Scared update !

[halaahmed]

Hi guys,

I have seen my Rheumy last Saturday and if you still remember, after I was told I'm in remission, I had more than 10 days of constant pain and swelling. My ESR, CRP were elevated too.

Now after some little investigation, I and my doctor found out that I was taking the wrong dose of MTX !!!

Here's the story:

At the beginning of my treatment I saw another rheumy who prescribed 7.5 mg of MTX and that was agreed on by my current rheumy later. But the first doctor didn't write it on the prescription as 7.5 she wrote (3 marks) and she assumed that people will understand it.

Whenever I go to a pharmacy to get the injection, the person who gave me the injection just followed the (3 marks) instructions and they varied the syrenge of course, sometimes the regular one, sometimes the insulin, bottom line: I was taking NOTHING, a 3 mg or something, that's why my inflammation increased.

Being in shock, my doctor decided to raise the dose to 12.5 mg of MTX weekly and folic acid everyday.

I'm scared of raising the dose. Is 12.5 mg a normal regular dose, will I survive it? I have a thin week body...what bad things should I expect if I take this dose...my doctor said that he can't prescribe 7.5 mg any more cause my inflammation has increased....help please

[nomoreheels]

It's little wonder I couldn't understand your last post. It didn't even cross my mind you'd have been dispensed an incorrect dose! From previous posts you'd said that you were taking 7.5mg & my replies have been based on that dose, but you weren't to know & I would never have thought you weren't being prescribed it! I've no idea what "3 marks" could be or indeed mean & I must say I'm more than a little surprised it was never questioned by the Pharmacist who dispensed the MTX for you or your GP if he was the repeat prescriber! Were you being given prefilled syringes or syringes & a vial of MTX? I'm wondering, are you in the UK? It's not something I've ever come across as prescriptions for cytotoxic meds are usually double checked before handed over.

Anyway to your question of if you'll survive taking 12.5mg. Yes you will, even if slight of frame. There's no reason to be scared, I was 57kg when first started on MTX at 15mg but orally though no or little different in weight when started on injections 15mg/20mg. My dose had to be reduced from 20mg but it was due to a liver issue not my BMI. Some Rheumies do prefer to introduce their patients to MTX at lower doses & titre up but it's not unusual to start on 12.5mg so don't worry. I believe the highest dose of MTX used in Rheumatology is 27.5mg in the UK though I have heard of 30mg being prescribed. You'll be taking less than half of that & so in effect 12.5mg could be considered a low to mid dose & depending on what your blood results reveal & his examination of you he may increase it or decrease it in time. As I said in my previous reply my Rheumy has recently increased my dose to 17.5mg & I found out today that my last blood test from a fortnight ago shows I'm reacting well to it, levels all good so I may be going up to 20mg to try to get my RD in my feet controlled. Assuming you are in the UK you'll be able to open this link from the NRAS website nras.org.uk/methotrexate-in.... It explains all about MTX, how it was found to be useful for RD patients & the doses prescribed, it may put your mind at ease? Do remember that even though you've had a very low dose it may take a little time to build up in your system & improvements may not be immediately noticed.

One more thing, this present Rheumy has prescribed folic acid for you every day, including the day you inject? This may be his way but it is unusual to take it the same day as there is thought it reduces the effect of the MTX.

I hope you're now on the road to proper treatment & are confident in your new Rheumy, it can make a big difference especially for you having had such a shall we say "unusual" start.