Methotrexate

[sweenys]

Hi Diagnosed Nov 22 and started methotrexate 15mg. My dose was increased to 20mg back in march and at my last check up with nurse she said that my liver function was slightly high but check in 3 months. Over the summer I have been feeling very fatigued and this week I have been off work feeling sick, exhausted and diarrhoea. My AST level has gone from 21iU/L to 46. Just wondering if increase in methotrexate might be the cause.

[AgedCrone]

Test results can differ if a different lab does the testing…but if you are feeling unwell/worried do check with your rheumy nurse.

But on the whole labs will draw attention to out of range tests.

[helixhelix]

it is possible, but also possible that it’s due to an infection or similar. When is your next blood test? If not too far away avoid all alcohol and make sure you stay hydrated and see what has happened.

[sweenys in reply to helixhelix]

Thanks, my next blood test is not until Nov and I don't drink much alcohol anyway.

[Runrig01]

it’s certainly possible the increased dose is causing these symptoms, but hopefully will settle down. The liver enzymes they generally only stop when they are more than 3 x the upper limit of the range.

[sweenys in reply to Runrig01]

Wow! 3x upper limit that's high surely damage to the liver has already started by then.

[helixhelix in reply to sweenys]

Not really, the liver is truly remarkable in that it heals itself a lot of the time.

[Runrig01 in reply to sweenys]

Here’s the screenshot of what my gp sent me from their shared care agreement

MTX guidance re blood results

[sweenys in reply to Runrig01]

Thank you very helpful

[Happy5]

Maybe your body still adjusting to the higher dose, are you taking 20mg tablets? If so speak with nurse on the advice line about your symptoms. I was advised to take folic acid every day except MTX day , also prescribed medication to reduce the nausea symptom. Fatigue is part of it so I try to have less strenuous days post MTX day.

Any way there's lots to try but discuss with consultant, RA team , I'm sure a solution can be found.

[Chockyuk]

Hi

My question is, do you take any other meds that could possibly have an interaction, as that is worth looking into.

When I first started on 20mg my ALT shot up to 84, so my Rheumatologist lowered the dose to 10mg. Eventually, after discussing with my GP, I lowered my dose of Omeprazol which I’ve been taking for excess stomach acid (and is known to increase toxicity of Methotrexate) and my ALT dropped significantly. After flaring, I’m now back on 20mg of Methotrexate and also 4 x tablets a day of Sulphasalazine and my liver function tests have remained very low 🤞🤞

But definitely talk to your Rheumatologist, if your liver function tests don’t go down. My Consultant is very vigilant and when my tests were 84, she took me off it right away for a few weeks until my liver recovered.

👍

[sweenys]

Thanks for the advice. My Rheumatology nurse has requested a blood test to check levels again instead of waiting another 3 months.