Methotrexate, covid jab and naproxen: I'm due to start... - NRAS

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Methotrexate, covid jab and naproxen

Gottarelax profile image
52 Replies

I'm due to start taking methotrexate in a couple of weeks when the consultant can organise my prescription. From what I've read here I think that you have to stop taking it to have a covid jab. Since I'll be called to have the jab soon anyway, would it make sense to try to get the jab earlier so that I don't start/stop/start medication? I am keen to have the jab as vulnerable people are in my household.

Another query...I am currently taking naproxen and since I find that the benefits of methotrexate are going to take a long while to take effect, I'm wondering (should have asked the consultant) can naproxen taken alongside during this phase?

Thank you!

52 Replies
bpeal1 profile image
bpeal1

Personally I think it would be wise to try to have the covid jab a couple of weeks before starting Methotrexate if you can. I'm also quite sure many people take naproxen with methotrexate but please check with your rheumatologist that they are happy for you to do this.

AgedCrone profile image
AgedCrone

Speak to,your rheumy nurse both about taking Naproxen,& when to start taking the Methotrexate..

Usually your NHS consultant will pass on the prescribing of the methotrexate to your general practitioner …and when you first start…. if you don’t have your blood tests every two weeks then every four weeks (well the timings might have changed….I was on it a long time ago) they won’t issue your prescription - so make sure you get the dates of your blood tests right!

I recently missed a blood test…& the laboratory wrote to me saying if I hadn’t had it within the next seven days my prescription would be cancelled….so they do keep tabs on us!

Gottarelax profile image
Gottarelax in reply to AgedCrone

Thank you, that's really helpful advice. The consultant said that he'd initiate the fortnightly blood tests and the monthly rheumy nurse appointments. I've got a useless memory so I'm going to have to set scheduled reminders! Hopefully, I can pre-arrange regular blood test appointments at the surgery rather than joining the butcher's queue (take a number and wait for an hour) at the hospital phlebotomy centre.

AgedCrone profile image
AgedCrone in reply to Gottarelax

I’m the other way ….I can book my blood test at the hospital online sometimes the same afternoon…. but my GP practice is very cost conscious and it takes at least 10 days to get an appointment to get a blood test…. because they want to do lots of tests ….because they get paid for doing it! Oh yes…….it then takes another week listening to the answerphone message…telling you what time somebody will be there to give you the result….and that turns out to be a person who just reads the results of her screen but doesn’t know what they mean!

Needless to say….. I go to the hospital!

Gottarelax profile image
Gottarelax in reply to AgedCrone

Ah OK, I may see how things go. I'm not really used to using the health services as I've not really been ill for a long time and only moved here recently. Having said that, I found you do have to wait a few days normally at our surgery for a blood take. I was just hoping that if it's a regular requirement they may give me a day/time that is on repeat (like every 2nd Tuesday at 9 am). Perhaps that's too much like common sense!

AgedCrone profile image
AgedCrone in reply to Gottarelax

That is definitely too much like common sense…….,especially as quite often you need a blood test at short notice…in the middle of a drug not working or some other hiccup…. and you need to be able to get it quickly …so ask around anyone you know who is with your GP practice….to see how they manage.

We have something called Swiftqueue…I think it’s nationwide…works very well…ask your rheumy nurse if you have that or some other system.

As you are going to be getting RA drugs you will need an NHS GP to get your prescription….if a Private consultant prescribes them…unless he instigates a shared care arrangement with your GP you would have to pay for a private prescription.

Especially if you end up on Biologics….they are only available on the NHS…..you can’t get them privately…& even if you could you’d need a mortgage to buy them.

This RA business gets to be an art …….working your way around it!

Hope you are one of the lucky ones and get on well with methotrexate ….I swallowed it like Smarties every Friday night for seven years …..then it suddenly stopped working…but it was if my RA had disappeared whilst I was on it.

Gottarelax profile image
Gottarelax in reply to AgedCrone

thank you for such helpful advice. The private consultant is on the NHS team that I’ve also seen and is putting the prescription through the NHS so all care from now on will be NHS based. Hoping that I’ve not got unrealistic expectations of methotrexate and that I tolerate them well but glad to ditch steroids.

