Is this true??

I was reading that it can be dangerous to take methotrexate with omeprazole - I wasn't clear when reading whether it referred to the dose(s) used to treat RA and AS, or whether it referred to significantly higher dose for diseases ( e.g. Cancer). Is anyone able to share some light on this please?

82 Replies

  • Hi I haven't heard as I'm on both plus Bisomar Benepali and have been taking them since 2014

  • Thanks for your response popsmith. I've been trying to locate the article to clarify but it definitely mentioned this. Like I say, it may have been referring to higher doses? Not certain.

    Like you, I've been taking it alongside firstly humira and now enbrel but I only began taking methotrexate a couple of months ago and because it was increased recently, I wanted to read more about it?

    If I can locate the article, I'll update.


  • Hi

    I am taking omeorazole at the moment and was taking methotrexate for approx 2 years prior to that.

    I have stopped methotrexate (for other reasons) now but there was never a problem when I took both at same time.

    Take care,



  • I'd be very surprised if that were the case! I was prescribed Omeprazole last February after an endoscopy revealed inflammation of the gut. My RhA diagnosis did not follow until April. There are now three of us in the family being treated in three different Rheumy clinics across two counties and each is prescribed with the Methotrexate and Omeprazole combination plus folic acid. I consider myself very fortunate that I have not suffered any nausea but I put that down to the fact that I take my meds with my milky cereal each morning. There's only one snag: I now have to take a weekly dose of Risedronate Sodium with a full glass of water, for bone density, so I have to delay breakfast and the daily meds on Mondays to allow that to be absorbed in an upright stance before imbibing usual food and drinks containing milk.

  • I haven't heard of any problems Eiram. I take MXT and also take 1600 mg slow release Brufen with omeprazole every day. Having said that, my rheumatologist only prescribed the Brufen it was my doctor who said I should be taking the stomach protector as well.

  • Thanks everyone. I can't find the article but I looked it up and instantly found this

    There is evidence that coadministration of methotrexate and omeprazole prolongs the elimination of methotrexate via the kidneys.

    I too have been taking both of them safely and without issue and I guess that's why I was surprised to read about any contraindications ?

    Similar to you downtime it was my gp who prescribed the omeprazole ( as opposed to rheumatologist) but I'm pretty sue the pharmacist would pick up if there was any issues with taking both?

    Just was a bit surprised to have read about it ?

    Thanks everyone, my mind is now at ease again!

  • I got really sick at one stage after injecting my MTX - even worse than usual for me. I really felt as if I'd been poisoned and could barely function for a few days. I literally felt on death's door and it was very scary,

    When I described this experience to my pharmacist she looked at my prescribed meds and advised me that, for some, the Omaprazole/ PPI can significantly increase the toxicity of MTX. This is because the stomach protector inhibits the natural passing of toxicity as required. Yes it protects as intended, but for some, even at a low dose, this is at too high a price and can be dangerous.

    So you were right in what you've read but this really doesn't affect most on lower doses it seems. But although it applies more to those who take MTX for cancer - some of us react badly to small doses of toxicity where other don't and this doesn't only apply to those taking MTX at much higher doses. It applied to me at only about 17.5 or less. I have problems with PPIs anyway despite severe GERD. I have severe Sjogrens so am often unable to process toxicity because of systemic lack of moisture. PPIs are not at all good for me in general - they make me ill as do NSAIDs. We are all different in what we can tolerate and one person's antidote will be another's poison.

    The pharmacist suggested I try Ranitidine instead - which I did and still do and I never got sick like that again from MTX - although it did make me ill too often to continue with finally. Hope this helps.

  • Hi Marie

    I think you are very fortunate to have been able to get Omeprazole because I was refused it. As a result, I had constant diarrhoea and bleeding and awful nagging pain worse than that of RA. I then had a positive test result for helicobacter-pylori but it took three months to get a GP appt. I showed the result to the surgery and they said they just did not have any appts and weren't booking more than six weeks in advance.

    I finally got one before Christmas. I have a stomach ulcer as a result of not taking Omeprazole with the RA meds. Unfortunately, I did not know that it was available over the counter (so it can't be that harmful) - it costs about £60/month but I would have paid it to avoid this misery.

    Anyway, the upshot is that the GP was worried to death saying she did not want to alarm me but it might be cancer and I am supposed to have an urgent gastroscopy and colonoscopy.

    All this could have been avoided if I had been treated with a modicum of competence. I had to wait 6 months for a rheumatology appt and by the time I got the meds after another six months, they did not even work. I started taking Omeprazole for the stomach problem last week and the relief is overwhelming. I have come off the RA meds.

    I am not concerned about the cancer issue but I do feel that I never want to see a conventional doctor again .

    Therefore, I would think the Omeprazole is a good protection against stomach ulcers which have a nasty habit of turning cancerous. However, if I were you, I would check with the person who prescribed the Omeprazole.

  • Hi delicateinput

    Your experience sounds horrendous and it is awful that you had to to go through that.

    Over here, I don't believe omeprazole is available over the counter, it needs to be prescribed. I wouldn't argue that this drug has efficacy and in many cases is very protective.

