Ibuprofen with MTX?: As some of you know I've just... - NRAS


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Ibuprofen with MTX?


As some of you know I've just started on MTX. My GP put a repeat prescription for Ibuprofen in with the MTX and folic acid. In the pamphlet it says care should be taken with NSAIDs so I'm not sure whether to just keep on taking 3x 400mg per day with meals as directed, or whether I should just take them as an when required now?

I don't like taking 3 a day as they mess up my tummy a bit but they do at least take the edge off the pain when it's bad. Yesterday it wasn't so bad so I didn't take any and then by night my wrists and knuckles felt as if they had gone back to broken status and I could do nothing with them at all. I took the ibuprofen and other pain meds at night and another one this morning but then the pain has lessened a little over the day today so I didn't bother at lunch time. I know it's fine to just take paracetamol but the ibuprofen seems to work better if it's taken regularly but I can't always face it. Any advice?

23 Replies


I took diclac and paracetamol for over a year with no problems but I took a tummy protector losec. Paracetamol works v well for pain relief. But you hav to build it up in your system for effectiveness.

If you still have inflammation in your blood you will need to supplement the mtx with iboprufin until all is under control. That is my opinion for what its worth.

Good luck, Gina.

Hi Tilda, You should ask about other options for NSAIDS if you have a problem with Ibuprofen as there are a few available.

I tried Ibuprofen when first had symptoms before diagnosis, and my tummy just couldnt handle them, so I mentioned that to the rheummy when I first saw him and he prescribed Etodolac that has been fine....good luck!

Hi Tilda, I use Nurofen Gel Capsules which don't cause quite the irritation with the stomach that the tablets do. My Rheumy said to take 400mg of Nurofen and 1000mg Paracetemol when the pain was bad. I do find it works.

You can also ask your GP for something to protect your stomach. I take Lanzaprazole when needed which apparently coats the stomach lining and if I get acid reflux, I take a Zantac tablet to stop that.#

Hope all goes well. LavendarLady x

Hidden in reply to LavendarLady

Oops sorry LL we posted simultaneously! Thanks that is really helpful I'll get some gel capsules. My non gel ones were free on prescription (Scotland) because he really wanted me to take them regularly and I think he thought if they were free with instructions I would be more likely to do so. But I'd rather pay and have a less sore tummy! That mix does work for me too. Hope you are feeling less fed up today? Tilda x


Thanks - I did mention this to my GP when he phoned following my diagnosis but he said he thought more steroids would be a better option if I flare because he feels benefits of steroids outway the side effects of a stronger/ different NSAID. The RA really not that bad just now - or rather it is only in hands and wrists not in feet, knees or shoulders as it was before the last spell on Prednisolone -so I prefer to keep going until hopefully the MTX improves things. I just wondered if others are on this many ibuprofen taken regularly as well as MTX - just feel like I'm awash with different drugs and not convinced i need to be just now? But whenever i stop taking the ibuprofen it seems to get much worse again so I'm probably answering my own question really! TTx

Hello again, I'm glad you say you aren't too bad in general. Ive been taking + anti tnf for longer than I care to think and I don't need anything else. Sometimes I'm achy but usually rest helps. But I think that my response has stabilised a bit. Have a good day

Cathie xx

My iPad deleted mtx, I take mtx and anti tnf

I take celebrex for inflammation which doesn't upset my tummy. I am on MTX . Good luck Xxx


Morning Tilda, when I asked my consultant about the need for steriods or nsaid's he told me that it was very important to get swelling down as quickly and as much as possible so the MXT can do it's job and be more effective....

how are you feeling after you dose of MXT? xx


Thanks Williby - Im feeling fine but extremely tired now - just can't seem to get enough sleep? No nausea though which is good. Haven't yet started feeling hairless but as you know that's my biggest worry - trying not to feel cross with rheumy for starting me off on a drug that has hairloss as a possible side effect despite my telling him I've suffered complete allopecia twice in my life? I know there are other more serious hazards of MTX and many other drugs we take but that's the one that frightens me most because of my history.

Apart from that I've decided to be a good girl and take the ibuprofen as directed because I don't want my hands and wrists to continue to suffer any more than they have to. I need them too much!

