Got a heavy cold - in a muddle about it all/MTX

Hi - I'm stuffed with cold and feel lousy tonight and know I can't take over the over the counter decongestants etc because of MTX - nor a hot whisky toddy as we got first footed today and I've already had a dram. Should I take my full quota of pain meds including ibuprofen and also my 15mgs of MTX tomorrow as planned? I know that if it goes to my chest later in the week or tomorrow there might be an issue with antibiotics and MTX but not sure if its bad to take it when ill otherwise? I can't ask GPs as they are closed until Weds and didn't want to bother NHS 24 unless it gets significantly worse and leads to infection - but it feels more flu-like now I admit and everything hurts. Advice re tomorrow's MTX dose would be much appreciated if anyone knows?

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Hi there, I've found that colds hit me worse than they used to, but so far (fingers crossed) have stayed as colds & not developed into anything worse so if you look after yourself it may just stay as a cold. I asked my doc about things like night nurse and she was v relaxed about it - she said as long as I watch the paracetamol intake so don't double up on that then not to fret too much if it's not a regular thing. She reckoned getting a good night's sleep was more important.... Of course that's just one opinion, and others may not agree. However I'd try to deal with cold and carry on with MTX tomorrow and not worry about anything worse as it may not happen.


Thanks Polly that makes sense and I feel a bit foolish for even asking really. I did have a text chat with my GP friend earlier and she suggested alcohol instead of decongestants as better mix. Now I don't know about others here but alcohol sends me to sleep and then acts as a stimulant in the middle of the night and also she didn't seem to think alcohol a prob with MTX which was interesting? I guess GPs rely on their handbooks to check out what works with what mostly and her's would be at work. So I think I'll stay off all of that and go for an extra Amitriptyline, a couple of paracetamols and the obligatory ibuprofen and hope that I manage to sleep okay. Last night it was the tickly cough that kept me and half the household up but I feel more optimistic after what you've said about colds and RA/ MTX because my son's one has gone away now and that's where I got it from. Our family tend to suffer up in our ears, noses and throats and sinusitis is the usual direction the cold leads - to not chest.


TildaT - First time on here and I'm amazed that so many people are on the same stuff as I am. Can I ask why you take Amytriptyline? I also have the added complication that 4 years of MTX has given me diabetes (the consultant says It has possibly been brought on early as I may have got diabetes in due course anyway). This REALLY complicates things for cold remedies. You cannot take decongestants with amytriptyline. A definite NO from the pharmacy and the internet contra-indications list. There is only one type of cold/cough remedy available to diabetics, Robutussin, but even they now have a not inside that says they cannot be taken by dibetics even though they are sugar-free! As far as the MTX is concerned, i ask every time, without fail, if it is compatible with any other drug. I used to think Robutussin was safe, but now it isnt...


I think it's just a case of hot honey and lemon and some olbas oil Gilly for all of us on these meds. That's all I did and it seems to have seen me through and out the other side now.

I hadn't heard of a link with MTX and Diabetes? - that worries me as I have no family history of RA but a very long one of diabetes and I'm very like the side of the family who have it physically too. I try to keep the weight off and hope that I don't get it but if MTX brings it on then I'm stuffed probably and they are both autoimmune diseases of course. TTx


Ps I take Amitriptyline like a lot of people here - because i was getting severe neuralgia in my hands, like toothache, about 6 months ago and when I described this to my GP he went all thoughtful and said "try this - it used to be used as an anti-depressent back in the 70s but it had too many side effects at a high dose - now gets used for relief from chronic pain and other things sometimes". I only take 10 to 20mgs depending on how early in the night it is that I remember or how bad the pain is. My friend take a much higher dose for her back and she finds it helps a bit. It has a sedative element that is good for people with insomnia too - and that includes me!


I take zapping 3x a day and amitriptyline on a night to help me sleep. It doesn't take the pain away.


Hi Tilda,

No Mtx this week in case it turns into infection. Make apt with GP to check you out. Don't worry, I have had less colds etc in 3 years I have been on mtx, my doc usually gives me an anti biot to be on safe side. I did'nt know about over the counter decongestants & mtz being a no no.

Hope you have had your flu vaccine this year?

I usually mix up manuka honey, paracetamol, and fresh lemons and that helps. Soluble vitamin c also for colds..