    My concern is the effect / combination of this drug with others, particularly methotrexate. I take a real cocktail of heavy drugs and I don't doubt I benefit from something to protect the stomach but I want to be sure that what I take works with all the other drugs and not, potentially, against it?

    I am glad to hear things feel better for you now and wish you the very best for the future.


  • Methotrexate is an anti cancer drug. Even if it increases toxicity (at high dosages), I can't reasonably see how an anti cancer drug will cause cancer. I am taking 40 mg Omeprazole/day. A normal dose is much lower so if they had given it to me in the first place (or even told me to buy it), it would have cost less.

    I looked on the internet yesterday and Boots sell it for £10 for ten 10mg tablets and they have a special offer. It is always risky buying off the internet.

    However, if it is available in the UK over the counter, it can't be a drug that is going to cause much harm if taken correctly. It comes with a comprehensive leaflet of when and when not to take it.

  • I can honestly say I was unaware that you could buy omeprazole over the counter in the U.K. - you live and learn.

    My raising this though has little to do with how safe omeprazole is. I know it's an effective and safe drug. The issue is is taken alongside methotrexate.

    I hear what you're saying also in that if it wasn't safe, it wouldn't be prescribed. That's fine if what it also means every gp is up to date and aware of medications used for RA and AS and their contraindications. Most, I would say are not.

    It also works on the premise of effective communication between gp and rheumatology consultant. This, in my experience has not always been the best either ?

    I too have never heard of

    Methotrexate causing cancer per Sen it it is linked to certain cancers, as are the biologics we take?

    Thanks for your input.


  • I did not know that Methotrexate and biologics are linked to certain cancers. It just shows that you really need to monitor yourself. I certainly won't be taking any drugs again. Just to clarify, I was saying that Omeprazole must be safe as it is over the counter but looking at the leaflet it seems to have an awful lot of complications. A lot of unsafe drugs are on prescription so, again, people really do need to monitor them personally rather than solely relying on doctors.

    Many thanks for your replies.

  • I'm sorry but I don't agree with this logic about drugs you can buy OTC being necessarily harmless or safe! You can buy Ibuprofen, Benalyn, Nightnurse, paracetamol, antihistamines, hydrocortizone and Aspirin all OTC too - but they can cause significant problems for some people if taken long term - or even short term if you already have stomach ulcers/ gastric bleeding, liver or renal problems.

    They simply aren't made for long term usage off prescription. For those of us with long term conditions it's really important to get regular drug overviews to check that things aren't contraindicating.

    And there have been large scale studies showing that PPIs can and do inhibit the absorption of essential minerals and vitamins so they aren't just drugs to pop away without some proper thought and discussion with a gp. And I too spent nine months on prescription NSAIDs without being advised to take a stomach protector and this has caused me severe upper GI problems now - but PPIs cause me as many problems so I discussed this with my GP and I now take Ranitidine - which is from a different family and works much better for me with no side effects.

  • Over the counter medicine is pretty safe if you read the leaflets and follow the instructions.

    Eiram50 has kindly explained her concerns about taking Omeprazole in conjunction with prescribed RA drugs, but also the cancer related problems regarding certain prescribed RA medication. Omeprazole is perfectly safe taken on its own in accordance with the instructions. I won't taking RA prescribed drugs again. I never thought it was worth it and I am finding it all too much. It is easier to put up with the RA rather than far more serious conditions.

    You did well to last nine months without a proton pump inhibitor. I lasted three months and from two weeks I had severe GI symptoms. A number of people on here have complained about this almost immediately but were advised that the body gets used to the drug. It did not in my case - I just got worse and worse.

    Were you referred urgently for cancer investigations, as I have been? I really do not understand why though the symptoms have alarmed my GP and the surgeon I saw but it took months to get a GP appt. I tested positive for h-pylori which causes stomach ulcers to become cancerous in most cases of stomach cancer. I really would have liked to discuss it with a consultant as I really do not want the investigations.

  • I've had so many serious, hospitalising drug interactions that I'm wary now. But having primary Sjogrens Syndrome puts sufferers at a significantly increased risk of Non Hodgkin Lymphoma and acid induced oesophageal cancer is also something that worries me as it does you. I was fast tracked for gastroscope while in hospital suffering from drug induced pancreatitis in 2015, I was fast tracked for a colonoscopy last year for rectal bleeding. They found severe reflux and bleeding haemorrhoids - no cancer so far thankfully.

    Despite potentially life threatening reactions to DMARDs, the worst drugs for me are those that have just been upgraded to class C because people have been getting them on prescription and selling them and they have caused fatalities. Doctors have handed these out like smarties to me and anyone with chronic pain condition, despite the fact that their original purpose was to treat clinical depression and epilepsy. I hated these drugs most because there is no monitoring for them and they are extremely hard to come off once they have altered the brain pathways.

