Coming off of Enbrel and Methotrexate before Operation

[MJSlide1958]

Dear All,

I would be very grateful for others experiences whilst on a weekly Biologic prefilled and weekly Methotrexate tablets with Folic Acid 5mg 6 days a week. My daughter is 32 years old and having a Laparoscopy Operation to remove bilateral ovarian dermoid cysts on 16 May.

When should she come off of Biologic pre filled weekly injection? And when should she come off of weekly Methotrexate tablets. (Is it two weeks before Op? or one week before Op?). No doubt some of you may have been in same situation before an Operation therefore your experiences would be very much appreciated. Thanks all

[medway-lady]

Check with the surgeon or the aneathatist when going for the pre op. Opinions vary, I very recently had a medical procedure (no one talks about operation it appears now) and was told to carry on with Benapali and AZA only stopped the Riveroxaban for Heperin for a few days. So this is a subject only a medical professional can answer based on the patient and procedure.

[MJSlide1958 in reply to medway-lady]

Thank you, awaiting instruction, but they are busy too! She did not take her Enbrel last night, but I would like her to take her MTX this week and then not take because op planned to 16th May.

[KittyJ]

she needs to speak to her doctors about that, people can tell you what they did but it’s your daughters doctors instructions she must follow 😊

[MJSlide1958 in reply to KittyJ]

Thanks I am awaiting instruction, but all Rheumys have different advice. This is a problem? I have no instruction what she can take in the meantime? Paracetamol or Ibruprofen?? I don't know??

[KittyJ in reply to MJSlide1958]

Not a problem, you just have to wait, it’s her rheumys that know her so their advice should be followed. Hopefully she’s not off it long enough for it to affect her negatively 🤞🏻

[MJSlide1958 in reply to KittyJ]

Hope so thanks so much. Best wishes

[MJSlide1958 in reply to KittyJ]

Rheumy nurse has said 1mg paracetamol every 4-6 hours???

[medway-lady in reply to MJSlide1958]

I was told when I broke my lag last year hat paracetamol must be taken regularly so every 4 hours no more than 8 a day. But not to leave it. I am unable to take any NSAIDs due to CKD but it did work.

[MJSlide1958 in reply to medway-lady]

Thank you so much. I hope you get well soon. This is very reassuring to know paracetamol works. Was the dose 2 x 500 per 4-6 hours, not sure of the dosage?

[medway-lady in reply to MJSlide1958]

Yes and I’m really well. going to Cyprus on Sunday. So need a break and this is a recovery rest. Or that’s my excuse for being waited on hand and foot. I think the Gentamyacin antibiotic has now gone and so now it’s look forward just have to get a bit fitter as the worst thing was not being able to go for walk.

[MJSlide1958 in reply to medway-lady]

Ah so glad, have a fantastic time, you defo earned it! Take care and thanks

[KittyJ in reply to MJSlide1958]

There you go then 🤞🏻 I’m glad she got a quick reply.

[MJSlide1958 in reply to KittyJ]

😊👍

[MJSlide1958 in reply to KittyJ]

Sorry, 1gm paracetamol every 4-6 hours no more than 8 per day.

[Rusticgarden]

Best to ask her Rheumatology team as we aren't medically qualified

[bpeal1]

You need to ask the surgeon (not the rheumatologist) ultimately it’s their decision whether surgery goes ahead or not. Hopefully if they are not confident about RA and associated medications they will take advice from her rheumatologist or ask her to follow their advice.

It is a delicate balancing act as uncontrolled inflammation is also a risk to healing. It really depends on how well your daughter’s disease is controlled, the risk of flaring from stopping medication and the infection risk from this particular surgery. She needs to contact the surgeons secretary asap. If she stops medication when they wanted her to continue or vice versa she risks the surgery being cancelled.

[MJSlide1958 in reply to bpeal1]

Thanks you are so right, this is what I think too. Therefore I have been in touch with Rheumy, Surgeon and Secretary. What ever happens she has had to come off of Enbrel and MTX for two weeks. She can only take paracetamol every 4-6hrs not to exceed 8 tablets a day. But the thing that is hard for her is she has a 40hr a week job and is stressful, therefore I worry very much about that. Thank you

[Seatgeorge]

Ring the reaumy nurse they usually get back within 48 hours,she will ask the consultant for you, plus ask your gp or ring 111, you need a medical opinion, I think people are very supportive and helpful on here but we're not medicaly qualified, I would have thought they would have advised you at the hospital when the appointment was made? good luck.

[MJSlide1958 in reply to Seatgeorge]

Yes, correct, thanks. We have had numerous advice and will go ahead with what the surgeon wants because he is doing the op and also the antes...... control professionals. The Op has to be done, that is the thing! Therefore we have to trust all will be ok. I do very much worry about her inflammation going up. The professionals will be away of everything. It is so good for everyone's replies on this forum, so very helpful to know others experiences too. Many thanks to all

[Cedrus]

I had to come off methotrexate ( it prevents healing) 3 weeks before a spinal fusion operation and stay off it for 3 weeks after the op too. My RA consultant wanted less time it but the surgeon wanted more. They came to a comprise!

I shall have the same arrangement soon when I have another spinal fusion op.

[MJSlide1958 in reply to Cedrus]

Thank you so much. Surgeon's responsibility at the end of it all though, which is correct! I worry about the inflammation markers at the time of Operation, will that affect the procedure is my question to pre assessment and to the Anes and Surgeon on the day of admission. Obviously the pre assessment blood result has to be ok too. Many thanks again