:

bnf.nice.org.uk/interaction...

[cakerbaker in reply to citygirl1234]

Thank you for your advice. Yes headache gone but might need to stop the methotrexate anyway. Woke up yesterday with a mouth full of sore patches with a tongue that looks like it's had the end half dipped in boiling water. Honestly this is never ending isn't it?!

[citygirl1234 in reply to cakerbaker]

That’s not good! These things do always feel like buses but maybe you and methotrexate aren’t meant to be… :/ Mouth ulcers are the worst, but on the plus side it gives you a good excuse to put off seeing the dentist for a bit