co-amoxiclav and methotrexate

[lindyloo2018]

has anyone taken this antibiotic and survived without liver damage ??

other than that they say I can take flucloxacillin for 2 weeks..

gp is saying I should take it..

please advise asap, I'm panicking....

[vonniesims]

Maybe get a second opinion from your pharmacist.

[Karen12]

Do you mean in combination with methotrexate, or on its own causing liver damage?

I’ve taken it many times as it was my prophylactic antibiotic for many years. I always stopped any methotrexate though as you should with most antibiotics/infections.

[lindyloo2018 in reply to Karen12]

ok thanks, I have already taken this weeks mtx last sunday, cannot always get the timing perfect but I will not take next weeks mtx if I start Co-Amoxiclav tonight

[Kags1068]

HI Lindyloo

Yes, I've taken Co-Amoxiclav and MTX together. It was last year after being hospitalised with suspected Ischaemic Colitis. It was the antibiotic I was sent home with after being on IV antibiotics for 5 days. My liver was fine. I've been on MTX for just over 30 years. I was also taking Prednisolone, Humira, Cyclosporin and Hydroxychloroquine. I think I may have missed the MTX for 1 week whilst taking the co-amoxiclav, but that was it. I was fine. Hope that re-assures. 😊

[lindyloo2018 in reply to Kags1068]

ok thanks, I have already taken this weeks mtx last sunday, cannot always get the timing perfect but I will not take next weeks mtx if I start Co-Amoxiclav tonight

[Kags1068 in reply to lindyloo2018]

Sounds like a good plan. It's always tricky timing these things, as if you do ever need antibiotics it's sod's law that it won't ever tie up conveniently with having to take/miss another drug!😠 Hope you feel better soon.

[lindyloo2018 in reply to Kags1068]

many thanks, yes sod's law..

[Kags1068 in reply to lindyloo2018]

isn't it always ......?🙄

[trunchalobesity]

Ive had liver damage from Azathiaprene. I am discharged from hepatology as the liver is a self repairing organ.

I take coamoxiclav, ciproflaxin and Rifaximin on rotation and have done for a few years, with absolutely no impact on my liver. My LFTs are just fine.

Good luck x

[OldTed60 in reply to trunchalobesity]

Really helpful comment for me as I have SIBO as part of my scleroderma GI and am waiting for a GP phone call any moment now about prophylactic antibiotics. I'm on max dose of Mycophenolate which, unlike all the others inc MTX, mostly agrees with my liver. But my gastro had me down for Metronidazole following just a week on Rifaximin last month and I refused it as remember how nauseous it made me some years ago.

My friend with same conditions and meds as me has taken Co-amoxiclav for years at prophylactic dose for SIBO and it works well - liver bloods are always fine. But Methotrexate is a more problematic hepatic drug than Mycophenolate so that probably would need factoring in too. Azathioprine caused pancreatitis for me.

[trunchalobesity in reply to OldTed60]

My rotating anti biopics are for sibo.

I take mycophenolate at the maximum dose, 1.5g twice a day.

I had methotrexate without problems but I needed stronger drugs. I had cyclophosphamide infusions and now I’m on a biologic.

I take metoclopramide to help with anti sickness x

[OldTed60 in reply to trunchalobesity]

yes we’ve spoken before on SRUK. Everything the same as you including 3g Mycophenolate daily. My GP phoned and says gastro says I must stick to trying metronidazole as drug to rotate with Rifixamin as risk of anti microbial resistance so getting an extra anti emetic on top of domperdone. I asked about your others too but he said risk of C-dif too great with those too and too immunesuppressed? So we agreed that I’d try metronidazole for ten days with Cyclizine dread dress. He says just stop and phone gastro Secretary if I get too sick on it again. X

[trunchalobesity in reply to OldTed60]

some drugs are saving our lives and some make it worth living.

I couldn’t bare the SIBO symptoms.

I hope you get relief from those and the nausea x

[OldTed60 in reply to trunchalobesity]

I’m with you all the way - this SIBO has gone untreated for many years and now I’m being prescribed drug for it that caused severe nausea despite severe scleroderma gut?! 🤷🏼‍♀️X

[Jackie1947]

I cannot take that antibiotic no way. Gave me chronic diarrhoea which lasted for 3 weeks involving hospital tests.