    DMARDs (apart from Leflunomide) such as Methotrexate can be stopped immediately without any adverse withdrawal effects other than flares as symptoms return. They are very closely monitored and, despite serious reactions to a fairfew, I don't worry about taking them in the way that I do about steroids, NSAIDs, PPIs, antidepressants or anticonvulsants. For me there is no such thing as a safe medication, OTC or prescription - and certainly not Omaprazole. I have learned the very hard way to do my research and be wary for myself about what I take. My GI system does not cope well with having no acid - we need some acid in order to digest food. We need to be able to absorb vitamins such as iron and B12 to avoid diseases such as Pernious Anaemia which, unrecognised and untreated, scare me every bit as much as cancer. Dementia is a real risk from B12 deficiency. So it's not black and white at all for anyone here. As I've said I choose Ranitidine only, even if this increases the risk of oesophogal cancer. Living with a foul taste constantly for me is not an option and this is what Omaprazole and Lanzoperazole both do to me.

    You say "far more serious conditions" but RA and all the other connective tissue diseases can do tremendous harm too so this needs bearing in mind before making decisions any about what are safe or unsafe meds.

    Many cancers are curable where RA isn't and other related autoimmune diseases such as Scleroderma, Lupus, Vasculitis and Sjogrens can affect any of the organs and nervous systems too, so these are not diseases to be allowed to run amok. They are all very serious diseases!

  • So sorry to hear all that. Dmards have caused me damage and I would have been grateful to have Omaprazole to prevent it for 2/3 months. I have to take it now short-term for h-pylori infection so that antibiotics will work. The bad taste is not a problem compared with the damage done by RA drugs for me, to say nothing of the stress.

    I was really talking about the short-term usage, which it is only needed for. Eiram50 was enquiring about cancer link to Methotrexate.

    RA is usually treatable if treatment is started early. I am afraid I have known so many die from cancer even when diagnosed in the early stages that I don't think RA is as lethal.

    I don't normally take any sort of drugs - neither Naproxen nor prednisolone helped and again caused quite serious side effects. I am allergic to the latter. I usually use alternative herbal medicine intermittently.

    Many thanks for the info and I hope you will stay well (or as well as can be expected).

  • Hi delicateinput

    Just so there's no confusion, I wasn't specifically enquiringly / questioning the link between methotrexate and cancer. It is about the risks associated / contraindications in taking omeprazole and methotrexate together. Primarily levels of toxicity and damage to kidneys etc.


  • I see. Yes, some drugs do affect the kidneys - I've known a couple of people with that.

    I think low dose Omeprazole is for short-term use. To avoid what I have suffered, I would continue to use it till you see your consultant. I got these symptoms after two weeks without it.

    Another thought occurred to me. I was going to suggest you contact the medical information officer of the manufacturers but I see they are in Spain. That is a shame as they are a mine of information on drug side effects.

    Good luck with it all. I won't be taking any Dmards again after this episode. I think I am too old to tolerate them. I am grateful though to have the Omeprazole now, along with the antibiotics, as h-pylori can be dangerous. I only need it for a short time. Pity I didn't have it before to avoid all this.

  • No one should have to go through what you have. I am glad that you seem to be a bit more on top of things.

    I have been on omeprazole for the past 3.5 years and therefore would consider this as long term use?

    Again, I would say that omeprazole in and of its self has never been a concern for me - it certainly has a place when taking any medications long term . It simply is taking it alongside methotrexate specifically and the potential for significant harm in doing so that I need to discuss with consultant so that I can continue with confidence.

    Thanks for all your input and good luck for the future.


  • And it is with a heavy heart that I've now just popped another 20 mg of methotrexate in my mouth - so uneasy with this drug.

    And so far, after nearly 16 weeks, it is making no significant impact!

  • On the contrary in the case of omeprazole I'm afraid, which is a concern with it being available as a Pharmacy Only med, more so if bought online. Unless monitored omeprazole can cause problems. It may say in the leaflet I'm not sure but taken regularly over time it can result in calcium depletion & magnesium deficifiency, both a concern if there's a diagnosis of osteopenia or osteoporosis, or even if you haven't. If taken long term really levels of both ought to be tested periodically, particularly if you start having neurological problems, muscle cramps or other common symptoms of depletion of either or both. Alternatively you could supplement but again levels should really be checked periodically.

  • The leaflet says bone thinning is only a very slight risk after continued usage for over 12 months at a high dose. To protect the stomach from the effects of Dmards, only a low dose is required.

    We were really talking about short-term risk. Obviously, if Omeprazole is a cancer risk when used with Dmards/biologics, even in the short-term, nobody wants to risk it.

    I am only taking it now for a very short period in conjunction with antibiotics for an h-pylori infection. If I had had it previously, I would not be in the position of having an urgent cancer referral.

    Thankfully, I rarely use drugs. Osteoporosis is easily reversible (under age 70) - I have had it severely and it has reversed. I had no symptoms so it is not in the same category as cancer.

    I've ordered some Mastika gum capsules off the internet for the h-pylori. If I had known about them sooner, I might not have developed these serious GI symptoms. It is hard when you have to research everything but at least the internet can be helpful. I don't normally order off the internet as I once had probiotics which did not work, I think on account of incorrect storage, and were almost out of date.