Hope you feel better soon, Gina.


I had flu just before and over xmas my consultant cancelled my first rituximab infusion gave me penicillin and paraceatamol and it has cleared about 3days ago i also continued methotrexate injections and now hopfully i will have first in fusion on thursday in the hopes that it will help ease the pain but if any one can tell me kow i might feel for the following days i would be most gratfull xxx


Hello Tilda! I'm just gate-crashing you as per usual with little advice and just to blether...:)

Yes, Gina's mix of manuka honey is one I swear by, I also add ginger with helps with inflammation and tastes good to..

Poor you :( hope it passes without too much trouble. I'm up for the night and about to start my endless pile of ironing. My cystitis has decided to come back with pain and blood tonight, no way I'm going to sleep as I'm back and forth to loo constantly, must be an infection after all :( first I missed out on family get together on new years day and tomorrow/today I was going out for lunch with friends, arghhhh no chance now, could be worse..... the funny strange thing is that I feel amazing as far as the RA is concerned, little evidence of it the last couple of days, my theory is that my anti-bodies are too bust fighting of infection elsewhere then maybe it's leaving the whatdoyoucallits alone.....

and, I haven't even had a drink and I'm waffling like I've had a few :)

hope your okay and in the land of nod right now xx


I've been on antibiotics for the last two weeks tilda and mtx is a definyely a no no for and that came from the hospital. I'm not sure about tomorrows mtx yet will ring when they are in work. Havenyou spoke to the chemist that does your drugs for you on a regular basis, they are quite good if you ask them about over the counter meds they should be able to tell you what you van and can't have.

Wiliby, i was told that the anibodies in your body is attacking itself and i wouldn't get any colds/flu and until this dose that i've had over xmas i found that to be true. I have had been as fit as a fiddle until this winter. Quite why i've been attacked this time is beyond me,but when you are ill, boy does it hit you hard.

Hope you all get better soon.

Sylvi. xx


Hi All - thanks for your advice (and blether..Williby). Now I'm more concerned about you Williby than I am about my cold by far. My cold is just that - a real runny eyed, red nosed downpour. Haven't had anything like this since the flu last year but this isn't flu it's just a typical head cold so far. Am staying in bed - mainly because I can't see anything as eyes are so runny. I think I will take the MTX this evening with my tea because to date I've had no side effects apart from tiredness and my hands and wrists, though still sore, are definitely much better this week than they were last week.

I asked the pharmacist about over the counter meds and she said no decongestants just the usual ibuprofen and paracetamol and hot hone(I've run out of manuka;-() and lemon same as you say Gina so am about to go and do that for my tickly tickly cough. As I say they rarely go down the way on me so I think the MTX should be safe enough but if it does turn into infection I guess it'll be later in the week and then i can always miss next week's dose. I so want to continue it to be in less pain in my fingers, hands and wrists it's worth it. Wondered if the reason I've been pretty well re virus's until this one is because my immune system has been so busy nibbling away and bullying my joints that it has protected me from germs more efficiently also and on that logic maybe the MTX is supressing the immune system now more effectively so I'm undefended and therefore more at risk of germs? If so maybe the same goes for all of us who have been resisting the bugs about us but our meds are doing their jobs and lowering our defences to plague us with Cystitis (W), Bronchitis (S) and other rotten bugs such as the common cold?

And yes I did have my first ever flu jab just before starting the MTX - they had run out but found a single dose at the very back of the fridge and gave it to little 'ol me! TTx


hello again, glad your not having any side effects, it's a relief isn't it!

Rotten you have to stay in bed, then again I'm counting the hours until I can get to bed! I got some antibiotics this morning for infection.

I'm so thankful to Summer/Alison, she told me the antibiotic NOT to take and thats exactly what the nurse tried to give me, gosh the befefits of this site is never ending :)

Hope your better soon x


Tilda ,and all - No MTX during any infection of any kind, or source. MTX suppresses the immune system, one result is the decrease in White Blood Cells, the functiion of WBCs is to fight infection, actually by "eating up" the bacteria. The reason to not take MTX with an antibiotic is to allow your bonemarrow to increase the WBC, thus fighting the infection.