AgedCrone profile image
AgedCrone in reply to Gottarelax

Just don’t dwell on the downside of Mtx….of course there are a lot of posts from those who start on it expecting to be back to their old self overnight….because it is the most prescribed first Dmard….so thousands are prescribed it…..& those who do well on it are just so grateful…….they don’t bother to write about how well they feel…they just get on with enjoying their lives.But give it time….3/6 months….don’t just expect to be pain free  instantly…..but do get off the steroids asap……weaning yourself off those is very difficult…luckily they disagreed with me…so I never had to go through that.  A lot of people…….me included ….start by taking it after dinner……on the completely unproved theory that you will sleep through any side effects……well that worked for me….& as it’s only once a week it’s a doddle! Make sure you keep very well hydrated…..& if you are prescribed less than 6 Folic Acid tablets per week & you do feel a bit queasy…….speak to your rheumy nurse & ask her opinion of upping your dose. Good luck…..you have waited long enough to get started on your RA meds…you deserve success now! 

Gottarelax profile image
Gottarelax in reply to AgedCrone

Thank you for this advice. Folic acid hasn't been mentioned but having read on here about it's use, I did start taking folic acid just to make sure that I wasn't depleted before even starting but that's just a 100%RDA dosage. I'll be sure to enquire if it's not prescribed alongside the MTX. I like the idea of taking meds at a time that allows you to sleep through the worst of side effects. I'm just on a weekly tapering course of steroids so 20, 15,10,5 mg and I'll be off a week today. Hoping that it takes a while for my body to realise that I'm back to just naproxen and I don't go back to square one straight away as I'm feeling so much better at the moment.

AgedCrone profile image
AgedCrone in reply to Gottarelax

The 5mg dose of FA we are prescribed is only available on prescription…the OTC stuff is not sufficient…..I remember when I saw the prescribed dose I worked out there weren’t enough hours in the day to swallow all the pills it would take…..I was prescribed 6 per week from day one.

Sometimes it’s not offered…..so do ask.I had a brilliant Rheumy nurse when I started on Mtx…she virtually dared me to fail…so I just got stuck in & had great succcess with it.

When it failed….my rheumy just switched me to Leflunomide …instead….not as well as….I have never taken more than one Dmard at a time.

As it happens…Lfl was an A1 disaster…& that was when I switched to Rtx infusions….& if Covid hadn’t appeared…I’m convinced it would still be working!

Gottarelax profile image
Gottarelax in reply to AgedCrone

I've just had the letter through and I'll be prescribed 5mg Folic Acid so it looks like I'm being looked after. I'll be started on 15 mg MTX and then up to 20 mg after 2 weeks.

AgedCrone profile image
AgedCrone in reply to Gottarelax

Good Luck.I hope all goes well and methotrexate kicks in quickly for you and you’ll be hunky-dory for Christmas!🎄

Gottarelax profile image
Gottarelax in reply to AgedCrone

🤣I was counting the weeks on the calendar...it's going to be cutting it fine for Christmas but if it's going to work I should be feeling at least a little better by then 🎄

AgedCrone profile image
AgedCrone in reply to Gottarelax

Now stop doubting. ….3/6 months is only a guess…… for some it does start working sooner …..but play it by ear. It will work…swallow those 6 little pills, drink plenty of water& forget it! Don’t think every twinge means it’s not working…& if you feel a bit nauseous suck a sweet & you’ll be fine! I’m 99% sure the majority who do well on MTX….keep it quiet…..so please be optimistic.

Gottarelax profile image
Gottarelax in reply to AgedCrone

I am feeling optimistic - even the nausea will help me lose the weight I've gained through inactivity and steroids so I hope to have the added bonus of my clothes fitting for Christmas too!

AgedCrone profile image
AgedCrone in reply to Gottarelax

That’s the spirit.Unfortunately I’m a skinny…& my venture into Leflunomide led me to lose 12kgs in a month.So if Mtx should fail you…maybe try it!I AM JOKING!! 

Ernie52 profile image
Ernie52 in reply to Gottarelax

hubby was on same pattern of steroids, and dosage. He had one session of roid rage!! Where he was going to kill me lol 🤣 not funny at time but just the once while on the higher dose! He has come off steroids now no side effects at all, hes been off them 3 weeks now. Hope you will be as successful.

Gottarelax profile image
Gottarelax in reply to Ernie52

When I was on 20 mg, I didn't sleep for 3 nights and was still hyper but shattered at the same time...so I can understand why hubby was feeling murderous 🤣

AgedCrone profile image
AgedCrone in reply to Ernie52

I hope your hubby is never tempted back on steroids…the psychosis can get worse……& is truly terrifying.

bpeal1 profile image
bpeal1 in reply to AgedCrone

I’m the same. I always get my blood tests done at the hospital now. Since Covid the hospital have really sorted out the efficiency of the phlebotomy department and the doctors surgery has become a nightmare. To book at the hospital I just send an email (and if I email a couple of weeks in advance I can choose exactly what time I want). The department runs on time and they have a large waiting area.

