Methotrexate and PPI: I have been taking hydroxy... - NRAS


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Methotrexate and PPI

Nanabrodie profile image

I have been taking hydroxy chloroquine for about 5 months and have just been subscribed methotrexate and folic acid. Rheumy didnt day to stop hydroxy so guess I take them alongside each other. One thing I am concerned about (as well as all the possible side effects) is the fact that I take Lanzaprosol a Proton Pump Inhibitor and have been reading about the possible interactions. The MTX has been given by the hospital and the PPI by my GP (I have been on this for a number of years) Is anyone else on both of these and if so are they causing any problems? I’m not due to take my first dose of MTX until Monday. Bit worried 😧

55 Replies

Morning. :)

I take Lanzaprosol 30mg 1 tablet once a day to counter act the Ibuprofen I take (when needed) as well as Hydroxy, MTX and FA. I take the Lanzaprosol approx an hour before breakfast and hydroxy half way through breakfast and if needed an ibuprofen after breakfast .... before RA I very rarely ate breakfast, now it's a must for me. :)

I told my Rheumy consultant that I was taking it and she said it was ok to carry on with it, so I have. Yes you keep taking the hydroxy, agree no one told me to keep taking it but joined here and got great advice. :)

Nanabrodie profile image
Nanabrodie in reply to purl

Thank you purl that has really put my mind at rest. I always take PPI as soon as I wake up and take hydroxy with breakfast wasn’t sure whether to take MTX at the same time or with dinner at around 6.30pm in case of nausea etc. Do you suffer any side effects?

purl profile image
purl in reply to Nanabrodie

I take MTX after dinner (about 6.30pm) on a Tuesday and then FA after dinner on a Wednesday, this works for me and so far no nausea etc.

I am now taking 15mg of MTX built up over 4 weeks, that's how they do it here - wk 1= 3 tabs, wk 2= 4 tabs, wk 3 =5 tabs and wk 4 = 6 tabs, I take 1 FA a week of 5mg.

Nanabrodie profile image
Nanabrodie in reply to purl

I’ve been given 2.5mg x 4 tabs (10mg) once a week followed by 5mg folic acid for 12 weeks by which time I should have another appointment to see rheumy. Having said that from my first appointment until follow up which was supposed to be 6-8 weeks it was in fact 5 months! So I don’t know how long it will be before I see her again. Thanks again for all your help.

Yes I take them all too. There's an ideal world where you avoid any possible interactions, and then there's RA world where you compromise. As purl says I space them out so several hours between an anti-inflammatory and a PPI.

Thank you 😊

I am on all 3 also, along with rituxan infusion 2x every 6 months. Also take famotidine 40mg 2x daily. I guess I haven’t read enough on it, just trusted my rheumy and pharmacist to keep an eye on it. However, I usually take my MTX injection during the day, waiting for my daughter who is taking prerequisites for RN school, give it to me. She likes doing it. I usually give it to myself. She’s a 22year old mom of an 8 month old, full schedule in college and a wife. I understand that things get crazy and we both forget. This probably didn’t help, I think I rambled through this. But anyway, I hope you find the answer you’re looking for.

Wish I could help, all I can say is MTX a no no

Nanabrodie profile image
Nanabrodie in reply to Leither8


Leither8 profile image
Leither8 in reply to Nanabrodie

You ask me why and really everything effects people differently, originally I was on

20 mg a week of Methotrexate followed the day after with Folic Acid and the dosage was reduced gradually down to 7.5 mg. It caused me severe breathlessness it damaged my Toenails some thing the Rheumatologist disagreed with but point was proven when my toenails cleared up and my breathing improved when he stopped it I was wrongly diagnosed with Pulmonary Fibrosis and although he restarted me on Methotrexate I stopped it on my own accord due to the same problem. I have a different Doctor now and I take 5mg a day of Prednisolone and that seems to be doing the trick but really I suppose I should not really criticize as I am much better of than most when I see the poor condition of some people when I visit hospital I feel really lucky. I sincerely hope things improve for you.

Nanabrodie profile image
Nanabrodie in reply to Leither8

Should say RA not rash 😊

Thank you for getting back to me. I am quite nervous about taking MXT but will give it a go. I am not suffering much at all, my biggest Problem is my left hand and wrist but it’s nothing I can’t cope with. I do occasionally have a day where it seems that every bit of me hurts and I feel exhausted but it passes. I am more concerned about the RASH progressing and I would rather take the medication if it stops or slows down it’s progress .