You do not need to be taking an antibiotic to warrent eliminating MTX. Better to stop the MTX immediately and give your body a better chance and time to fight an infection of any kind, no matter whether you take an antibiotic or not. MTX is contra indicated in infection. Not just with antibiotics.

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Thanks Loret. Panicked when I finally spotted your post and phone out of hours NHS24 service then my hubby told them I can't cope with light or noise have a dreadful headache despite full quota pain meds and lots water plus swollen face (it's called being full of snot!).She asked me to come into hospital health centre see an out of hours GP straight away but it's a 30 min drive each way and horrible wind and sleet and I only wanted to know about the MTX so i declined. A dr will phone to advise soon. Hands are brilliant today I can wipe, squeeze toothpaste etc unload and load dishwasher without hurting and am squinty but looking at this screen now so not meningitis as they fear - just a really lousy fluey cold?!

Hope he says I can take MTX but prob not you are right:-( - oh well at least I've taken advice not just ploughed ahead with the MTX regardless. Thanks for making me be responsible! Ttx


How bizarre that nurse tried to give u the drug not meant?

Am nursing such a roaring head I can't lie down but if I stand up I feel sick can't bear light and SO cold despite hot water bot. My family make a virtue of ignoring illness so are all ignoring me - fair do's really as I'm no Florence N when hubby is ill - but all so grumpy that I'm just going down for top up water as when they speak it hurts and then they get even grumpier if I don't stand listening. What a moan I feel but guess ive been moaning about pain all year so they can't take me seriously now I've got a common cold - but wow what a cold?!

Middle son has borrowed my laptop to write a discursive essay on Death Penalty for Higher English but he's watching tv and listening to music at same time on it so I'm forced to use my iPhone to write this! have no stamina for teen parenting these days.

So glad you saw a nurse at least although it doesn't sound too good that she tried to medicate you with the wrong drug Williby?! . Got to stop and try to warm up again. Take care. Tx


Hi T

You've been given good advice, so I am gonna say ditto.

Wrap up warm, take care and I hope you recover soon

Sci x


Hope you feel better ..I take the honey and fresh lemon remedy too when required.. my powerful immune system which gives me my RA!, So far hasnt weakend to give me a cold yet! xx


Isn't it crazy the different advice that doc's give about MTX and infections.The only time i was told to miss a dose was when i had a very itchy rash.Even when i was in hospital with pnuemonia on an antibiotic drip i was told i could take that week's MTX injection.Who is right? because if consultants disgree what chance have we got

Hope you feel better soon

Julie x


Well the doc did phone and say compromise and take it tomorrow but I felt well enough to go down and have my dinner with the family, face the lights and the music later - so decided to take it and risk the consequences. The thing is that it's just so wonderful to have my hands moving and being almost pain and stiffness free again. I don't know if this is because of the MTX or because I've been taking all the ibuprofen and paracetamol (although I did take those last week and still had really bad hands mid week) or whether it's just because of all the physio and stress ball exercising I've been doing?

But whatever it is I like it too much to jeopardise it just for a cold. Everyone else has a much worse time with RA than I do it seems plus many of you have additional complications such as fibro to bear. For me the RA's gone away everywhere except hands and wrists and I feel that maybe if I keep up with MTX my hands will go into full remission sometime soon and I will be able to come off it - and maybe - just maybe I'll be one of those incredibly lucky people for whom it just goes away?

So here's hoping that if I take all the honey and lemon as you lovely people prescribe I won't have to confess to taking the MTX dose despite GPs compromise request. Sorry Loret and Gina - I might possibly regret this but I just don't think I'm sick enough to warrant not taking it. My immune system must be reasonably strong prior to MTX because the whole family were laid low by similar cold about 4 weeks ago and I managed to nurse them and breathe in their germs and never got so much as a sniffle. Which makes me think that this cold and the improvement in my hands and wrists must be down to the MTX lowering my immune system successfully.TTx


It is interesting the different advice all doctors give! I have always been told to have a blood test immediately if I have even a sore throat on MTX or other meds, and turned out to be a good thing a year ago! A week before Christmas 2010 after being on MTX for about 7 weeks I had a cold that wasn't even the worst I have ever had, and only went to the doc as it was the first one I had had on MTX, and had been told to see them if I got any kind of illness. They did a blood test which showed severely low white cells which they said wouldn't have been able to fight infection, so had to be taken off MTX permanently and almost ended up spending Christmas in hospital! (I have only now convinced them to let me give MTX another go - a year on - on a very low dose, with prednisolone as that seems to boost my white cell count!)...

so without wanting to worry you, do be careful and don't be afraid to bother the doc if you aren't feeling great...xx


Hey Heatherherp - that is a startling story indeed! No one ever said anything to me about what to do re colds etc so i never thought about it until now. They just give you the MTX and thats it. Pharmacist said nothing either?