  • That may not be the case for others though who either ignore the advice or don't read the leaflet, many don't, & buy it on a continual basis, which is likely if they suffer from GORD & don't see a doctor thinking they're sorting the problem themselves. This is the concern about omeprazole no longer being a prescription only med. I do hope you were prescribed it to take with your antibiotics? The PIL in my box clearly states one of the reasons it's prescribed is for "Ulcers which are infected with bacteria called ‘Helicobacter pylori’. If you have this condition, your doctor may also prescribe antibiotics to treat the infection and allow the ulcer to heal."

    I hope the antibiotics do the job & you feel better soon.

  • The trouble is that no country or state can protect against stupidity. If you do not read the precautions in any situation (like crossing the road or fitting a plug), it is dangerous. I can't see many people taking Omeprazole continuously because it costs around £60/100 per month depending on dose and even in the worst cases of acid reflux it would not be necessary all the time. Even if people do not read leaflets initially, they certainly do when they start to get symptoms. Paracetomol will kill in a day or two if an excessive dose is taken but deaths from this must be extremely rare if at all.

    I am taking Omeprazole with two antibiotics. My gripe is that I was not told about it or given it to take with the Dmards, which caused the ulcer. H-pylori was present for a long time and has no symptoms and came up on a private screening, confirmed by the GP's tests (causing another delay). Not having been able to get a GP appt for three months, she is now in a panic because the symptoms are of cancer and has made an urgent referral. All of this could have been avoided. I am sure it isn't but there is some problem. Some people would be hysterical by now.

  • That's crazy, 3 months for an appointment? I'd like to know the mortality rates of their patients! Probably a pointless question because if you could you would but are you not able to register with another Practice, one which can offer patients appointments within a reasonable time? Even if it means you'd have to travel further afield, surely it'd be worth it to be seen more promptly. Probably not on the same scale but I live in an area highly populated by retired people & I could have an appointment the same day. I take it you live in London or another highly populated area, either that or your GP Practice is oversubscribed with patients or is lacking in GP's, or has a rubbish appointment booking system. Have you tried asking to be added to your GP's day list when you ring for an appointment? It's worth a try, I did it myself this morning when I was late phoning for a same-day appointment.

  • what a dreadful time u been through i just wanted to ask u a question does lansoprazole do the same job as omeprezole hope things getting better for you now ty mary xx

  • Not sure but if it is a proton pump inhibitor, it would do the same job. I think Omedprezole is marvellous in my state and it has relieved the stomach pain. I just don't understand why some people can get anything they want and others are refused.

  • Hi

    Just wanted to make you aware that I'm in Scotland (UK) and therefore things are maybe more Available through the NHS perhaps?


  • Scotland has a far better health service, I've heard from people I know who live there including a GP. For example, I know people who cannot get varicose veins done on the NHS in England but it is easily available in Scotland.

    However, there is a huge individual disparity in England even at the same surgery. Some people get same day or next day appts for trivial issues and others wait months with serious symptoms. The surgery knew I had h-pylori which is known to cause stomach cancer if there is an ulcer. They also knew that I was suffering bowel symptoms from the RA meds and likely had a stomach ulcer. They also knew that I have had bleeding for years because of thrush. It does not take much intelligence to work out there was a high risk of a bowel or stomach ulcer which can be a cancer risk. But they could not even be bothered to treat the h-pylori. I know we can do research on the internet but by the time I found everything out, it was too late.

    Likewise, I had to wait six months for an NHS rheumatology appt whilst others got them in a couple of weeks. If everybody was treated fairly, they would all be seen within the three month guideline for the meds to work and they would all be offered a proton pump inhibitor - and I would not be going through this. I did see a rheumatologist privately but he assumed that because the NHS wasn't bothering, it could not be RA.

    I have to have the investigations at the end of January but saw the GP on 13 December (which was a cancellation as otherwise the appt was 4 January). This is under a two-week urgent cancer referral. An urgent appt puts the wind up people if it is not necessary. I did not even see a consultant. I would like to have discussed it with an English speaker as I don't think the procedures are necessary. The surgeon I saw was very alert but he has put this down as an urgent cancer referral. Good job I don't trust them as otherwise I would be having a heart attack. In any case, the diarroea and pain are clearing up with the antibiotics but not the bleeding. Hopefully, I will be OK by the end of the month.

    Sorry to go on - but once you start!!! I'll never go near them again.

    I hope you mind is at rest regarding Omeprazole. I certainly would take it if I were you.

  • Hi delicate input

    I think your experience is horrendous and totally unacceptable. Even in Scotland there can be differences in timescales for being seen by gp / consultants etc but I've never heard of

    Anyone experiencing such seriously significant symptoms and not being seen almost immediately? I'm genuinely appalled and sorry that you e had to go through it all and I wish for good changes for you this year.

    As for the omeprazole I am not convinced that alongside methotrexate, it is the best thing? I understand the risks associated in having no protection and unfortunately, you certainly paint a clear picture of this.

    I will discuss further with rhuemetologist and as always, I will follow his advice. I won't be stopping it until I've discussed it with him and if this is indeed the best way forward in terms of the combined risk in taking it with the methotrexate.


