Methotrexate and Liver Enzymes: I've been on... - NRAS

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Methotrexate and Liver Enzymes

SlothSandpit profile image
13 Replies

I've been on Methotrexate since September and the last month, I've had elevated liver enzymes. Luckily the rheumatology nurses are quite on it, and they've told me to miss my next dose and get another blood test next week to see if the levels start to come down.

While they've been elevated, I've been feeling so wiped out and exhausted. Has anyone else experienced this? Did you feel poorly whilst your levels were elevated?

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SlothSandpit profile image
SlothSandpit
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13 Replies
Neonkittie17 profile image
Neonkittie17

I remember feeling wiped out early on when I had changed to Mtx, but mostly from the previous med losing its efficacy and RA not under control. My LFT did elevate and I did exactly the same as you have have been advised and it worked and didn’t have more issues in that way. Mtx can make you feel tired when you’re not used to it but until Mtx was working to control RA I felt very tired. Hope you can pace yourself in any activity needed and rest when needed and that it soon improves.

SlothSandpit profile image
SlothSandpit in reply toNeonkittie17

Thank you, you're always so great at replying Neonkittie17 🥰 It definitely wiped me out for the first few weeks but since these results, I just feel horrendous all the time. It's such a busy time of year as well, so it's tricky to find time to rest but I will do my best.

Neonkittie17 profile image
Neonkittie17 in reply toSlothSandpit

You’re welcome. Thank you. 💗 As long as you have your blood tests and tell rheumy/nurse when when anything out of sync, I’d say fatigue is in fortunately part and parcel of it all. 😑. Especially when you are relatively fairly new to the med. I think and feel you’ll have much improvement. 🙏🏻🤞🏻

hemsworth profile image
hemsworth

Yes on 20 mg of methotrexate per week my liver results were always concerning. I got fed up of the warnings so dropped the dose to 15 mg per week and have had no trouble since. Rheumy approved of my decision and still have blood tests every 3 months but no bad results. Also take hydroxychloroquine daily and inject benepali weekly.

SlothSandpit profile image
SlothSandpit in reply tohemsworth

I was only on 12.5mg and they put me down to 10mg and they're still raised! I think maybe MTX might not be the one for me.

hemsworth profile image
hemsworth in reply toSlothSandpit

Yes sounds as if you have a problem with m'trexate. By the way don't know if this has any bearing - I never drink any alcohol?

SlothSandpit profile image
SlothSandpit in reply tohemsworth

I also don't drink! 😂

helenlw7 profile image
helenlw7

I’ve been on mtx for many years without any liver issues, until August this year. My numbers were all raised. I stopped the mtx and when the didn’t come down I was booked in for a liver scan then a nuclear liver scan. The results came back as normal and after about 6 weeks the numbers were back to where they’d been.

SlothSandpit profile image
SlothSandpit in reply tohelenlw7

That's really good to hear. Did you feel unwell at all whilst they were raised?

helenlw7 profile image
helenlw7

I felt really tired, but the original blood tests found I was also Vitamin B12 deficient so that contributed to the fatigue.

nomoreheels profile image
nomoreheels

I've found after years on MTX blips happen & you're relatively new to it so, to be honest, it might be that you're experiencing them too. See what's thought once your levels return to within reference & you restart MTX, your nurses will have a clearer idea then. You're probably aware RD itself can cause fatigue, that might be just what it is with the recent addition of MTX. It is commonly coprescribed with adalimumab but surely your Rheumy will intervene if your LFT's continue to be a problem.

Not meaning to be nosy but do you limit your alcohol since starting MTX? If you do imbibe maybe stop until your next blood test & thereafter avoid on MTX day, maybe the day after too, see if that helps in reducing your LFT. Not what you want to here when Christmas is so close but worth considering if you do like the odd glass of wine or spirits.

SlothSandpit profile image
SlothSandpit in reply tonomoreheels

Ah yes I've been on adalimumab for about two years now! So the mtx was an addition. Yeah I didn't really drink before taking it, I might have one beer a month or something at home, so I don't think that's a factor.

nomoreheels profile image
nomoreheels in reply toSlothSandpit

I believe you get a better response from adalimumab with MTX than without so if you can tolerate it all the better.

I wouldn’t think a beer a month will be enough to affect your liver function. When I first had out of range results my Consultant asked if I’d been drinking alcohol & I don't think he ever quite believed me when I said no. He said by alcohol he meant spirits. Lager & wine were not included as one was necessary to keep hydrated especially in the summer, & the other was a necessary accompaniment with food!

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