Drugs

[Mariafrancis54]

I have now been diagnosed with RA and so the pills begin. My first prescription is 200mg of hydroxychloroquine daily, methotrexate 10mg on Monday rising to 15mg after 2 weeks and flick acid 5mg on a Friday . Trouble is I don't know if taking them together is best or spacing them and I'm terrified of the side effects - any advice please?

[nomoreheels]

Hiya Mariafrancis. I know, it's looking at those meds, it's become all very real, even though you know things aren't right you're now starting to medicate to deal with it. I admit I just took mine, I didn't think about it because I just wanted the pain to go!

I'm not too sure what you mean about spacing them but if you mean dosing the MTX I would, I'll explain why later. Firstly try to think of the meds working & don't concentrate on side effects, it helps honestly it does. Secondly I'm a bit grumpy, your Rheumy should have taken time to explain what you're asking or even do as mine did & write down what's to be taken & when. Anyhow seeing as he/she didn't....HCQ was my first DMARD, 400mg daily. I took mine as 200mg in the morning with breakfast & 200mg with my evening meal but as you're on 200mg really it's when you prefer to take it, assuming it's not stated on the pharmacy label on your box of HCQ.

My MTX tablets (15mg weekly) I took as 2 with each meal, as recommended by my Consultant so you could choose to take your initial dose with say 2 with breakfast & 2 with dinner. Some take all their MTX tablets in one go just before bed though I was advised against that, reason being they full dose will sit on the tum risking nausea or sickness. If you do have any side effects your weekly folic acid could be increased. We take them for that reason, MTX is an antifolate so we need to supplement what the MTX takes, it's necessary. There aren't any recommendations as such for prescribing folic acid so it's really what the Rheumy prefers, for example I take 5mg 6 times a week, just not MTX day but I started on one the day before MTX then the day before & the day after. I now inject, we don't lose any of the effect as it goes straight into the blood stream unlike tablets which go through the digestive tract. This was because my liver reacted to 20mg in tablet form so I can now take 17.5mg without problems. Also, injections are indicated if you have disruptive or intolerable side effects with tablets.

No doubt you'll find the best way that works for you but the good thing is you're on the first step of treating the disease. Do bear in mind that whilst that both the HCQ & MTX start working from the moment you take them they're slow acting so you won't see results immediately, it can take anything up to 12 or a little longer.

I hope this helps but if you've any other questions just ask, we've all been where you are just now so can share our experiences or tips. 😀

[Bookworm55 in reply to nomoreheels]

Excellent advice - I'm on identical dosages of exactly the same meds and agree with all the above. Especially the part about not 'overthinking' things - I usually read everything but must admit that I read nothing about the drugs before I took them. My opinion was that I needed them to prevent further RA damage and if I did get side effects ( I didn't ) they would soon show themselves. Good luck!

[Mariafrancis54 in reply to Bookworm55]

Thank you bookworm55 - I do agree but it's all new to me so thought I should - however first mtx yesterday and took the advice from nomoreheels and split them - woke feeling bilious and heady - let's wait and see

[Bookworm55 in reply to Mariafrancis54]

Yes you're quite right to do what feels right for you. I sometimes feel I have been a bit reckless regarding my medication! Fingers crossed all settles down for you but of course there are many alternative drugs and everybody is different in how they react so you will surely find those that suit you.

[Mariafrancis54 in reply to Bookworm55]

Thank you so much - you have really helped

[nomoreheels in reply to nomoreheels]

One thing I forgot to mention is if you also take a PPI (omeprazole or similar) it's recommended you leave a gap between taking that & your HCQ, I think it's 2 or 3 hours but don't quote me on that.

[Mariafrancis54]

No idea what a PPI is ?

[DelicateInput in reply to Mariafrancis54]

Proton Pump Inhibitor is a tablet that stops the stomach producing acid, and thus protects it against the side effects of some DMARDS. It is prescribed for some people taking DMARDS. Have a look at the packet of your Hydroxychloroquine and if it is Quinoric, you will definitely need a PPI. You can buy Omeprazole over the counter but it is expensive to use long term (£10/week). A lot of people on here (me included) have had gastro intestinal problems caused by Quinoric. Make sure you get Hydroxychloroquine by Zentiva next time.