  • yes i googled it its on prescription seeing doc thursday i have wrote the name down will see what he says looks a good pill lol mary xx ty

  • Hi Mary

    I'm not sure if one is better than the other, they are both pump inhibitors and from the methotrexate point of view, I can't see how there'd be any difference in relation to contraindications but it may be, like all of us have found through our journey, that one suits better than the other?


  • thanks for reply i am only on the lansoprazole capsules i stopped all my ra medicines in oct due to side effects i have been ok but last couple days can see inflammation in hands i was going to try brufen or nurofen cant take salafaszine spelt wrong dosnt agree with me i am very sensitive to the strong drugs lol i can only but try definetly need inflammetarys mary xx

  • Have you tried arcoxia Mary ? I take this - 90mg once per day and it is stronger and for me, more effective than brufen.

  • no havent heard of that one would i be able to buy it from chemist or is it from doctor xx

  • Definitely from gp Mary.

    It is very good, least has been for


  • hi eram just back from docs she said aroxia would be no good for me as i have a lot of trouble with high blood pressure she told me to try the nurofen but i dont think thats strong enough any way if inflammation on hand dosnt go down got to go back to her i came off the salfalazine as that didnt agree with me it was worth a try thank you hope u having a good day lv mary xx

  • Oh I'm sorry to hear that Mary. It's a difficult situation when you know that over the counter meds won't make any difference. Did she offer any significant advice if you get no relief from the neurofen?

    Was working today and

    Feeling it after taking the methotrexate yesterday - just a horrible drug and one

    In which I've yet to feel any benefit


  • all she said was if the nurofen dont work talk to rhumy and they will give me something stronger rhumy dont know i have stopped sulfalazine i wasnt due back there till april how often do u go to rhumy i was on methotrexate for 9 years 22..5 then it stopped working xx

  • I see him minimum every 3 months and when things feel more settled, every six

    Months. He is pretty good ( lacks the necessary social skills tho !)

    I wouldn't be in pain Mary, maybe it's worth asking to see rheumy before April? I know the drugs we take are harsh at the very least but sometimes I fear they may be a necessary evil. I wish you luck going forward


  • its strange really not in pain all the time i find mornings the worst but eases up once i take painkillers i think this very cold bout of weather we been getting hasnt helped anyone do u take anything else with yourmtx xx

  • No the weather certainly doesn't help!

    I takenfolic acid 6 days a week

    With the methotrexate. I am on weekly enbrel injections, arcoxia, omeprazole, tramadol and Paracetamol. There are times when I also have to take diazepam for the spasms but that's infrequently. I guess all of them help but I'm constantly swollen, in pain and sooo tired but like everyone else, we just have to keep going.

  • folic acid very good i know someone down this end who is on embrel and she was saying how good it is sorry to hear u r constantly in pain and u also working that tiredness is terrible that comes with the ra will keep a look on posts see how u doing hope u manage to get good nights sleep take care xx

  • Thank you Mary. You too x

  • I had heard this too, also with NSAIDs and Sulphasalazine. but wasn't particularly concerned as we are well monitored. Anyway you prompted me to look it up. And it refers to high dose use of MTX. This is an extract from a research paper about it.

    There is evidence to suggest that concomitant use of methotrexate (primarily at high doses) with PPIs such as omeprazole, esomeprazole, and pantoprazole may decrease methotrexate clearance, leading to elevated serum levels of methotrexate and/or its metabolite hydroxymethotrexate, possibly leading to methotrexate toxicities. Based on the reviewed data, the FDA updated the methotrexate label to include the possible drug–drug interaction between high-dose methotrexate and PPIs. Physicians should be alerted to this potential drug–drug interaction in patients receiving concomitant high-dose methotrexate and PPIs.

  • It can also occasionally apply to those on lower doses too Helix - it certainly did to me, as I've described above. It is important to know this if you are one such, because this can be a potentially dangerous combination of meds if so. I was told this by a particularly assiduous and experienced pharmacist.

  • Yes, nearly everything we take has potential to cause difficulties in a very few people - some even react to coatings on different tablets. It's a good reminder to always check out any odd effects. with your rheumy/doctor/pharmacist, and to check your blood results yourself so you can ask questions.

  • I asked the pharmacist at the time, rather than the doctor, because I thought it must have been a dodgy batch of Metoject. From what she explained I don't think it's as infrequent as you suggest - and there is a good alternative in Ranitidine or even other PPIs. These stomach protector medications can also inhibit the absorption of vital minerals and vitamins such as B12 and iron.

    Also it was definitely listed on the Metoject sheet as a potential contraindication - or perhaps on the Omaprazole sheet, but I can't double check this now as no longer have either in my possession.

    And yes it may be quite rare but I'd hate for anyone else to go through this experience so felt I should respond with my story. Especially because a much less severe version of this also happened to me a month ago when I took Lansoperazole with my new DMARD, Mycophenolate - which isn't even cytotoxic like MTX. As soon as it happened I read up and found confirmation that a PPI might cause this tummy drama with MMF - so I switched back to Ranitidine. All absolutely fine again now.

  • Thank you HH

    You'll see from my earlier post I wasn't sure if it applied to lower doses. That's reassuring .