Hope you're finding work more okay now you've settled into a routine - and the young ones are flourishing? TTxx


no wonder your concerned about hairloss after having had alopecia, was your alopecia connected with the birth of your sons? I as because I have seen this happen a few times but yet there doesn't seem to be a known cause.....

Work hasn't changed I'm afraid, nothing changed to make things easier but I decided to do exactly what I'm told, not make a fuss and in jan 12 when there will be a new timetable implemented and a chance for them to sorts things out for me, hopefully they will and if not I'll go down the grievance route. Thought I'd give my new boss some time to see that I'm actually a very capable helpful non trouble causing employee before I start stomping my feet! :)

anyway, when I look at the bigger picture, I realise that work isn't really that important, I sort of have my health and very glad to be feeling better.

Glad you don't have the nausea, thats what I fear more than the hairloss, so hairloss is what I've got, right at the very front, i'm preparing for a 'comb over' :)



Oh dear - you are very pragmatic about hair loss compared to how I will be if I get it Williby!

And although I wouldn't have welcomed the nausea with open arms of course I was nauseous when i took Sulphasalazine back in June and it just aided with my quest to lose a chunk more weight, having been obese back in April, now down to very overweight and hoping to get down to within my rightful BMI by this time next year.

If I do get significant hair loss I will go to my GP and ask to be taken off the MTX and put on a different DMARD because it will make me depressed for sure - and I don't want or need that! As a good feminist I do theoretically know that I'm worth more than the sum of my hair - but in reality it really does keep me going when people comment on my hair and I do absolutely nothing to it beyond dragging a brush through it most mornings. Daft to feel this way ain't it?!

I had total allopecia when I was a kid - about 9-11 years and then again when I was an art student, although not nearly as badly- and then again pretty terribly after I had given birth to my youngest pretty soon after the middle one (21 months between them) - so I'm convinced that it was hormonal in that instance - probably all three times actually. So maybe it's going to stay put with MTX but if not.. well I have warned my healthcare team how I feel..but not sure how sympathetic the rheumy will be? I've even found myself quietly hoping that I have to come off because of the blood results which is pretty extreme but that's how strongly I feel?

Re your work place - I think you're wise not to rock the boat until you've won them over with your grace, charm and great sense of humour Williby. Best to come in strong when they are all smiling and whip the rug from under their feet when they no longer expecting it I quite agree! Tilda xx

Hidden in reply to Hidden

I think it's hormone related also, so as you say, hopefully you'll be okay with this going by your picture you have a lovely thick head of hair :)

your funny ''As a good feminist I do theoretically know that I'm worth more than the sum of my hair'' I wonder if it's the artist in you that makes your reading so entertaining :) haha and I've al the grace of a cucumber, charm of phil mitchell but sense of humour is essential being married to my husband :) but t thanks for your kind words!

oops got to go xx

Hidden in reply to Hidden

Cucumber - I'm positively melon-like in grace terms?! Thanks i chose that photo, taken a few weeks ago in London on route to the funeral shortly before the tube broke down and we almost missed the service! I wanted to show off my hair a bit to you all just in case ...!

And dont be daft you don't acquire humour from someone else - perhaps your hubby gets it from you or maybe you are mutually inspired?! Whatever it will stand you in good stead throughout all adversity I'm sure - and that includes your work! TTx


Ibuprofen should always be taken with food, as people suggested if you are taking three regularly each day a stomach protectact like omeprazole or lansoprazole is recommended .

Some other anti inflammatories such as etorcoxib are less agressive on the stomach.


Thanks Alison - yes it does say that on my prescription packet so I've been sticking to it on day's where I've been remembering to take it. I find it hard to take 3 ibuprofen a day on good days but usually pay for this later on at night so am now sticking strictly to the rules from today. I've run out of Omaprazole but my GP gave me that when I was on the Prednisolone and will get some more soon - just getting myself on the right track again. TTx

hi ... im new today .. i have just started on MTX combined with salazopyrin .. im becoming obsessed with web sites on MTX im actually sending myself round the twist ... i was actually taking loads of ibuprofen everyday just to rid the pain . After a couple of flare ups my rhumatologist decided to put me on MTX but im thinking is it best to have a bit of pain or fear the side affects that MTX can bring ... ive had panic attacks thinking i have the side affects ! i have burning sensations in my body which i think is through stress ... im going to ask about the flu injection tomoroz at my docs ... i just cant believe what i have turned into as about a year ago i was a happy go lucky person now i feel depressed thinking of the outcome of my life .... Just hope it gets better


First of all hello and welcome to you Essexgirl!

