Antibiotics and MTX

[Gilliancheche]

For the first time since starting MTX I have had to take antibiotics for a sinus infection. I know I should not use MTX while taking the antibiotics, but when can I start again? If I finish Sunday morning can I inject Monday night? I am overseas on holiday and will email my rheumatology team as not possible to call the advice line which I usually use.

Many thanks

[Runrig01]

I was told to wait at least 48hrs, to check infection doesn’t start up again

[oldtimer2]

I wouldn't worry too much either way. Methotrexate is a long acting medicine so stopping for a short time doesn't make much difference to our blood levels - the level gradually declines.

There was some research that found that, in some people, stopping methotrexate while on antibiotics helped them to recover more quickly. But it also showed that, for some people who flared easily when methotrexate was paused, this was counter-productive. They became more ill with the Rheumatoid Arthritis.

Like most things, it's a balance, a trade-off. If you might flare because of stopping the methotrexate, then start it as soon as you can. If you don't flare quickly if you stop, then you can leave it until when it's next due. I hope that makes sense and you feel better soon. Not good being unwell while you're away!

[Cat-E in reply to oldtimer2]

I thought we had to pause the MTX while on antibiotics to reduce the toxic load to the liver? I've only been on them once while on mtx and it was a 5 day course so it slotted in between my mtx routine 😀

[oldtimer2 in reply to Cat-E]

Had another thought - some antibiotics raise the levels of methotrexate as they are excreted through the kidneys. If you were advised to stop the methotrexate because you were on one of those then you can restart once you have completed the antibitoic course. Amoxicillin seems to be the common one. It's probably only a problem anyway if you were on the much larger doses of methotrexate that are used in cancer treatment.

[oldtimer2]

Methotrexate is long acting. Have you got problems with your liver function? I've not heard of that reason for stopping Methotrexate shortterm but you should be advised by your medical team if you have liver function problems.