    Like you twitchytoes, I've been unwell for last few days; a cough, pain on left side and vomiting ( seeing doc tomorrow) and the only thing different has been my dose of methotrexate has been doubled hence this prompted me to read more about it.

    I do feel reassured though so thank you both for your responses.


  • Omeprazole carries it's own side effects. I was given Omeprazole with oral mtx on my prescription note. The phamacist told me that it can cause added problems, so I decided to take the oral mtx alone. I figured I don't need anymore drugs in my system , but if mtx bothered my tummy then I would take it next time. I was lucky as mtx never bothered my tummy....having said this, ask your doctors opinion.

  • Thank you everyone- on balance, I think it's worth speaking To my gp about it tomorrow and I'll speak to my consultant about it to, just to ensure it is the most appropriate thing to be taking.


  • I've nothing to add re. omeprazole but clearly it is important to get Mtx out of our system efficiently in order to avoid side effects & keeping well-hydrated 24/7 is the main way of helping elimination along.

  • Thank you postle2. If honest , I'm not the greatest at drinking water but I do drink a lot of tea?

  • I believe you need water pure & simple. I drink a fair bit of tea & coffee too and don't enjoy water unless it's refreshment on a hot day. So I don't treat water like a drink as such ..... I just pour it down my throat at regular intervals & job done!

    If I thought Mtx was disagreeing with me, hydration would be the first thing I'd take a long, hard look at before jumping to any conclusions. If we don't drink enough water then we're kind of asking for trouble, especially as there are no contraindications between water and any other substance as far as I know!

  • Yes I'd heard of that along time ago when I was first prescribed them but my specialist read all the do's and don'ts because there's cancer in the family and he was giving me the option which he really did with any new drug , I've had no problems at all, the makers have to put all this information in the paper work to protect themselves and sometimes it's worries hell out of us but if your worried ask you specialist too explain his choice of Meds so you can understand why he chose that one for you


  • Thanks DC, I will have this conversation with my rheumatology consultant , primarily because he never prescribed it for me and I'm not even sure he knows that I take it?

    It was prescribed to me from gp about 3 years ago , before diagnosis, to support tummy with all the pain killers and anti imflammatories I was taking.


  • My doctors never prescribe any Meds todo with my RA he just refers me back to them which is a pain in the neck but it saves on mistakes , or he gets a very big book out which gives them the same info , but I suppose dealing with lots of different illnesses is not the same as specialising in just RA I hope you get on ok Marie xx🌹

  • OMG !!

    Many, many thanks to all who have contributed to this item.

    I am one of those rare people who had tremendous problems on low dose MTX and heaved my heart out every time I took it. I was (and still am,) on 8 Omeprazole a day plus Ranitidine because of Naproxen damaging my stomach causing a huge ulcer covering half of the inside. I believe the MTX was also a contributing factor to this as well.

    I will be investigating this subject with my Pharmacist, my GP and my Rheumy asap now to ensure I am not doing more harm than good with my current medication all round !

    This discussion, i firmly believe, explains the mysterious kidney and liver damage I now have that has become a mystery among my medics as to its cause and I will be discussing this subject with them asap.

    I seem to be particularly susceptible to low dose problems of a few drugs so I will be eternally grateful for this site and it's contributors for highlighting this crucial subject.

    Many thanks to you all ! Mwah !

    X xx

  • Hi Xandii

    I'm sorry to hear that and genuinely wish you well. Please keep us informed .

    When I see my gp tomorrow I will ask to see my rheummy before my next arranged appointment to discuss further .

    I guess my concern is the way I've been feeling since methotrexate has been doubled and the fact that these are such heavy drugs we take that I want to be sure I'm not storing other problems for the future.


  • If you look on it gives you information about drug interactions. It also says to speak to your doctor.

  • Hi Eiram50,

    I was on Omeprazole (20mg), 15 mg MTX and 5mg Pred.

    The RA I have goes for my hands, feet and lungs (though luckily lung issue is very mild and controlled). However I am under both the Rheumatologist and the Chest Clinic.

    It was my consultant at the Chest Clinic that stopped my Omeprazole. I had a persistent mucous cough and he said to double up the Omeprazole for a couple of months as the Pred I was taking (though coated) was increasing the mucous in my stomach and that was going on to irritate my throat.

    The next day he rang me at home and said change of plans he had done some reading and I was not to take Omeprazole at all due to the interaction between MTX and Omeprazole and I was put on Lansprazole.

    Now it may be because I had to double up on the Lansprazole (60mg), I don't know and did not ask at the time. My stomach is better now and I am back to 30 mg of the Lansprazole but I am not to go back to Omeprazole.


  • Thank you for this joy. The more I read, coupled with the feedback here is really making me question the safety and efficacy of taking omeprazole with the methotrexate.

    I will definitely speak further with consultant about this.

  • Yes good idea Eiram50. Let us know what your Consultant says.

    I am due my 6 month review at the Chest Clinic at the end of Jan. So will get some more info from the consultant re interaction and dosage. Just made a note in my file - otherwise I will forget to ask!

  • Brilliant! Thank you and good luck


  • I have been on both for nearly two years now.

