Taking Augmentin while on Methotrexate?

Hello all!

I am a long-time lurker and first-time poster here, and I finally have a question that I am so so confused about. I have had a suspected "sinus infection" or sinusitis for a solid month now. I went to a clinic and was put on Doxycycline because the clinic doctor said that any type of Amoxicillan or Augmentin was a big no-no since I was taking Methotrexate (am currently on 15mgs of MTX 1x week). The Doxy didn't seem to work, and now they want to try me on Azithromyacin, which I can't take because of severe stomach issues. I have conferred with my regular rheumatologist, who said that there can be a slight interaction with Augmentin, but another consulting rheumatologist I has said it's okay to take Augmentin with Methotrexate as the interaction is slight. I am so confused at this point, and it seems my regular prescribing doctor is, too. I am in the U.S., but I love being on this board... it's indispensable, and you all here from the UK are so nice.

Thanks to anyone here who has advice, I am a bit desperate at this point...

18 Replies

  • I have been in the same situation as you. One rheumy said to stop mtx whenever you are on antibiotics and my 2nd rheumy said as long as it's only a 7 day course of antibiotics.

    I'm not a doctor, I sold beer for a living, but I ended up skipping a week of mtx when I needed an antibiotic. I like to caution on the safe side.


  • Well that's a possible solution! I've never had a problem missing a week of MTX. I never used to do it, and for the first 5 years was absolutely rigid about taking at the same time, same day each week. Now I'm much more relaxed. In fact I'm about to go away for a week for my birthday, and am not taking any MTX with me. I intend to have the occasional glass of wine instead.

  • That's what I do on my annual holiday helix helix and also at Christmas- the only 2 times a year I now have a drink. I do stop taking mtx if I have an infection or am on antibiotics as advised by my rheumatologist team but also this is often when my ALT goes up.

  • Happy Birthday Helix!!! Enjoy your wine...I'm assuming you are turning

    25 again.,,, :)

  • Happy birthday for when it comes. Enjoy your break - and your wine !


  • Thanks!

  • I'm allergic to Amoxicillan so can't really help I'm sorry to say, but I usually get Clarithamyacin (or a spelling something like that,) and often like now ! get chest infections and this with the Doxy does work. It's a shame that the RA medications cause these problems but hopefully you'll get a response from someone who does know the answer to this issue. x

  • Welcome, pleased you've decided to join us, you're now officially a non lurker!

    Augmentin for the greater part is made up of amoxicillin, a semi synthetic penicillin. As we're advised not to take penicillin based antibiotics when on MTX I'd either ask the prescriber or the Pharmacist who filled the script for advice. If it's the better antibiotic for what's ailing you & in your situation if it's a short course of a week or less I'd not take my MTX until you've completed the course, but do check for certain it is contraindicated with MTX first.

  • Yep, my rheumy now told me to skip my methotrexate while I was taking the Augmentin, and also that I should have a blood lab drawn the week after taking the antibiotic. Weird that they're being super-cautious about this... makes me a little nervous to take it, now. I took Doxycycline for this supposed sinus infection, and had no problem, but it may not have worked.

  • Good. He's maybe erring in the side of caution, or he follows guidelines more rigidly than some! It's that the level of MTX in your system can rise because penicillins affect the ability of the kidneys to remove it from your body. It can cause very unpleasant side effects so that why he's ordering bloods the week after you've finished the course. It will probably be to check your creatinine & urea levels, to determine if your levels are ok to start your MTX again.

    I hope it sorts it & you feel better soon.

  • I have a similar problem and was prescribed co-amoxicab same as augmentin. My consultant said it was alright for me to take with MXT.

  • Thanks, this is helpful!

  • I've been told that the only antibiotic I can't take while on methotrexate is trimethoprim type. I've always taken and been prescribed amoxocillin with no probs. I have never stopped mtx with infections - chest,ear etc and am always surprised when people do. Ask your pharmacist as they should be more aware of the interactions of drugs.

  • Thanks for your response! I guess my doctors are a little more cautious, having me go off the methotrexate. They said they want to monitor my blood if I'm on Augmentin (clavamox)... not sure why it's quite this way if it's not a big deal.

  • A cautionary note that most probably know but it's worth mentioning. Avoid taking a course of Augmentin more than once in a three month period because of the risk of C-Diff. I didn't find that out until after being prescribed two courses within 45 days. I ended up incredibly sick, weak and basically unable to eat anything without getting horribly ill. It took me well over a year to get better.

  • Thanks for mentioning this Nitrobunny. Sorry you had to find this out the hard way.

  • Thanks! Yes, it was pretty devistating. I had absolutely no clue that you should not repeat it in a short period of time.

  • When I've taken a chest infection and been on either antibiotics or steroid tablets I have never gotten my Mtx the nurse specialist has said it's too dangerous even if I have stopped taken the antiobotics the day previous. She used to say the drug was still in your system and it would need 48 hours before it was safe to take the Methrotex injection

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