I've been having some difficulties swallowing tablets the last 6 months or so plus acid reflux/ dyspepsia discomfort at night so saw GP recently. I've had an endoscopy today and have got a telephone call with said GP on Tuesday, although I doubt he'll have any results for a while.
He has been talking about giving me medication but says that Omeprazole and Lansoprazole aren't advised with mtx so is talking about a drug called Famotidine.
Has anyone had similar issues or tried Famotidine?
Appreciate any advice, thanks. Xx
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Circledancer
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so all PPIs slow the clearance of methotrexate. When I discussed this with my rheumatologist, she said it was only at high doses, like when it’s used for chemotherapy that it’s a concern, and doesn’t apply to the doses rheumatology patients take. She also said any concerns would be picked up in the blood tests, when levels were getting too high.
Like others I’ve been on different PPIs over the last 12 years, with no issues. If you look up methotrexate in the BNF there are literally 100s of interactions listed, many of which only refer to high doses, which 25mg, the maximum dose prescribed by rheumatologists, is not.
hello, I have taken omeprazole for years. Last year after an op my sodium dropped so they put me on famotidine with the omeprazole. It seems to work. I take 25mg of methotrexate a week.
Thank you everyone for your replies. All very helpful for me to discuss things with my GP next week. He did look up interactions on his computer when I saw him last and he definitely said that PPI's were not advised with mtx. I might ask to delay decision on medication until we get the results from the endoscopy.I usually manage the reflux and dyspepsia fine with gaviscon double action but the swallowing tablets and them sticking in my throat sometimes is bothering me more.
There does seem a move away from using PPI drugs long term and trying to control he symptoms of reflux in other ways. There's a useful article here about using non-pharmaceutical techniques: healthline.com/nutrition/he.... Weight loss, of course, is easier advised than achieved!
I've also found that using Gaviscon (which is available over the counter) is often sufficient when I have a bad bout.
I was on Omeprazole for two years (started it when I was on MTX but now I'm on Hydroxychloroquine). After a discussion with my GP, I weaned myself off Omeprazole by taking Slippery Elm capsules. It's a type of tree bark that puts a mucous lining through the guts and it worked a treat, very rarely get a problem now.
I just came across this on Healthline.com…an American site.
It was explaining why Ranitidine was withdrawn
“Ranitidine, brand name Zantac, is now marketed as Zantac 360, which contains a different active ingredient (famotidine). Famotidine is in the same class as ranitidine and works the same way but has not been found to contain unacceptable levels of NDMA.”
Personally I really mourned the withdrawal of Ranitidine..having tried Lanzoprazole,Omazeprazol & Esomeprazole witn zero success.
I don’t know any more than this….but any other Ranitidine fans might ask their doctors if the same Zantac 360 is available in UK.
Hi Circledancer. If you’re having problems swallowing, do you have a dry mouth? I used to take Amitriptyline and kept getting them stuck in my throat which really burned. I had to make sure I ate either a biscuit or banana with a drink to make sure they went down properly. Honestly, nothing is simple is it? 🙄 Good luck.
Hi Blackwitch, Thanks for your reply. I do have dry mouth and eyes, but was tested for Sjogrens years ago and told no. I use Biotene mouthwash and Hylotear forte eyedrops plus have to drink whilst eating. I do think the reason tablets are or feel like they're sticking is down to dryness but also think perhaps my swallowing reflex might be weak. I always take tablets with a large drink of water but still they often take several attempts to go down.Xx
Hi restarting this thread have been taking Ppis off and on for a while stopped.rheumatology said can take lansoprazole as others have mentioned I take methotrexate and hydroxychloroquine x twice daily and weekly methotrexate struggling to find correct time to take ppi as usually would be am when do people take their Ppi morning then for me hydroxychloroquine at lunch time ? 4 hours needed between meds. Will ask the hospital next time but never got enough time for questions.
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Methotrexate prescribed
Avoiding Methotrexate 
Omeprazole and Hydroxychloroquine added to the mix.
