Hi, I currently take 25mg MTX by mediject & I have recently read on the NICE.org.uk site that taking Naproxen alongside MTX can increase the risk of nephrotoxicity & advise that severity of interaction = Severe. Also that Omeprozole with MTX decreases the clearence of MTX, & can lead to toxicity & should be" used with caution or avoid".
Help please, Im not sure why im being given these drugs together...anyone any thoughts on this.....I cant wait for my next appointment. 
There is the ideal world, where these things are listed as something you should avoid, and the real world where you have to make compromises.
I have been taking this combination for 7 years now with no problems. When I asked my rheumy she said that any problems would be identified early through our blood tests, and that the guidance is just that - guidance.
If you read more about interactions you will see that in some cases they say that x & y MUST not be taken together. For most tho' it is more that you avoid if you don't have to - we don't have much of a choice if we want a quality of life.
I tend to leave a few hours between taking omeprazole and NSAID, which make me feel happier...
I read you can’t take certain antibiotics like amoxicillin but doctors/rheumatologist say ok.
I have taken this combination for over 5 years, with no problems. Prescribed to me by my Gp and Rheumatologist, neither have shown any concerns. My pharmacist queried it but said it was ok as my Rheumatologist was ok about it.
Please be assured that your Rheumy is well aware of contraindications between meds when prescribing them for you, he'll have done it all his working life. In reality maybe it seems slapdash but in RD world it's weighing one thing against another, inflammation & joint destruction versus disease control & some semblance of normality. It's one reason why we have drug monitoring blood tests, to keep an eye on how our meds are affecting our liver & kidneys as well as our inflammation levels etc. So you see they are used with caution.
I was diagnosed 9 years ago & have been prescribed omeprazole from day one because I was coprescribed 2 NSAIDs, I take it to this day with my current NSAID etoricoxib. I've also been prescribed MTX 8 years. My liver accepts MTX at 17.5mg but go up to 20mg & my results are high but I need MTX & my NSAID so the dose is kept at 17.5mg. It can be a balancing act but it's doable.
NICE guidelines don't take into account that there's accepted use between certain meds for specific diseases so in those instances it's not always an accurate resource, it would be too exhaustive to list each condition. For naproxen coprescribed with MTX it states 'Manufacturer advises monitor and adjust dose' which is just what is done, we're monitored with the regular blood tests & in my instance the dose was adjusted because of high liver function.
If you're concerned about it Tricia do ask your Rheumy, he'll explain his reasons for prescribing as he has but if you ask everyone here I'm pretty sure at one time or another they'll have been on this combination, or at least a DMARD, an NSAID & a proton pump inhibitor.
Thank you all for your really usefull replies....I guess we really do have to trust our rheumys..I really do find this Forum very helpful & reassuring.. best wishes to everyone X
As helixhelix says, there are contraindications regarding the use of DMARDS like naproxen with MTX. Normally when 2 drugs “clash” the problem is that one of the drugs is metabolised more slowly and you’re on a high dose of MTX to start with.
However, as with any drug you have to weigh up the benefit vs the risk and the fact is these two drugs are commonly prescribed together. I wouldn’t worry about it too much, as you regularly get monitored so any potential problem can be picked up early. Like helixhelix, I’ve taken this combination for many years.
If you aren’t already taking a PPI to protect your stomach from excess acid, maybe it would be a good idea to suggest it to him.
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