  • Thank you for responding Multijo. I've been on omeprazole for about 3-3.5 years and omeprazole in and of itself is t the issue but I question it alongside methotrexate. From what I read also, these can be taken for a while without any complications but it doesn't mean that this is true for everybody, all of the time? I'm

    Of the view it's better to check it out.

  • I haven't had chance to read through your other replies so apols if any of my reply has already been covered Marie. There is evidence to suggest omeprazole & others in the same class, lansoprazole, pantoprazole etc, all proton pump inhibitors (ppi's), can delay elimination of MTX, resulting in renal (kidney) toxicity. The important thing is the warning is as a general rule, but not always, in relation to high dose MTX & generally not the doses we take for RD, AS & related diseases. Evidence does exist of renal toxicity in low doses but as I said it's generally less in DMARD doses. Our urea & creatinine (kidney) levels are included in our MTX drug monitoring bloods so any abnormal readings can be acted upon quickly.

    In a similar vein you'll probably also read at some time that sulfasalazine & leflunomide should be avoided with MTX as each could cause liver problems yet they're both often prescribed with MTX. Again drug monitoring bloods pick up on any abnormal results.

    It's all a matter of weighing up what meds are necessary to control the disease, the main aim, & as NSAIDs are often prescribed alongside DMARDs it's necessary to prescribe a ppi if we're to avoid the possiblity of having peptic ulcers from the use of them. I've been on various NSAIDs & a ppi, 20mg omeprazole, from diagnosis in 2008 & started MTX in 2009, with no problems in nearly 8 years but we all have different tolerances of course!

    I hope this answers your question & eases your mind but if you're still concerned do ask your Rheumy or nurse at your next appointment, they'll explain & answer any questions you may have. Or ask the Pharmacist at the chemist where you get your scripts filled, he/she will know all the meds you're on & their possible interactions. x

  • Thank you NMH - I was looking out for

    Your response !

    It does ease my mind but to be honest, I'll have the chat anyway as I'm not convinced my meds are doing what they should . thank you all for taking the time to Reply .


  • I've been a bit tied up. My h is having an angiogram today, so I stayed with him for a few hours. He should have had it this morning but it's been delayed so I've come home to sort the dogs.

    I'd have a chat with your team, you can ask what you want then. Or you could ask your Pharmacist for a complete med review if you're concerned your meds aren't doing what they should. He/she may be able to offer to suggest alternatives, though they tend not to with specialist meds because of course your that's your Rheumy's area of expertise! They can though offer your GP their opinion of alternatives if it's thought you could change to a more suitable one he/she's could prescribe such as ppi's, pain relief etc. I have one annually with my Pharmacist but she's never changed anything, in fact always remarks she doesn't really need to bother because I know my meds & always question her before I start a new one!

  • Sorry to hear about your husband, I hope things go well for him and thank you for taking the time to offer your sound advice.


  • You're welcome, it's good to share! Thank you, it's just another of ever increasing problems with his heart following a heart op in 2015 I'm afraid, yet further investigations, this'll be his third angio. I've just had a call from the nurse on the ward. They had to go in through his groin, which I know he'll have been pleased about as he found it preferable last time. It took longer than expected (which always makes you wonder) so on bed rest til 7 when they'll decide if he'll need to stay in overnight. It's visiting 7 til 8 so I'll go up anyway.

  • Wishing you both the very best.


  • Wishing your husband all the very best, we recently took my oh's brother for an angiogram, luckily he was fine, no blockage, despite severe heart failure, drugs are so far helping him, but a real worry, as I'm sure you know. Take care. X

  • Thank you Gigi. Just got home a little over an hour ago. As he's had CABG it had to be done through his femoral artery so up to the ward he went once they'd found a bed for him, then they've got you haven't they?! Anyway, all's well, the two which weren't grafted are narrowed but that was sort of expected as it had been discussed with his Surgeon a couple of months ago. He's due another op to remove broken sternal wires & plate his sternum but that was delayed, hence the opportunity for this angiogram. On his latest 3D CT scan approx 50% of his sternal bone had regrown so it's hoped that will increase & aid his breastbone in being more stable when he goes in again.

    I'm pleased your oh's brother is managed on meds, I hope it remains that way for a good long time. x

  • Good to hear your husband is settled

    For the night - now you should get some rest.


  • We both slept well thank you Marie. H was up 3 times but that's his normal!

  • Goodness me, I have to say I had to look that up. It's amazing what they can do. I do hope this helps improve your husbands life. But more surgery for him. They do seem to keep a very close eye on you, which of course they should. I do hope you managed to get some sleep and rest last night. Oh's brother had electric shock treatment, early December, it worked for a short time, at the moment drugs adjusted regularly, age 61 he has had to retire. We are still getting over the farce of treating him for phumonia and sending him home 3 times without a heart check. He had 83% heart damage. Thank for your wishes. All the best best for your husband and take good care of yourself as well. X

  • Long reply Gigi so please see below marked with 💤

  • Have read all the posts with interest. I have been concerned recently about taking lansoprazol, I was prescribed this about 12 years ago after I was dx with hiatus hernia and bleeding in the stomach. I had terrible reflux problems, possibly caused by voltarol r and steroids. They stopped the reflux straight away. I was taking two, but recently dropped to one in the morning, as concerned as my Dexa scan results are low, my diet is good, I take Calseos, Vit b12 inj. Folic acid, so was wondering if the lansoprazol was stopping me absorbing all the vitamins to rebuild my bones. I have a review on the 17th of this month. So will put this on my list to ask when I see the rheumatology nurse. Also on mtx 10 mg. thx for all the info. X

  • No, thank you Gigi71, that's really interesting.