Sure it will get better for both of us soon. I feel much more positive from being here and getting support from everyone on this great forum so you have definitely come to the right place.

I have taken my 3 ibuprofen today and hands are definitely a little less sore tonight although I still can't squeeze the toothpaste out had to get a son to do that for me! The toothpaste and shampoo will be my measure for when MTX works or not I think?!

Since I had a formal diagnosis from the rheumy a week ago I have been feeling a lot more cheerful even though the pain hasn't gone away and nothing has really changed - I am just relieved to know what i've got to deal with now.

Tonight I was at my choir rehearsal and the chief physio - who is also our local rheumy person/ nurse came up to me and asked me how i'd got on last week because she was away and missed my consultation. I told her it is RA and another friend/ choir member chipped in "We are all going to will Tilda's hair not to fall out on this drug!" and the physio woman said "oh no that won't happen I'm sure. Almost all of our patients on Methotrexate seem to do really well and it'll just be the minority that suffer hair loss. On the whole MTX is very well tolerated and for many patients it really does make a huge difference". I told her about the allopecia and how I'd read about hair loss and nausea on this forum and she pointed out that if people come on this site complaining of nausea and hairloss on MTX it's because they are the few people who are affected and are looking for advice and support understandably - but are not the majority for whom it works very well.

So I then asked her if she would support me coming off if I do get hair loss and she said "yes of course I'll email the consultant and you can come straight off it I promise!". It was amazing - I felt so lucky to be this well supported - and I had a few witnesses too. I may not have a rheumy team like others but I do at least have a choir and this forum!

Please don't fret because as the physio pointed out stress makes our hair fall out and us feel sick/ burning sensations etc. Think you are going to be fine and you probably will be but if you're not they monitor you closely so you can always try something else? Take care please. Tilda x

hi .. i went to my docs today and i asked about ibruprofen taken with MTX and he said only with monitoring from your doc but paracetamol is best if need or co-codamol

as it make you feel nausea .. thankyou for your welcome .. its great on here i feel i am on a site with real people and it helps with questions you may want to ask and to be able to moan to people who know what your going through xx


Yes I agree it makes you feel stronger in everyday life having people on this site to share worries, moans and stories with doesn't it? I know it works well because yesterday was third day in row where someone's offloaded on me and wept on my shoulder in my car so I must be coming over as emotionally strong I think? Wouldn't be feeling so strong if it wasn't for RA friends here on HU!

My repeat prescription for ibuprofen (x3 per day) came from the chemist's with my MTX so assume my GP knows what he is doing as we spoke on the phone about this very briefly last week. I think Williby's point from her rheumy is probably key re getting inflammation down with steroids or NSAIDs in order for the MTX to work?

I'm not bothering with regular painkillers just as and when needed - mainly last thing at night after a day using my hands and wrists. If it comes back in my shoulders, knees or ankles I will check with GP again about what's best but just really need my fingers to be less stiff and swollen for now. Take care TTx

helixhelix in reply to Hidden

Chances are that neither of you will be on that many Ibuprofen for that long - so I wouldn't worry about combining things at the moment. My doc said same as Wiliby's - take NSAIDs and MTX cos important thing is to squash the evil inflammation. Before MTX started working for me I was chewing through packets of them, and painkillers. So much so that the people on checkout at Morrison's had begun to recognise me as I was in so often buying more. And now a packet lasts for days & days. But do protect your stomach while you're taking them.

My toothpaste equivalent (brings images of Prince Charles & his equiries to mind...) is bedmaking. I found trying to push the sheets down between the mattress & bedframe absolutely excruciating - and it was one day when I noticed that I was doing it without yelping that I really realised that the drugs were working. I think it's a great idea to have a few things to measure how you're doing, so I might see if I can find some more to motivate me to do even better. I do also have collection of little stick women drawings that show good & bad days.


Hmm I also find bed making very hard but don;t have a frame that I have to squeeze sheets into on our bed - but the boys do so i know just what you mean. Thanks Polly for your words of encouragement - you make me feel it's all upwards and onwards in a good way from here on - but I won't hold you to it if it doesn't work out like that i promise! TTx

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