Am due 2 Start a new medication next week Metroxa... - LUPUS UK
Am due 2 Start a new medication next week Metroxate as Azathrioprine was not working and wonder what the side affects r?
Hi Lisa78 I couldnot tolerate Azathioprine made me so ill and was started on Methotrexate 6 month ago, and had no side effects what so ever, and it seems it has helped considerably, within a week or two l felt so much better, and still do, I was so ill for nearly 3 years previous virtually in bed more than out, and joint pain and felt so so ill , but thanks to methorexate there has been a great improvement, still suffer joint pains but not as severe, and when l get a flair it does not seem half as bad and does not last as long as before... By the way l have SLE Rhum Arthritis, And Thyroid problems. So wish you good luck and it hope will work for you too. Hope this helps (hugs) x x
Hi, I have also had methotrexate suggested. I have SLE,Fibro,Osteoarthritis and an underactive thyroid. I am interested in what you have said. It sounds like it has helped you. I wonder if you suffered from lead type legs...and if so has it helped with that? My legs go so heavy that I cannot walk, joint swelling/pain,malar rash, extreme fatigue etc....I continually flare. I have tried without methotrexate but I wonder if I have to try it.
Oh gosh, I am due to start Azathioprine soon and have now heard three bad reviews of it and no good ones!
Could you tell me what side effects you had? Why do they try Aza first and not go straight to Methotrexate?
I had huge itching response to Hydroxy and had to stop it. Am taking only Meloxicam at present which has caused lots of tummy problems tho it does control my daytime pain. Flares are frequent and have four courses of Prednisolone since March which is why my rheumy is putting me on Aza.
Does anyone out there have any good experience of Azathioprine pls?
Bethsuejane i've not had any severe reactions to Azathrioprine they've just stopped helping now after 6yrs.I am also on Prednisolone & unable 2 take Hydroxy coz they damage my eyesight.Azathrioprine really need help its just the illness has progressed.Methotrexate is very strong from what i've been told hence why they start u off on Azathrioprine
HI I am on methotrexate been on it for around 3 years, had problems with the oral ones my mouth was so sore and they made me feel sickly, but now injecting it and no problems hope you get on ok with it
I recently wrote three short articles on hydroxychloroquine (plaquenil), methotrexate and azathioprine. Copies of those articles are pasted below. These essays are meant to give a cursory overview of the medications. There are many research sources on the Internet which give a more detailed description of the drugs' uses and side effects. It's a good idea, when looking up information like this, to refer only to peer-reviewed journals. That's the only kind of material I consider, maybe because I'm a born skeptic and have to check everything out for myself. Well, anyway, here are the articles. Hope they are helpful.
Methotrexate
Methotrexate is an immunosuppressive drug—which means it interferes with the production of some kinds of immune cells. Back in the 1950's doctors noticed that patients who had certain types of cancer did better if they were deficient in folic acid. This observation led to the development of methotrexate, which interferes with the action of folic acid. Treatment with methotrexate became common for selected cancers because the medicine was found to have less side effects than some other preparations.
Eventually, methotrexate was discovered to be useful in suppressing immune activity in autoimmune diseases, especially rheumatoid arthritis, but also lupus and Crohn's disease, among others. Doses necessary to achieve a therapeutic effect in lupus are much lower than those administered in the treatment of cancer. Consequently, side effects may not be as severe.
However, methotrexate is a powerful drug and can have very serious side effects. It is absolutely prohibited if there is a chance of pregnancy. Even after discontinuing use of the drug, pregnancy must be delayed until all of the medicine has cleared from the system. Among the many serious side effects that may occur as a result of taking methotrexate are liver damage, lung damage, and nervous system complications.
Drug interactions include penicillins, probenecid, phenobarbitol, carbamazepine, Bactrim and NSAIDs (although NSAIDs may sometimes be prescribed in combination with methotrexate). It is recommended that while on Methotrexate the patient abstain from drinking because of possible damage to the liver. It is essential that the patient be monitored (blood tests) regularly. Any sign of shortness of breath or chest discomfort should be reported immediately to the doctor.
Patients taking methotrexate often are prescribed a folic acid supplement to avoid deficiency.
Though Methotrexate is widely used for the treatment of lupus, it is generally not the medicine of choice for those who have lupus nephritis or organ involvement. According to the Mayo Clinic, methotrexate should be used with caution in lupus patients with these symptoms.
While methotrexate is a powerful drug and can have potentially serious side effects, the fact remains that it has been very useful in the treatment of a variety of diseases. As with every medicine, risk has to weighed against benefit. For many patients, the benefits are greater than the risk.
Azathioprine
Azathioprine is an immunosuppressant which was designed in 1957 for use in chemotherapy; however, the drug was discovered to be useful in the treatment of some autoimmune diseases, including lupus.
Although today azathioprine is widely accepted as a lupus treatment, the Food and Drug Administration (USA) has approved the drug for only two uses: kidney transplants and rhuematoid arthritis. All other uses are considered “off-label”.