[lindyloo2018]

h, diarrhoea with penicillins can be avoided by taking a live yogurt drink every day whilst you are on penicillins to put the good bacteria back in the body . it works I have done it a few times now.

thanks

[Egpa]

hI,I have just come off co-amoxiclave for the flair up off bronciactsis and chest infection, had to stop my mtx 20 injections for the two weeks I was on them. Taken my jab this week, then can't take it next week because I have got my covid boster and flu jab. Hope to get back on track soon as my joints are getting stiff. I have always had mtx and co-amoxiclave no problems so far. Got blood tests next Wednesday. Hope you get better soon. Take care and stay safe.

[lindyloo2018 in reply to Egpa]

try jointace omega 3 vitamin capsules or seven seas cod liver oil - both in boots chemist

[Rosie-NRAS Partner NRAS in reply to lindyloo2018]

Please don't forget to speak with your health care team before taking any supplements as they may be contraindicated with your medications.

[Egpa in reply to lindyloo2018]

thanks, but I have been told by my consultants not to take any other vitamin supplements than what they give me.

[Hidden]

Am on last day of Flucloxicillin which seems to have done or is doing its job without doing anything to me.

I was taken off all my rheumy tablets before taking it, but NOT because of it.

I got another blood clot in my leg, my 4th DVT! Both legs also had bad infections so had to go back on warfarin and heparin which meant off the rheumy drugs!

Last day today of Flucloxicillin and have been told to start my rheumy drugs again so hopefully you be ok.

At moment I am having to make daily visits to warfarin clinic until they get my inr into target figures, which may take time due to rheumy drugs, but we'll get there in the end!

Good luck and don't panic, zap your infection soon as possible and feel better soon.

[lindyloo2018 in reply to Hidden]

Hi, I find that several things can be done to thin the blood, 75mg daily aspirin, garlic capsules, vitamin e tablets, I take jointace omega 3 usually and it helps

[oldtimer2]

High doses of amoxicillin taken together with methotrexate may affect your blood count rather than your liver. This is because it may increase the amount of methotrexate in your body by competing for the enzymes that break it down. It is sensible, therefore, to stop your methotrexate, which also may help your body to produce more defences against the infection (as methotrexate is intended to reduce your inflammatory response).

But in normal usuage it doesn't usually have enough effect to make much difference, so don't worry too much!

[lindyloo2018 in reply to oldtimer2]

now that is a brilliant response, you must have looked into this deeply as I have.

I have seen my wbc go as high as 17 ( higher than range 3.5 to 10) without mtx and about 5 when taking weekly mtx.

I guess the 17 means infection which is why I am taking co-amoxiclav for a week, 500mg 3 times a day - is that what you mean by a high dose?

odd thing is I will have to keep a check on it as -

18 oct wbc 12.7, neutrophils 10.4

19 oct wbc 7.0, neutrophils 5.5

I don't know if this is because mtx has kicked back in after a 2 week abscence or that mother nature is winding down after infection..hmmm

but I started taking the antibiotics yesterday , so too late now

[Leics]

I’m taking amoxicillin every day as a prophylactic antibiotic and I’m currently on methotrexate injections too. I think as far as I’m aware if you’ve been prescribed amoxyclav it’s because you have an infection and I’ve been told to pause mtx if I have an infection to give my body chance to fight it off. Having said that I’ve had lots of courses of amoxyclav in the past and it’s never affected my liver. We are all different though and what affects one won’t affect another. But if your GP says you’re ok to have it then I’d take their advice. If you feel more poorly when taking it though inform your GP and they will perhaps switch it. But I would take the antibiotics and hopefully you’ll be absolutely fine with no issues at all. It can affect my tum a bit so a live yogurt (not at the same time) every day stops side effects of occasional thrush and diarrhoea. But for me that’s because most antibiotics have that effect and I expect it so don’t worry about it as it’s short term and better that than the infection I’m suffering from when prescribed them. Hope that helps and you feel better soon.

