I had to come off subcut methotrexate after four weeks because of the nausea, stomach issues and oral thrush. It was decided to rechallenge it and I took my second dose on Saturday. After my first injection last week I was very sick. This week still tummy cramps etc and now I have the oral thrush back just two days after injecting. They are struggling to offer me anything else because of my blood pressure.
Has anyone found a solution to the sore mouth?
I can understand getting mouth problems on MTX injections as it's usually due to your folate being depleted by the MTX but it's more unusual to have stomach problems on them as it doesn't go through the gastrointestinal tract so I'm wondering if you've something else gastro related going on. I take it you've started on a lower dose than when you were previously on it & been prescribed enough folic acid? If not that's where I'd start, request you reduce your MTX dose & given an increase in folic acid, I take 6 x 5 mg weekly. I don't tolerate anything above 17.5mg injections though it's my liver that's affected once I reach 20mg.
You could try a salt water mouth rinse, though not a quick swirl & spit, swill round your mouth for a minute or so then spit. Or a very dilute test tree oil solution, must be only two or three drops in a small glass though! If that doesn't appeal or makes you nauseous you could ask yor GP for miconazole gel (Daktarin) or similar.
I hope you can find a solution given that you've pretty much run out of options. There's no guarantee you wouldn't have side effects or maybe raised BP on anti-TNF's or biologics, not sure if they have that affect, but have they not been suggested if you can't tolerate other DMARDs & have these problems on MTX?
Hi nomoreheels. They put me back on 10mg and I'm taking 5mg folic acid daily. I've even moved on to the folate equivalent in case I have the gene that stops synthetic folic acid being absorbed. I got all this last time too. As soon as I stop the injections all the stomach symptoms stop.
I seem to be in a cash strapped area where biologics are not offered unless you're years in to the disease.
The only thing I can do is ask tomorrow for them to drop it to 7.5mg and try again. The consultant was considering it so that at least I had something in my system even if it wasn't going to put me in to remission. I feel that makes me a bit of a second class citizen. Sorry you've got aggressive all over RA and failed triple therapy but we've not got the money for anything else
No, you mustn't think that way. I would definitely ask to go down a dose. I do wonder though if it is that you have the methylenetetrahydrofolate reductase gene if this could account for your previously high BP, oral thrush &, if it's been a problem in the past whilst on MTX, anaemia. I say this because as you know MTX nicks off with what natural folate we store (B9 & B12)?
Don't know if this helps,but if you qualify for Biologics RTX lowers your BP.......if you take BP pills you are told not to take them on the day of infusion...I don't know if it continues to have that effect afterwards....ask your rheumy.
Thank you for that Kathy, I wasn't sure. I'll make a note!