  • 💤

    Thank you Gigi. Heart-wise he's had a 100% improvement in symptoms. We're very lucky, our local hospital's Cardiology Unit is a Centre of Excellence & I must say from our experience it deserves that accolade. H was fortunate & didn't have a heart attack prior to surgery, that makes a marked difference in recovery. The problem's been as I said previously that about half of the sternal wires that are used to join up the breastbone failed which caused his breastbone to move freely causing considerable pain. Some of the bone at the base of the sternum has died causing further issues so it's not as straightforward as it could be. As sternal dehiscence is quite rare, 2-3%, he divulged to us he'd not had need to perform a resternotomy & repair before so it was planned he'd do it two-handed but the cardiology reconstructive Surgeon would lead. On the morning of the op he was called away on an emergency at another hospital so my h's surgeon, preferring to go ahead in the knowledge my h was in considerable pain, attempted the repair using thicker gauge wire rather than plating which made sense given he's never used the plating method before. That failed too & the inflammation caused by movement has resulted in costochondritis on top of the pain of his breastbone being unstable & the broken wires migrating into the chest cavity. Fortunately he's not had acute necrotising mediastinitis, a deep tissue infection which is often accompanied in sternal dehiscence. Being diabetic increases the risk so that could have been really complicated & worrying as it can be life-threatening if not treated promptly so that's a big positive & something we've to be thankful for!

    Another op was planned to plate his breastbone together but was cancelled 10 mins after he was due to go up theatre. The reconstructive Surgeon examined him in the ward's waiting room. He wasn't convinced it would benefit or may even make it worse so deferred the op until it was determined, as he suspected, that he had costochondritis again & if so that was treated first. At an appointment with his Surgeon a fortnight later he said he disagreed with the decision not to operate & in no uncertain terms was less than happy that in the 5 weeks leading up to the op the reconstructive Surgeon didn't call him in order to examine him rather it was left until the 11th hour to do so. We'd never heard him be so verbose! His Surgeon has since secured a colleague from a different hospital to accompany him in theatre for the next op planned once another 3D CT scan determines his sterum bone has indeed continued to grow.

    The doctor he's under at the Pain Clinic gave him two steroid injections in his chest just before Christmas. They've now worn off but they only eased some of the background pain not the stabbing pain which causes him to breathe shallowly to stave off the worst of the pain.

    Did your oh's brother have an arrhythmia? I think that's when they need to shock the heart into a more regular rhythm. Will he need to have it again to correct the rhythm? I'm guessing if they've given him a percentage of heart damage he'd had a heart attack, I might be wrong but I think I'm right in saying that damage only occurs following cardiac arrest? It does seem quite common that respiratory issues are investigated first, I suppose because it's generally less costly. After my h presented with breathing problems the testing suggested asthma & was treated a such. It was only once there was no improvement from the 2 inhalers he was prescribed that they started looking elsewhere for the cause. I was concerned it could be heart related & wanted him to see my GP as she's well up on heart issues having had them herself but, no, he saw his own. To my mind if a patient has breathing troubles & a family history of heart conditions, or even if they don't, initial investigations should include a quick check on the Practice's ECG, it costs sod all & most have them, or can borrow one from another Practice locally, I lent out ours often enough to others in our town!

    Anyway, sorry for the tome. I hope they can get your oh's brother better controlled soon & thanks again for your kind words. x

  • Hi NMH. My Goodness, your hubby has had a lot to go through, pleased to hear you have a good hospital though. Even that said, still up to the expertise of the surgeons. You both have a good knowledge of his problems, and the next procedures, they never seem straightforward. I only have one personal friend with RA and she contracted TB after taking Humira and her treatment, or lack of it is very different to mine. I do however have more friends and family members with heart problems, my eldest son had a heart attack aged 42 and had 2 stents, 6 years ago. He was made redundant twice in the city and I believe this was all stress related. I was devastated at the time and still worry now. His lifestyle is hectic, still works in the city, up at 5am for the Far East markets and home late. He states he never stresses now and I have to believe him, not easy. Yes, oh's brother has arrhythmia, and he will need to have this done again. He was very ill leading up to going into hospital, a quiet man, who rarely complains, put it down to chest infections, was worse when he got home from a cruise. We do find it hard to get very much info from both him and his wife, even thought she and I are good friends. She is a PA at Great Ormond street hospital and takes it all in her stride. We where out for lunch with them on Monday and they are not keen to talk about it, so we have to respect that. He still has ongoing tests and sees the practice nurse every week. We are hoping for the best. I do hope all goes well for your husband, it all takes time. I also get costochonditus and it's very painful. All very worrying for you too, so take care. X

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