[lindyloo2018 in reply to Leics]

Hi yes I do the yogurt thing too, it's great with penicillins

[lindyloo2018 in reply to Leics]

Hi how many days/weeks are you taking amoxicillin for ? do you take it all the time or have a break in between courses ?

many thanks

[lindyloo2018 in reply to Leics]

Hi please could you tell me what dosage of amoxicillin every day as a prophylactic antibiotic you are on?

many thanks

[Leics in reply to lindyloo2018]

I take 250 mg once a day everyday for the foreseeable future. I did used to have to take 500mg once a day but it upset my stomach too much. If I develope an infection then I have to stop all meds for RA which is only mtx and take a much higher dose of whatever antibiotics will clear it.

[lindyloo2018 in reply to Leics]

that helps many thanks

[BonnieG123]

hi, Lindyloo! Everything I looked up said to check with your doctor first. I do know that bloodwork needs to be done regularly to monitor if anything is happening to your liver. Best wishes.

[crashdoll]

Up until I randomly developed anaphylaxis to penicillin and I’m now confirmed as allergic, I was frequently on penicillin based antibiotics including home IVs.

As long as I take a break from MTX during the antibiotic course - as you should - it’s not a problem. My liver is fine.

I wouldn’t worry too much if, for example, you take MTX on a Tuesday but by Friday, you have an infection and need to start antibiotics. The important thing is treat the infection quickly and skip the next dose - or whatever is advised for you.

Hope this helps.

[Retirednhs]

HI, yes you can, l have taken it with no problems restart your methotrexatate 2 wks after taking it which is normal time for any antibiotic . Hope you are feeling better soon

[lindyloo2018 in reply to Retirednhs]

Hi, sorry to bother you again. is that just co-amoxiclav you can take for only 14 days ?

what happens if you need antibiotics for 20 consecutive days??

methinks I am in trouble.

[lindyloo2018 in reply to Retirednhs]

Hi sorry I need to ask regarding co-amoxiclav, what dose were you taking for 14 days?

Dosage for adults (including the elderly) and children over 12:

The usual dose is 375mg three times a day, preferably every 8 hours, for a maximum of 14 days.

For more severe infections: One 625mg tablet three times a day.

I am on the higher dose, maybe I need to get the dose lowered, I think I need to ask my gp

also asap.

many thanks

[lindyloo2018 in reply to Retirednhs]

Hello

I need to ask a favour

do you know what the normal rules are surrounding an RA flare and eklective surgery?

my RA is still flaring and I havr yet to start a 3 week prednisolone course.

is it considered safe to have elective surgery to my left wrist when I have active RA in my right elbow?

I don't know what the recommendations are, my RA cons says ask my hand surgeon and my hand surgeon says ask my RA consultant, I know if I take the pred I will have to postpone the op, but if I don't take the pred course, should surgery go ahead ?

do you have any personal experience or similar knowledge gleaned in this area?

please reply asap

many thanks

[Retirednhs in reply to lindyloo2018]

Hi , l have had wrist surgery and l am on permanent life long steroids as no longer producing my own this will be OK to continue with pre and post operation but not your methotrexate post operation until you come off your antibiotics and then restart on your normal day .See you are post op now obviously it will take a little longer to heal as l am sure you are aware because of your diabetes . Hope all goes well for you and it soon heals just keep it dry and clean and keep to the instructions your nurse gives you when it's dressed

[lindyloo2018 in reply to Retirednhs]

it's a high dose pred course for 3 weeks , 15mg,10mg,5mg, I will have to hold off surgery until steroids wear off. but the RA is still not under control. and will not be until after surgery or does the pred fix it enough for surgery ?

many thanks

..i am in a panic..

[lindyloo2018]

ok thanks, my cysts has not improved after 4 days of co-amoxiclav, it's still red and swollen it may have to get drained after all which was the last thing I wanted. that will mean that I am on antibiotics for more than one week whilst it is draining. as an insulin dependant diabetic taking mtx the last thing I wanted was an open wound for 2 weeks....so scared of sepsis...what to do?...wait until 7 days of antibiotics are finished or go get it drained now....

[crashdoll in reply to lindyloo2018]

Don’t wait. Hope you either got seen today or please go first thing tomorrow.

[lindyloo2018 in reply to crashdoll]

hi, the cyst is out, now I have a hole, I think I am more scared of the open wound than I was of the cyst..