I get my bloods taken on Thursday - everything fine to date and hands still so flexible - wrists only a little sore now so no regrets about taking the dose yet. This cold is all in my head (as opposed chest) really but we will see what the bloods say day after tomorrow.

I'm awake in mid of night because my son phoned asking for a lift 30 mins ago in middle of high winds and hail. Lucky for me another parent collecting spotted him and drove him home but I'm all woken now and head really stuffed full of stuff physically and mentally. Take care all x


Hi Wildi, Just occured to me, do you have an appt to see a doc this week? I've lost track of who is doing what. Might have to consider, with as much congestion as you seem to have (sounds really nasty) that it could be a sinus infection, besides a simple cold. Colds are viruses, infections are bacteria, and bacteria can take over a site when a virus has weakened it. Be sure to ask.

I believe the best, final answer re:MTX/infections is to come from the Rheumatologist. GPs don't usually have much, if any, education about Methotrexate use.

I can't blame you for not wanting to interrupt your MTX dose, considering your hands are better! Guess I would take that chance too.

Really sounds like you need a decongestant, not sure what that conflict is about. Well, hell, take the MTX and a decongestant and get better!! :) In the meantime, put a warm,damp towel on youir forehead and sinuses and hold it there, most of the time, rewarm it as it cools. That will open the sinus cavities and get it to drain, lay down, it will drain down the back of your throat. Best thing to do, even if you do get a decongestant. One most popular is Anti-histamines, found alone or in combination with Tylenol, acetominophin. If you can take Prednisone, no reason not to take an anti-histamine. Gotta get to bed. Sure hope I get up in the morning to all good news from you , Sylvia and Williby!


Thanks Loret. I have been trying your hot towel compress suggestion out and it feels nice - everything going click in my head which sounds promising! Greenish gunk starting to cough up - sorry to be so disgusting! Our family have a tendency to get sinus things as we all have narrow tubes so everything gets stuck up top. I'm not going for decongestants because frankly between my thyroxine and all the pain meds etc I'm on enough pills. I've lost a pound though (hoorah!) and am still improved today although headache is lurking and wrists are pretty sore again.

My GP is my point of contact with rheumy - I have no rheumy nurse or number of his secretary etc. If he has any concerns about me then he phones rheumy himself.

I'm trying to just rest up today at hubby's suggestion. I really do want to go to the studio and get some work done when I feel a bit stronger/ more energised later. Suspect he likes having the studio to himself as I'm so critical! Not going to try and go to the GP today as they have only opened again today and I know they will be fully booked and I'll get fobbed off by a grumpy receptionist with the very young probationer again. I see the practice nurse tomorrow for my mtx blood test anyway so will tell her about the cold and see what she says..and see what blood tests reveal re wbcs. Thanks for all your advice, as Williby says I don't know what I'd do without you lot!


LOL! I love your description of the grumpy, over-workedf and probably underpaid receptionist! Very familiar with a clinic or dr's office on the first morning open after 3 days off. It really is bad.

Yay, for the green stuff, that's progress. Be sure to report that to the nurse tomorrow. The color is significant. Gross, huh? Now, my job, a small portion of it, in Microbiology, was to stick a swab in it and transfer it to a series of culture plates containing different nutrients, streak with a hot wire to dilute out the organisms and incubate the whole stack of plates. The next day, we observe (read them) Have to identify each different type colony, there are many that are normal, so OK to be there. We have to recognize and identify and test for antibiotic sensitivity any others that do not belong there. These are the culprits, the cause of infection. After inoculating a series of chemicals with the suspicious colonies we put them back in the incubator.. Next day we can identify the organism by genetic make-up and see the drugs that can best be used to kill it.

That is why it takes so long to get the final report. How's that? I just surprised myself, by actually remembering how to do all that. Like riding a bike!