Nonetheless, azathioprine can be a powerful ally in the battle against lupus. The drug acts to inhibit cell reproduction, especially reproduction of T and B cells, two lymphocytes implicated in inflammation. Often, azathioprine is given in addition to a steroid. When azathioprine starts to take effect (which may not be for months) steroid use may be reduced or even eliminated.
People taking allopuranol, niacin, warfarin and certain muscle relaxants should be aware that potentially dangerous drug interactions have been observed between these and azathioprine. There is also some evidence that fetal damage may occur, although this is controversial. According to the Mayo Clinic: “Studies in pregnant women have demonstrated a risk to the fetus”. The Mayo site goes on to say that even though a potential risk to the fetus exists, in some cases this may be outweighed by a risk to the mother's life.
The chances of developing skin cancer rises with azathioprine use, as does the likelihood of developing a rare type of lymphoma. There is also the potential to experience bone marrow suppression and leukopenia.
The side effects listed above are just some, not all, of those that have been noted with azathioprine therapy. That said, this drug can be very useful and effective; it is taken with great benefit by many people. I came across the abstract of an article which describes the success rates for lupus patients who were treated with azathioprine (see Arthritis and Rheumatism, below). People who had begun the drug course with a poor prognosis showed a dramatic increase in survival rates and those with a good prognosis showed a dramatic decrease in hospitalizations.
Although reading about the side effects of a medicine may be upsetting, that shouldn't dissuade anyone from accepting proper, sometimes aggressive treatment for their disease.
Plaquenil
One of the first medications a lupus patient may be offered is Plaquenil. While every drug has side effects, Plaquenil is generally considered to be “safer” than many other medicines prescribed to treat lupus.
Researchers are finding out more about this drug all the time; the current state of science indicates that Plaquenil is effective against lupus, and some other inflammatory diseases, because it creates an inhospitable environment for some actors in the immune process. In this way Plaquenil inhibits the immune response and thus also inhibits inflammation.
Though Plaquenil is considered to be relatively “safe”, there are several populations in whom great care should be taken before the medicine is prescribed. If you are over the age of 60, the chance for retinal damage increases. If you have psoriasis or porphyria, taking this drug may exacerbate your condition. Anyone with reduced liver or kidney function should also consider carefully if the risks of the drugs outweigh its benefits. Plaquenil can be extremely dangerous for children, especially children under the age of 6. People who have a metabolic disorder called G6PD run the risk of developing severe anemia on Plaquenil therapy.
The most commonly addressed side effect of Plaquenil therapy is retinal damage. Every responsible opinion I have read prescribes a visual screening before therapy begins and then a re-check several weeks later. While it is rare for eye damage to occur, especially if therapy lasts less than five years, it is important to keep in mind that once damage occurs, it is most likely irreversible. And the changes in the retina may not be noticed subjectively but can be detected by sophisticated testing in the ophthalmologist's office. Many doctors recommend a yearly check-up; some recommend six months. If I were on Plaquenil I would go for six months because I'd like to detect damage before it goes very far.
With all of the warnings listed above (this is just a partial list of possible side effects) it would seem that Plaquenil is a dreadful drug. It really isn't for most people. Lupus is a serious disease and sometimes you have to take out a big gun to control it. Plaquenil is actually one of the smaller guns in the arsenal against lupus.
Originally used as a treatment for malaria, Plaquenil is useful not only in treating SLE (though not severe SLE), but also other inflammatory diseases. The drug is supposed to be particularly effective at treating discoid lupus.
All of the sources I consulted implicate higher-dose and longer-term Plaquenil treatment in increased risk of eye damage. So if you are on Plaquenil for many years, certainly as many as 8, your doctor might begin a conversation with you about switching to an alternative treatment.
Hi lupuswriter, I realize this is sometime after you wrote the above, but wondered if you could give me the source of the methatrexate info so I could show it to my rheumy.
I have trouble tolerating many forms of tablets, & have been unable to find a successful treatment for my lupus to date. I know that methatrexate is available as an injection, so wonder if this a possible alternative.
Unfortunately due to a succession of locum rheumies, it seems to be up to me to do the leg work. Hopefully they will take this into consideration if it's from a peer review journal.
Many thanks in anticipation, Roobarb. X
Hi,
I am sorry that lupus is resisting treatment in your case. I think you are absolutely right that you are your own best ally. The next best ally is a really smart rheumatologist who approaches your case with insight and care. I hope you have that on your side. As for the references, I hope these come through as links; if not, just paste the names of the articles in your Internet search and you should end up in the correct places.
There are three source articles I posted on my own website when I originally wrote this piece. These articles are:
*American College of Rheumatology: Methotrexate. rheumatology.org/practice/c...
*MedlinePlus: Methotrexate
nlm.nih.gov/medlineplus/dru...
*DermNet NZ: Methotrexate
dermnetnz.org/treatments/me...
If you have trouble locating these articles, I will forward more specific information to you. If you want me to hunt around for more information, I will do that too. Don't worry about the work. I love doing research.
All the best, lupuswriter