I relay feel for you having gone through the wrists fingers and knee pain myself originally I got these army coloured wrist supports which I must say helped a great deal with the pain and the use of my hands and I also bought knee supports but for a Lady I would imagine t would probably feel embarrassing with these NHS wrist supports but they do help and the ones that are available from disability shops are not so ugly. I also went through the Physiotherapy thing and it helped a bit but because I was still working at the time it was hard going. Sometimes simple exercises like opening and closing your hands can help your fingers. I must say I was very lucky in the fact that at the time I had a fantastic Lady Doctor who couldn't do enough for me unfortunately she is no longer at my surgery and since she left my experience at the surgery is frightening so much so that I stay away from my surgery as much as possible and I am sorry to say age comes into it, but what your are doing now communicating with other people can help so I hope it does GOOD LUCK!!!!!

Make sure you don't take hydroxy with omeprozole


I have taken both for some years without any problems.

If taken at same time can dampen effects of hydroxy

sorry to butt in but can you tell me why you can't take hydroxy with omeprozle???please

Was told omeprozole interferes and reduces effectiveness.also hydroxy can ruin it eyes but reverses after stopping. Mine was awful and saw the damage when I went for eye test on the screen

OH NO!! I am due to take that one on my next app

that's not good

No it's not I can see properly at night and feels like I have a blur in one eye. My friend has the same but she really has to stay on it. As I said the optromatist ( no idea on spelling) said it will reverse I've only been off 2 weeks x

Because of how omeprazole (or any other PPI) works it can interfere with how the HCQ is absorbed in your gut, meaning it won't work as well. It's better to take HCQ with food too.

yeah thanks got that nomoreheels its the eye bit that's scary

Please don't worry. If it's retinal toxicity (or retinopathy) that concerns you whilst it is known it's a very rare side effect & usually related to length of time you've taken it, 5 years or more, & in relation to dose (if you've been on max dose, 400mg per day). This is why we are asked to have an eye test before we start HCQ (a baseline test) & annually thereafter, unless otherwise requested. I had light sensitivity on HCQ & because of that I had my eyes tested more regularly by an Opthalmologist (Specialist in hospital). I didn't have any problems with my eyes otherwise on 400mg per day. If it's a concern please do talk to your Rheumy about it. Hope this helps.

I will thank you

Hiya, you are supposed to leave 4 hours between hydroxychloroquine and omeprazole. I take my hydroxychloroquine with brekkie and then take my omeprazole with lunch. Metho I always took just before bed in order to minimise the sickness that I got. Methotrexate can be a miracle drug for many people, it’s common to be on two different drugs as they work together to help your swelling/fatigue. Good luck with it. Hope all goes ok.

Thank you 😊

My heart consultant has indicated that my breathlessness is due to MTX for RA.

That’s interesting, I used to have terrible breathlessness but also suffer with AF. Had cardiac ablation last year and have been fine since so nice to know that if I get breathless again it’s more likely to be MTX.

Have you had an echocardiogram? I am always breathless and have extra fluid in pericardium due to ra apparently

I did have an X-ray in July with dye being put through my arteries etc but have heard nothing. I’m due to see my consultant (EP) at Guys again in January so will find out the results then. Guess it’s not bad news as I’m sure I would have heard.

🤞 it's all clear x

Thank you

I don't know but I would ask my rheumatology consultant. GP are not expert in rheum. they normally follow advice from hospital . Sorry I cannot help you more . Good luck Nanabrodie

I've been on HCQ/MTX double therapy, not for long because it was when I was stopping HCQ but I'd check if he intends you to remain on HCQ. I've been on MTX 9 years though & taken a PPI for 10. Have any of the articles you've read mentioned it's high dose MTX, or when given intravenously? If so then don't worry, it's fine for us as we take low dose MTX. If you're still concerned though mention it to your Rheumy next time.

You do need to be sure to leave 4 hours between taking your HCQ & your lansoprazole though. Best to take the lansoprazole first to help ease tum effects of HCQ or any other meds such as NSAIDs.

I hope MTX works as well for you as it has for me.

I’ve been really interested in this chain of discussion. I was diagnosed with RA 5 years ago. I was taking hydroxychloroquine with breakfast and supper, but this dose has recently been halved and I just take it at breakfast-time. I currently take 2 omeprazole capsules on waking. I take 30mg Methotrexate (sub cut) weekly and folic acid 6 days a week. In the last few weeks I have had some reflux problems. Is it because I take the omeprazole too close to the hydroxychloroquine?

Otherwise the RA is well controlled, and I have recently given up all my painkillers, so I know I’m one of the lucky ones. The reflux is horrid though and I’d love to get rid of it!

I’d love to hear other people’s thoughts.

Many thanks!

VeronicaF profile image
VeronicaF in reply to Fuzzywig

that's good to hear fuzzywig, can I ask how your hair fared with it?

Fuzzywig profile image
Fuzzywig in reply to VeronicaF

My hair really worried me to begin with!! I’ve always had very fine hair, but plenty of it, and when I started the Methotrexate I was warned it might change. I was horrified when I looked at my hairbrush, but in fact it’s all settled down, and using a caffeine shampoo has really helped. Now even I can’t tell the difference from before.