AgedCrone profile image
AgedCrone in reply to bpeal1

Yes we can book blood tests  hours or weeks ahead……as soon as my rheumy decides I need an infusion the rheumy nurses tell  me & I choose a date & book my blood test an appropriate time ahead.The phlebotomy Dept doesn’t even have a receptionist….we just check in on a screen,& if we are a “walk in” needing a blood test immediately…we log in on that screen & the phlebotomists have a screen in their rooms & fit us in.You’d think that might be “hit & miss”…..but because like GP appointments a lot just don’t turn up for a booked test …you never have to wait too long.

Sheila_G profile image
Sheila_G

Absolutely. I would have the jab before you start mxt. I don't think it would be wise to miss a dose of mxt as it can take 3 months before it is established.

Gottarelax profile image
Gottarelax in reply to Sheila_G

I was at the covid vaccination centre yesterday with daughter so took the chance to speak with the duty Dr. She said that they don’t recommend stopping methotrexate to have the jab and that I’d have to have the prescription before possibly being offered an early boost. Really seems like a lack of joined up thinking. They also refused to immunise my daughter who was booked in despite the fact that she’d had two letters with her NHS number on stating that she was eligible (she’s asthmatic).

bpeal1 profile image
bpeal1 in reply to Gottarelax

Sounds like you had a jobs worth person. Took my son and daughter on Saturday for their Covid boosters and they didn’t even want to look at the letters.

Speak to your rheumatology team for advice. If they think you should have it before starting Methotrexate they can provide a letter. Maybe take it to a different vaccination centre.

Ascidian profile image
Ascidian in reply to Gottarelax

Perhaps try talking to your rheumatologist and asking if you could get the prescription asap but not start taking the meds until 2 weeks after your covid jab - then you would have a prescription to show. The doc who said you don't need to stop it is out of date, I believe. Our rheumy dept are now officially recommending a 2 week break from mtx after covid, flu or pneumonia jabs, as it has been shown (the VROOM study) to inhibit your immune response. Good luck with the mtx. I had some improvement very quickly, but after 11 months I had a much bigger improvement - pretty much full remission. No side effects after the first 2 weeks.

Sheila_G profile image
Sheila_G in reply to Gottarelax

What?? That's ridiculous on both counts. Do you have a drop in centre nearby? I would go there with your daughter and take her letters with you. If you have a text message or letter for yourself, take those as well. Don't mention anything about mxt. Good luck

Gottarelax profile image
Gottarelax in reply to Sheila_G

Around here it's appointment only. We went to a local pharmacy after the 1st letter but didn't take the letter as we had booked through the portal and you have to be in the system to book in the first place (I can't book for me). She fobbed me off saying that the letter will have been generic so I didn't query. A couple of weeks later when we got the 2nd letter I saw that it said her name and NHS number so it was specific for her so booked at the vaccination centre where I thought they'd just do it on seeing the letter. Only those on oral immunosuppressants are to be given it at the moment and she isn't, she uses steroid puffers. I also said that I was just about to go on MTX thinking that that would add weight. I can't have a jab for a week because of my shoulder steroid injection so wasn't trying to get one there and then for me but rather asked for advice regarding getting the jab before starting MTX. In a few days when hopefully my private notes are sent to NHS, I'll query it with the rheumy nurse and get the right advice. Maybe they'll then send a letter for me.

Sheila_G profile image
Sheila_G in reply to Gottarelax

Ok. Well I hope you get some satisfaction regarding your daughter, very soon.

vonniesims profile image
vonniesims

you could check about the Naproxen with your pharmacistv

Gottarelax profile image
Gottarelax in reply to vonniesims

I tend to forget about the pharmacist- so much more accessible!

smilelines profile image
smilelines

hope all goes well with your methotrexate and it works marvellously.

runningbracken profile image
runningbracken

I have 4 covid jabs. I was taking MTX an Naproxen while having the jabs. Had no problems at all. When i asked consultant about this he said not to worry I'd be good, and I was. I've been on the two drugs for over 4 years now.

GinnyE profile image
GinnyE

I stop my methotrexate for two weeks after my covid jabs. I believe this is the current opinion and I have always done it. It should give your body a better chance to make antibodies. It did mine. I would get the covid jab asap before starting methotrexate. But check with medics too.

Brychni profile image
Brychni

Hi there - I carried on with MTX when I had one of my covid jabs and not the other. ALso yes you can take Naproxen but a lot of people here don't find it very effective. I was prescribed Etoricoxib and it's amazing. Doesn't affect the stomach and it works immediately and long term.

greynot profile image
greynot

We're all different, but I've been taking both Methotrexate (20 mg) for 3 years and am also taking Naproxen for osteoarthritis (yes, I have the double whammy). My rheumatologist suggested re-starting it, and made sure I was also taking Lanzoprazole to protect my stomach while taking it.