Keep on keeping on girl, keep up the hot towel, it's working. The crakling is the sinus cavities loosening up. :) Cheers, Love, Loret


Thanks for all that Loret - read it to my youngest who didn't squirm in disgust but looked quite interested. I don't think he could do a job like that though - too much of a people person and would get fed up with all the mere mortals dressed in lab coats with lab decor to match. Yes he's got the artistic gene in him too but not like us, who are more like you in our approach to making art. No his is the sensibility of a designer for certain! A very different creature to research led visual artists such as me and my partner. We approach our art very much in the way that you would approach snot - in fact I think we've depicted snot and blood several times in our embroidery and paintings so you won't catch me squirming too much - a little perhaps but not too much. Fascinating is what it is!

Yes I did the compressing for most of the moring and then got bored, tried to do my daily work out and nearly passed out and my OH came in to find me white as anything and breathless and generally not well. I got a helluva lecture from him about white blood cells (he works in a care home and they have to do some nursing and first aid training etc) and now I've been reclined for most of the day going off my head with boredom. Can't concentrate long enough to read and can't find anything remotely captivating on tv so I keep wittering away on here instead - it's more fun! Take care TTx


Hi Tilda - hope you're starting to feel better! What Nicky-NRAS says below is very true re the white blood count and comparing it to what is normal for each of us - I do have a tendency under normal circumstances to be just on the lower border of normal, so doesn't take much to drop them to silly levels! It's weird as prednisolone has really bumped them up, which is why I seem to be fine on MTX at the moment! We are all different and hopefully all goes well with your appointment tomorrow!


i was given antibiotics just before christmas and i asked about taking my MTX and my doc said because its only a low dose you can still take antibiotics .... wen my doc prescribes medication it flags up on the system to say wether its compatible with the MTX .... i took antibiotics and it was fine ... had a good pain free christmas ,,, but its true you just dont know wat to believe

debs x


Hopefully I'm more in your situ Debs. If the med profession don't warn you then how are you supposed to know? If it wasn't for HU I'd be completely unaware that MTX had half these problems associated with it! I wasn't even given contraindications with it - just and Arthritis Research leaflet that the rheumy gave me and that says nothing about viral infections or antibiotics? My GP did go pale though when he thought for a second I said I'd taken 6 tablets a day - rather than a week! I pointed out that even if I'd lived to tell the tale I'd have runout on day 3 if that had been the case! TTx


To stop taking methotrexate or to continue to take a dose when you have a viral infection is always a difficult decision and the outcome will vary between individuals. It is likely that health professionals have differing views and these are shaped by their experiences because there is no hard and fast rule on this question. It is advisable to be aware of the 'normal for you' level of the white cell count (WBC) from regular blood tests. If the level is on the low side of normal a drop might mean that the level is becoming too low to safely cope with the viral infection. If the WBC is in the mid-range or higher then the body is less at risk. Remember, however, that methotrexate takes many weeks to be entirely eliminated from the body even when it is stopped completely. This means that there is a level of the drug in the system even when 1 dose is missed. If antibiotics are needed then the recommendation is to temporarily stop methotrexate. If the viral infection causes fever or there is any doubt about continuing methotrexate then NRAS will always recommend to everyone calling the Helpline that advice should be sought from a medical professional who knows them well and is involved in their direct care. Nicky NRAS


Thanks Nicky. I have already taken the MTX last night because I did, as you say, get conflicting advice and decided to use my instincts. I'm now feeling pretty useless - but more washed out and tired, low appetite no energy than ill or feverish as I felt yesterday. This could be because I'm anemic and unable to fight this virus properly but it could equally be that I'm just in a post fluey cold state and eating and drinking as healthily as I can (i.e iron rich foods and vit C) should get me through it - well that's what I'm hoping anyway.

Sometimes we just have to read all the advice with gratitude and then follow our own instincts and hope they are good ones! Tilda.


PS My favourite GP just phoned and she said she would have advised me to go ahead and take it anyway - but says all will be clearer when I've had my blood test tomorrow - but she thinks I'm probably just post cold and having a day at home avoiding lurgies should have helped a bit. She said the nurse will say if she thinks I'm sounding chesty or need checking by a doctor anyway. Thanks all TTx


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