[Mariafrancis54 in reply to DelicateInput]

Thank you Delicateinput - I will check the packaging - I felt sick and heady the day after the mtx - is that normal?

[nomoreheels in reply to Mariafrancis54]

It's a stomach protector, PPI stands for Proton Pump Inhibitor, they're also prescribed for problems like acid reflux but for us with RD NICE recommends PPI's are prescribed alongside NSAIDs as as gastro protection, to prevent possible ulcers. I know both omeprazole & lansoprazole are capsules, not sure about others. We're often prescribed NSAIDs as part of our personalised med protocol. This link from ARUK explains arthritisresearchuk.org/art...

You'll note it's recommended you wait 4 hours after taking HCQ before taking a PPI, not the 2 or 3 hours I mentioned. That said I didn't, I've always taken my NSAID at night with omeprazole (a PPI) & I also took my evening dose of HCQ at the same time & suffered no ill effects. I've taken NSAIDs as long as I've had RD, since 2008, always with omeprazole. You won't necessarily be prescribed an NSAID with HCQ or any other DMARD unless it's needed. It's worth checking though if you're being prescribed an enteric or film coated HCQ (easily checked, it should be imprinted EC or FC on each tablet), they're kinder on your tum. If you have problems just request the following: 'Hydroxychloroquine Sulfate (Zentiva) 200mg film coated' & the ‘PIP number’ (Product Code) 120173.

[Mariafrancis54 in reply to nomoreheels]

Thank you - I have to look up some of your info but I am so grateful for your time and trouble

[nomoreheels in reply to Mariafrancis54]

No probs. 🙂

[Mariafrancis54 in reply to nomoreheels]

Thanks again

[Simba1992]

You can also protect your stomach and heal the damage in the stomach caused by meds with Colostrum. A nontoxic alternative with safe longterm use.

[nomoreheels in reply to Simba1992]

I'm not sure there's presently enough evidence yet to state it's long term safety. Certainly those with an allergy to cows milk shouldn't take bovine colostrum Simba.... I guess it's not suitable for vegetarians either.

[Simba1992 in reply to nomoreheels]

Yes it's really strange. Have been looking in to studies and recommended diets for RA. The diets that exclude dairy still recommend colostrum and the studies on the effect of colostrum on RA mention nothing about lactos sensitivity or eventual lactos intolerance. This has been a question mark for me since AIP excludes dairy all together. Must do some more research🤔

[Simba1992 in reply to Simba1992]

Found information right away! Colostrum in fact is very well tolerated even by those who have issues with lactose. There is such a small amount of lactose in colostrum, in fact it is often used to overcome lactose intolerance, with good results.😊Very interesting data on colostrum on the net, might interest those who looking for nontoxic alternatives.

[nomoreheels in reply to Simba1992]

Any evidence you can share I'd like to read Simba. You see I thought I'd solved a problem for my h as I'd been researching bovine colostrum but dismissed it because of the lactose issue. He's been told not to have any of the 'prazoles' again following a huge dip in his magnesium & calcium levels only realised when his blood was tested prior to having the first red blood cell transfusion, he was anaemic after his last op & he had a magnesium infusion following the RBC infusion. He's currently on Ranitidine & Gaviscon with poor results so need solid evidence before presenting it to his h's GP & Gastoenterologist for their considered opinion. Thing is whilst he's not diagnosed lactose intolerant even skimmed milk has to be used lightly, he puts it on cereal & dips the bowl away, soup style, in order to take in as little milk as possible as it upsets his stomach. So as I say if there's any more info you could share, particularly relating to overcoming lactose intolerance, I'd be interested to read it, thanks.

[Simba1992 in reply to nomoreheels]

ihealthtube.com/video/dairy...

Here nomoreheels, is one source, you can find more by searching after lactose intolerance, colostrum, research😊Hope this of some help. Good luck, Simba

[Mariafrancis54]

Thank you Simba1992 - I need to write down all of this info - it's really appreciated