But check with a professional for your personal situation.

Hopefully you can get in quick with your covid jab ( and flu too? ) before you start your methotrexate...

stbernhard profile image
stbernhard

My consultant told me that the consensus now is to stop MTX for two weeks after the Booster. That's what I will do. As for the rest, you must really talk to your GP or consultant. Good luck.

Maureengibson profile image
Maureengibson

I would definitely see if you can get your booster before starting. The new advice is to stop for 2 weeks. At the moment it’s only over 75s and immunosuppressed who can book online

hospitalhealthcare.com/covi...

Normally you can take naproxen alongside MTX, unless your risk of ulcers is high. So double check with your rheumatologist or pharmacist

bpeal1 profile image
bpeal1 in reply to Maureengibson

Also household contacts of Immunosuppressed can book online now.

Maureengibson profile image
Maureengibson in reply to bpeal1

yes, sorry forgot to add that 👍

jarujuda profile image
jarujuda

hi, I take naproxen with methotrexate when needed. Also I have had 4 Covid jabs and never stopped my methotrexate injections I have been on methotrexate for 3 years. 😊

Cheylann profile image
Cheylann in reply to jarujuda

ive never stopped my injections either and have had 4 covid vaccines. Not sure why people think you need to stop. Doesn't make sense to me.

Leics profile image
Leics

Slightly different here. I had a pneumococcal vaccination just over a week ago by immunology. I’m to have a blood test to see if I have any antibodies this time (failed last time). My immuno knows I’m on mtx injections and I reminded her several times. I wasn’t told to stop it but I’m not allowed any steroids coz that can affect the results I was told. Anyway it seems that there is still conflicting advice regarding when to have covid boosters and if meds are to be paused or not so I would ask your rheumy team and go with their advice. Seems sensible to have the jab and start mtx after a couple of weeks it usually takes that long for prescriptions anyway.

Gottarelax profile image
Gottarelax in reply to Leics

if I can get it I will but the vaccinators are very selective here…even if you have a letter!

Leics profile image
Leics in reply to Gottarelax

Well I’m being nagged by everyone including GP to have my next vaccination but I’m severely immune suppressed without the mtx on top. But I’m going to have to pause vaccination for a few weeks because immunology are doing some tests and to be honest I’m flaring a bit after pneumonia jab anyway so don’t want to add to it.

Cheylann profile image
Cheylann

you dont need to stop MTX to have a covid vaccination. Its the same as having a flu vaccine. Not necessary to stop the MTX. I take my mtx injection every week and have had 4 covid jabs with no problems. You can take anti inflammatories alongside mtx just remember to protect ypur stomach.

The only time ive ever stopped mtx is when ive had an infection and been on antibiotics.

Not sure why ypu think you think you need to stop mtx to have a vaccination.

Gottarelax profile image
Gottarelax in reply to Cheylann

It seems from this forum that some rheumatologists are recommending coming off MTX, I suspect that this is because as immunosuppressant it may render the vaccine less effective.

CripLady profile image
CripLady

Morning. I am on 25mg Mtx and never stopped taking it whilst having Covid jabs. I did move my Mtx day once so my jab was a few days before/ a few days after my Mtx day.

I found toxicity an ongoing issue when I was taking naproxen (with Mtx) but did so for several years. Feel loads better now I’ve moved to Amitriptyline.

We all react differently to things. You may be fine. But I would up your water intake and ask for an antiemetic.

Cheylann profile image
Cheylann in reply to CripLady

ive been prescribed amitryptilene however am too scared to try it. What does it do for you?

CripLady profile image
CripLady in reply to Cheylann

It’s been marvelous!! Hardly any pain now, and I sleep loads better and more deeply, which gives me considerably more energy.

Cheylann profile image
Cheylann in reply to CripLady

im really tempted to try it but a bit nervous as i take codeine for pain during the day.

How many mgs do you take?

What type of arthritis do you have as I cannot understand how it can take pain away when 15mgs MTX injections and codeine dont take all my pain away. I have Psa.

KittyJ profile image
KittyJ in reply to Cheylann

it’s worth trying though as you can always stop it if you find it’s not making any difference after a while. You’ll never know unless you try and it could make a lot of difference. One tip though I would suggest is to start on a low dose and work your way up if needed, with your doctors guidance of course. I took the amount my GP prescribed straight off and was like a zombie the next day, gradually building it up meant I could find the best dose for me. Let us know how you get on 😊

CripLady profile image
CripLady in reply to Cheylann

I have RA and Fibro. I take it before 7pm

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