Antibiotics (amoxicillin) with methotrexate- sore to breathe

[Sunshinereturns]

Hi, I take injectable methotrexate and am currently on a course of antibiotics. I read the warnings and felt slight trepidation but was assured by hospital it was fine.

I don’t know if it’s connected but yesterday I had such a deep pain within my ribs, deep within, that it hurt to walk and breathe. I wondered if I’d pulled an intercostal muscle without any strenuous or noticeable movement. Today it doesn’t hurt to move but there’s a tightness and soreness deep in my chest when I breathe in deeply, enough to mark me gasp.

is this coincidence or could this be a worrying interplay between methotrexate and antibiotic? Would be very grateful for anyone’s knowledge or experience.

Thanks

[Biofreak]

They should have told you to stop taking the methotrexate whilst you are taking antibiotics. The antibiotics won't work if you continue to take the methotrexate.

[Sunshinereturns in reply to Biofreak]

I think amoxicillin is the exception to the rule and can be taken safely in theory?

[Biofreak in reply to Sunshinereturns]

Didn't know that. Hope you feel better soon Sunshinereturns.

[sule in reply to Sunshinereturns]

I was told, on more than one occasion,not to take methotrexate and amoxicillin together. The antibiotic was more important so told to stop methotrexate until I had finished the antibiotics.

[Madmusiclover]

I’d call 111 in your position. I’m allergic to amoxicillin myself.

[helixhelix]

The only antibiotics you absolutely can’t take with methotrexate are ones containing trimethoprim/sulfamethxazole, like Bactrim. Sulpha antibiotics are possible, but not a preferred choice. The rest are fine. I

And whether or not you stop MtX with any antibiotics is very much on a case by case basis. Depends how bad the infection is, how fragile you are and so on. For the first 10 years I was never advised to stop, but more recently I am judged more fragile so the rheumy did tell me to stop when I had a viral infection.

What are you on antibiotics for? As maybe that is the cause of your discomfort?

But as madmusic lover says, if you feel concerned phone 111.

[Leics]

I have to take amoxicillin every day as a prophylactic but only a small dose and I inject mtx too. I’m lucky the reaction and side effects aren’t too bad. But as others have said if your taking a standard dose for an infection then perhaps pause your mtx for a week ? It’s difficult to know what is causing your symptoms but I would definitely get some advice from either GP or 111.

[Firion]

The advice I get from rheumatology is not to take methotrexate when you have an infection, whether or not you are given antibiotics, but especially not with antibiotics

[AgedCrone]

To be on the safe side….speak to your rheumy team….there are certain AB’s that react to MTX.

[Nuttyshirlz]

oh I’m allergic to it too. I took it came out in shillings and had real problems breathing then constant blackouts and somehow managed to ring 111 and told them how I was there sent ambulance who blue light me to hospital I spent 3 days in hospital on a drip. Wearing a red wrist band I was told at hospital that on no uncertain terms you shouldn’t take it when you on methotrexate. Hopefully you are ok and have rang 111 hopefully you didn’t get it as bad has I did.

[oldtimer2]

Methotrexate reduces your over-active immune state to a more normal level. If you have an infection your body needs to increase its immune activity to fight off the infection. Methotrexate takes quite some time to build up its effect and it takes also some time for the effect to be reversed, but it is often worth stopping for a couple of weeks to at least give your body a chance to increase its immune response. But that does increase the risk of a flare, so is not always recommended by rheumatologists.

Amoxycillin kills the bacteria by attacking proteins that make up the cell wall. There is no recorded interaction between amoxycillin and methotrexate, but there is interaction for some other antibiotics in the sulphonamide group.

The best source of information about drug interactions is usually the pharmacist, who if they don't know can easily look it up in their reference data. Nurses and doctors are usually poorly informed.

[Sunshinereturns in reply to oldtimer2]

Oh this is such a helpful response, many thanks. I feel reassured by this and also that it’s just happening at night, not daytime now so maybe I have just hurt my intercostal muscles. I just wanted to rule out a sinister connection and your reply thankfully does this.

Thanks so much to everyone who responded, I so appreciate and it all helps to build a bigger picture.

[Deeb1764]

I went anaphylactic on that mix and not to scare you but you can get reactions so be careful and call 111 if need be.

[Mall]

Important you seek medical advice re your symptoms.

Although I stopped taking methotrexate whilst on this antibiotic for a chest infection my liver reacted badly as seen in blood tests and took a good few weeks for my tsats to return to previous levels.

I tend to always stop methotrexate if I have an infection, or a severe head cold, for a week or two, to aid my bodies immune system and try to avoid antibiotics which I use as a last resort if I can’t shake off the infection. I am fortunate in that I don’t flare in the first 10 days or so of stopping methotrexate.