Methotrexate and omeprazole

[Dexter1414]

doctor told me that these are not good together anyone else been told this

[Runrig01]

I was taking both for years. It’s due to Omeprazole reducing clearance of the MTX. It usually is only a concern when on high doses, when it’s used as a chemotherapy drug, rather than the low doses rheumatology patients take.

[Dexter1414 in reply to Runrig01]

Are you still taking methotrexate and omeprazole

[Runrig01 in reply to Dexter1414]

I now take 25mg mtx and pantoprazole, which has an identical warning. My rheumatologist isn’t concerned, as we’re on low doses. Here’s what the BNF states

BNF - MTX

[Dexter1414 in reply to Runrig01]

How many tablets you take a week

[Runrig01 in reply to Dexter1414]

I’m confused, as I said 25mg which is 10 mtx tablets. Over the week to many yo add up, as I’m on 26 different meds

[Dexter1414 in reply to Runrig01]

I take 5 tablets a week

[MJSlide1958 in reply to Runrig01]

Hi, Is it always necessary to take omeprazole? Can MTX be taken with a full meal eg. after a full lunch or dinner. I think I remember my daughter's Rheumy advising her to take MTX after her evening meal before bed. No mention of prescribing omeprazole for her.

[helixhelix in reply to MJSlide1958]

Some people don’t need it. We are each different

[JenniferW]

Yeah, I get this every time I ask for a prescription of naproxen and omeprazole, it's tedious, they have to warn you there's a 3 star interaction between the omeprazole and the methotrexate, but as Runrig says, it's actually only a problem when the methotrexate is the much higher dose for cancer treatment.

[hazelcats]

My GP took me off omeprazole and prescribed lansoprazole instead. I have an existing hiatus hernia and am on mtx and naproxen amongst other meds

[welsh12]

That's why you need a gap of a few hours between taking it and methotrexate if you need the Ppi then the rheumatology GP pharmacy will advise using Dr Google just raises anxiety. I have been on ppis on and off I they tend to advise short doses now unless there is a long term condition you need them for.

[helixhelix]

over 14 years now! There is the ideal world and then there is the RA world where we have to make some compromises.

[wilbertjellyfish]

No. I've taken both for 7 years now

[Womble57]

HelloI was told the opposite... that I needed the omeprazole with the methotrexate and folic acid. Best just to keep asking rheumatology for advice .

[J1707-]

I take both PPIs and mtx from day 1 . I have no choice I need both meds

[Zahmu]

Hi, im taking both and never been advised that I can't take both. Now im curious 🤔

[Belle76]

leave at least a 2 hour window between ppi medication and other medication. This is what I have heard

[Spin1959]

I take both but not on the day of my methotrexate. I was also told not to take folic acid on the day I take my methotrexate

[Lex54]

Hi I am prescribed Lansoprazole and take it daily. I have been taking this for 4 years with no problems. Doesn't affect my Methotrexate, Sulfasalazine of Hydroxychloriquine uptake. Also take multiple other meds with no problems and no longer suffering from heartburn ! Rheumatologist prescribed this! I leave 30 minutes between taking and always take meds with food. Hope this helps!

[Sebastian247]

This is interesting, thanks for posting it. I was on MTX for 18 months, until I was diagnosed with neurotoxicity to it. I was also taking Naproxen and Omeprazole for much of that time, and continuously for the six months before rheumatology took me off MTX.

At no point was I told there could be an interaction between NSAIDS, PPIs and MTX. I note the research and others say it's only a problem when on high dose MTX. However I've learned through experience people react to drugs differently because we are all unique, and there are always exceptions to the norm. Had I known this at the time I would have stopped taking naproxen and omeprazole, at least for a period of time to see if it helped with the MTX side effects.

The responses to your post also once again highlight inconsistencies in information and treatment provided to RA sufferers.

[Dexter1414 in reply to Sebastian247]

How many tablets you take

[Sebastian247 in reply to Dexter1414]

I was on 20mg a week. However, I note that in the research it states 'primarily at high doses' (of MTX). I read into that problems can occur at lower doses, but presumably much less frequently. The consultant rheumatologist who identified I was suffering from neurotoxicity and stopped the MTX said it was rare. He never mentioned my taking omeprazole and naproxen, or suggested I stop taking them instead.

[Dayli]

A rheumatology guy once advised me to get off Omeprazole and Naproxen ASAP as they both eventually cause the gastric problems they are prescribed to prevent. I had only been on them a few months but I was fortunate that Methotrexate worked for me and I stopped the other meds. I had no problems while I was taking them.

[Dexter1414 in reply to Dayli]

How many tablets you on a week

[Dayli in reply to Dexter1414]

I am now on 10mg Methotrexate (4 tabs a week). 12 years now and this is as low a dose I can get. I am regarded as in medical remission.

I have been lucky, I just wish it was the same for everyone. Good luck with everything.

[AgedCrone]

You have really got to start trusting your rheumy team…..and if you don’t understand something about your treatment, ask them! We are not qualified to advise you. …we all have doubts about our drugs sometimes. ….so we ask our doctors to explain.

Your example of Omeprazole & Mtx could well refer to people taking Mtx doses ten times what we are prescribed for RA.

What you are asking is something we can’t answer. One treatment may not be good for you, but it could be very good for someone else.

We all have different needs. …..so the only people who can advise you what is best for you are the medical team who are treating you….so have a conversation with them asap.

[ruth_p]

I’ve been taking them together for years and have just had the omeprazole dose doubled due to stomach issues. I haven’t had any problems.

[Daisy70]

Golly. I take both and the Dr never mentioned this. No problems so far, 3 years in

[Briefencounter]

I take Lansoprazole along with methotrexate, sulfasalazine plus other RA medication , without any problems . Have done for many years .

[MomentoMori]

I'm on Mtx and esomeprazole for years and my Rheum, GP and Pharmacist are not concerned. They said because I'm on low dose Mtx and not the higher dose that cancer patients are prescribed. Though Mtx is considered a form of chemotherapy, when it is used for treating RA and other auto-immune conditions, our low doses usually doesn't have an effect with these other medications. This is what I have been told and it's been fine for me for years. But they have to tell you as a general warning and precaution. Everyone's body reacts differently. Hope that reassures a bit.

[trace58]

I have heard this not good to beon Omeprozolelong term also heard helps to develope dementia!