MTX and Omeprazole: Hi I am 3rd month of MTX injections... - NRAS


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MTX and Omeprazole


Hi I am 3rd month of MTX injections only on 15 at the moment, I also have osteoarthritis for which I take naproxen and Omeprazole to protect my stomach....happened to read the leaflet on Omeprazole and was surprised to read that people on MTX should not take it! The Rheumy knows that I take this, so I'm a little concerned/confused, any views? Thanks Kate

23 Replies

Once again a situation of weighing risks and benefits. This is a med RA patients often use for years even though recommendations state that you should not use it longterm and not mix it with mtx.To make an educated decision conserning whether to take the med or not you really need all the information you can get. Listen to your doctor and hear what he has to say and do your own research, also on alternative treatments. It's your body and you should feel confortable with your choice of treatment. Good luck😊

Hi Kate there has been a lot said about this on this forum so if you go and click on my posts you will be able to read what is about it to put your mind at rest

This is the reply I gave to beekey's post Kate, it's copied from an earlier one to Marie (Eiram50).

Oddly enough we discussed this not long ago, this is the reply I gave then.

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 function) 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

I take 20mg with my morning meds. I've since been advised to take another 20mg omeprazole in the evening when I take etoricoxib.

I hope this helps?

Kate23 in reply to nomoreheels

Really appreciate your indepth reply nomoreheels, my bloods have been within range and haven't flagged any problems arising. Fingers crossed (if I could) it stays that way....I'm expecting the MTX dose to be put up on my next Rheumy visit and will certainly ask....Need to jot it down or else it will sail out of my mind as soon as my name is called! Thanks again xx

nomoreheels in reply to Kate23

You're welcome. That's good about your bloods, I hope they stay that way. I write a bullet point list when I see my Rheumy or her Registrar, that way it's easily understood if she chooses to read it. I hope the increase in dose helps.

Kate23 in reply to nomoreheels

Bullet points is a great idea, getting to see the consultant is such a big deal that my usual nonchalant attitude flies straight out the window!

I take both, I think it's to to with the absorption of the mtx through your stomach. But as you are on injections then the omeprazole won't effect it 🙂

Kate23 in reply to ruth_p

Thanks Ruth_p that's reassuring, just don't want my liver and kidneys under more than they can cope about physician heal thy self!

Thanks to Sarah.

I took Naproxen for 10 days when GP prescribed it for my joint pain mainly in foot and hands, and I stopped because it didn’t help at all.

Later I was diagnosed with PsA, which is similar to RA. And I read about NSAID causes leaky gut, which is one of the causes to autoimmune disease. I don’t know whether it is true or not but I believe autoimmune disease should be treated targeting the root but not symptoms, although our doctors and rheumatologist couldn’t be able to tell what the root is :) Autoimmune disease is war, your body is your country, the pain is like a stranger comes to your land and behaves like a spy, you definitely want to know what is he going to do, who sends him, is there anymore of them... when you know there are thousands of them coming, killing this one doesn’t help. You should question him, let him tell you what is their weakness... So I decided not to take any NSAID. I haven’t started MTX yet, trying paleo diet at the moment. I lost almost 20kg in couple of months. Still in pain. It’s been tough.

I don’t have osteoarthritis experiences so I am not certain how NSAID will affect it. But for sure it isn’t good for stomach and gut.

Kate23 in reply to dahongbudong

I certainly feel like I have been invaded by a non welcome visitor, if he (RA) won't leave, I will have to make him tow the line and quieten his activity, may take awhile but it will happen, thank you for responding, . As a matter of interest how long are you going to give the Paleo diet to work before employing MTX or similar.?

dahongbudong in reply to Kate23

To be honest I don’t know... Probably two years..

I'm in the process of waiting on confirmation of a diagnosis for PsA and considering the options.

Are you going to continue to monitor your joints/bones in the interim, dahongbudong ? Blood work and imaging?

I am under rheumatologist’s care I can get access to MTX as soon as I want. But don’t think he will order more blood test and x rays as I ask. He will do when he think it is necessary.

Kate23 in reply to dahongbudong

That's a long time for RA to go un-managed and permanent damage could ensue...I wish you well on your journey.

dahongbudong in reply to Kate23

Thanks Kate. I need to give up smoking

Do try. It will probably do you more good than anything else.

MandiS in reply to dahongbudong

Hi dahongbudong

Read your post with interest . I was on MTX but came off about 5-6 weeks ago still on low dose of steroids about 2 weeks ago I had worst flare up and it's still going on . Saw Rheumy and Dr both of prescribe 30/500 cocodomol and told me to increase steroids for a week . Rheumy told me I really must restart the MTX to prevent joint damage. I am interested the diet you mention I did something similar when initially diagnosed but slowly all the bad things crept back in. Do you eat any grains at all ? Brown rice quinoa? Please let me know.

Have you felt a marked improvement?

Thanks Mandis66

dahongbudong in reply to MandiS

Hi MandiS, thanks for the reply.

I avoid all grains. Eat only meat, fish and vegetables, sometime sweet potatoes, and fruit in moderation. I am still aching, but swelling is not too bad.

I had two wheat beers in Munich last month, the day after one of my fingers got swollen. It is calming down now.

My feet, hands and elbows are not well, I have a constant electric burning sensation. I feel sometimes my hands and feet are like bombs.

It is very hard to give up everything you used to have everyday. But it worth to try when you are told you are going to take toxic meds for rest of your life.

I wouldn’t say there is a markable improvement but I have to put my faith and try the best because there aren’t many options for me.


Luckily I've never smoked (mum died of lung cancer) and now thanks to MTX I can't even have a ruddy drink!...but hey ho lots worse of than me!

Hi there I have been on these meds’ now for about four years, my bloods have been very stable. The naproxen is very good as for the omeprazole. I really don’t think I could cope now with out it, my doctors have tried to take me off it but I get very ill when they do. So as for taking them together yes you should be ok . But everyone is different so take care and keep a close eye on your self at the beginning till they are in your system!! Good luck I hope they work for you!!!

Hi you are correct. My daughters MTX leaflets states the same and also her pharmacist told her not to take Omep with MTX. I think it is ok with a Biologic med on its own??

I take MXT with PPI as do many. It was prescribed by my rheumy so better to check with rheumy rather than the leaflet about taking it not I would think. The MXT leaflet is also for cancer patients on higher doses?


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