Mmrr profile image
Mmrr in reply to Fuzzywig

I take pantoprazole rather than omeprazole, similar type of drug (protein pump inhibitor). I find it works better by splitting the dose taking one tab at breakfast time and one after dinner.

nomoreheels profile image
nomoreheels in reply to Fuzzywig

I'd see your GP. The interaction between omeprazole & HCQ isn't related to how well your omeprazole is working, why you're having acid reflux, it's that it stops HCQ working how it should. He may suggest an alternative PPI or an addition such as Gaviscon or even investigations. Still, it'd be best if you left a gap of 4 hours between your omeprazole & HCQ.

I wonder, were you told to take 40mg omeprazole in one dose? It could be for different reasons but when I went from 20mg to 40mg I took 20mg in the morning & 20mg at night (with my NSAID).

Really pleased you've been able to stop your pain relief. Every little helps & shows you're well controlled.

Fuzzywig profile image
Fuzzywig in reply to nomoreheels

Thank you very much! I really appreciate the support and advice.

nomoreheels profile image
nomoreheels in reply to Fuzzywig

You're welcome.

Methotrexate works well for many people and can make a real difference to people 's lives. Regular blood screening and supervision of course is required.

I was very healthy, a great outdoors person, long distance walker and swimmer with low cholesterol, healthy weight with no health issues and a healthy diet when RD struck.

To imply those of us with chronic health RD issues have so because of lifestyle is wrong.

If diet and 'simple' lifestyle changes work for you that's great , and I wish you well, but 'simple' lifestyle changes will do nothing for most with RD, otherwise no one would have RD, why would we choose to be ill, when 'simple' changes could give us our life back ?

nomoreheels profile image
nomoreheels in reply to Mmrr

I agree. MTX has kept me upright, able to do lots more than I thought possible after my first DMARD HCQ failed me. I wonder if it's the difference between our two countries? So many members in the US don't seem to have trust in their Rheumys, they talk of big pharma etc? It's a generalisation I know but often seems to be the case that 'lifestyle choices' crops up more too. We eat healthily, or we do if we want to help ourselves, we've to all make our own choices & not be browbeaten if for any reason we fail or don't 'do as we're told'.

Hiya hammer4481. I'm afraid the info you chose relates to high dose MTX, when, as you say, it's used in chemotherapy. To check please select the Professional version. MTX in low doses is a DMARD, even though it was originally produced for certain cancers the way it works on cells is helpful in controlling many of us with RD & associated conditions.

thanks for that link hammer4481

I found it very interesting

I was on --sulfasalazine and I found it difficulty breathing so took myself off it, when I told them why I stop it, they looked at me strange but its on that site, so I know it wasn't my imagination.

it said very rare hair loss on sulfasalazine but a lot of people on here found they did with it

looking at that site nearly all of them have shortness of breath

Methotrexate the only one you can have in injection form bypassing the stomach

I wish the others would do that too

They won’t inject me with it because I’m on anti coagulants.

It's true MTX doesn't suit everyone, show me a med that does, I wish there were one, but for many it does. I'm sorry it didn't suit you but hope your alternative holds your PsA (?). It is helpful if we have the correct info though.

I hope all goes well for your forthcoming op & you have an easy recovery.

mtx tablet were a no go sick all the time . then injection 10mg an then 15mg up to 20mg went well an I thought did me good ..then changed from injection to pen injection an I could not hold the trigger down long enough an lost most of the mtx . then suffered from short of breath an was stopped from mtx..

best thing for safety.. eiher call your gp or the nurse practitioner at the Rheumy Dept at hospital before going forward. They need oversight of all your meds and all your conditions. Good luck.

I’m interested in everyone’s’ replies. I’m on 22.5mg MTX, subcut which I have in a Wednesday night.

I also take hydroxychloroquine, Frolic acid, Omeprazole and Naproxen. I scoff all my daily pills in one go after my breakfast. Perhaps I’d better ask about this on my next Rheumy appointment.

I feel absolutely marvellous at the moment - the best I’ve felt in 5 years. MTX is my best friend and has given me back my life 😀😀

Fingers crossed my RA control lasts a while longer x

I have been told to take lanzaprozal at least 2 hours before hydroxy. I only take 10mg of MTX but have of course only started them this week so hopefully in a few months time when they start to take effect I’ll feel the difference.


I have just spent 3 days in hospital (long story) but the point is when they came around with the drugs trolley they gave me hydroxychloroquine and omeprazole at the same time. I couldn’t take my methotrexate because of antibiotics so that didn’t come into the equation. I must admit I have always taken my hydroxychloroquine and omeprazole together. It was only reading this thread that made me realise that I have been doing it wrong as I have never had a problem.

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