Methotrexate and blood tests?

[SusyTe]

Hi All. Could just do with a bit of advice about MTX and blood tests. Dr Hughes put me on MX (on top of my Pred) on the 28th March so have been on it for nearly 4 weeks now. He mentioned that because of the MTX I needed to arrange regular blood tests - FBC, kidney and liver - but I have not been able to sort that out with my doctor's surgery yet. Does anyone have any idea as to when these blood tests should start ideally and how often I will need to have them? I am seeing Dr H again on the 8th May.

[SnazzyD]

I used to do them monthly for our MX patients. Occasionally, it was six weeks by arrangement with the Rheum'y. In particular you need to know if your bone marrow is being suppressed, making you at risk of infection and clotting problems if your platelets are lowered. So you need to do it now really as you've been on them for four weeks already. Then ask what they meant by "regular" for you.

[SusyTe in reply to SnazzyD]

Thank you, Snazzy. I need to get on with it then. Unfortunately I am going away today and won't be back until next weekend then it's Bank Holiday so it will have to wait until after then. I have to say that I have not felt well since going on this extra drug - but it could be my imagination running away with me.

[Hidden]

Hi Susy

I'm on MTX and had two weekly tests for the first two months then monthly, my GP's Surgery will not issue a 'script for MTX without up to date bloods!

Do you have a Patient Monitoring Booklet? I always ring for the results and update my Booklet.

Hope that helps

Mrs N

[SusyTe in reply to Hidden]

Thanks, Mrs N. I don't have a Booklet - I will ask about that as well as the blood test.

[1602 in reply to SusyTe]

my nurse updates my booklet

[PMRpro Ambassador]

This may be a helpful article:

nras.org.uk/methotrexate-in...

and they say every 2 weeks while the dose is being titrated (adjusted upwards to the maximum) and for another 6 weeks and then monthly.

[SusyTe in reply to PMRpro]

Thanks, PMRpro - much appreciated and very interesting. I think I should have got a handle on the blood test issue earlier - just been megabusy at work and also had a close friend's funeral this week so not on top of things. And now I am going to stay with my Father this week to look after him while he has his bathroom refitted so will have to wait another week. At least if I call the surgery tomorrow morning and get a doctor's call back hopefully I can get the blood forms in place and then get an appointment the following week.

[PMRpro Ambassador in reply to SusyTe]

It should really have been set up BEFORE you even started taking it - I am assuming you had all the clearance tests done first?

[SusyTe in reply to PMRpro]

I did wonder about that, to be honest - but Dr H said to start taking it the next day after he saw me so I did. What clearance tests should I have had?

[PMRpro Ambassador in reply to SusyTe]

Liver function amongst others - doesn't it say in the article? It is to have a baseline, they may not be normal anyway.

I'll have a look later, lunchtime just now

[SusyTe in reply to PMRpro]

Sorry - yes it says FBC, kidney and liver - which is what Dr H said I needed to arrange - but he didn't say before I started taking it. I thought you meant there were other tests too. I have obviously missed something and should have already had the tests - will call my doctor tomorrow from my Father's and get it done as soon as I get back. Thank you. Have a super lunch! I need to get cracking with packing now so will be offline.

[PMRpro Ambassador in reply to PMRpro]

medscape.com/viewarticle/80...

lists:

"Initial laboratory testing should include a CBC with differential, renal function tests (BUN, creatinine), unrinalysis, liver function tests (LFT) (e.g., AST, ALT, alkaline phosphatase, bilirubin, and albumin), hepatitis serology (HBV and HCV), and HIV, TB, and pregnancy tests in at risk individuals.[2,4] The patient's blood counts and liver and renal function tests should be monitored throughout treatment. Initially done weekly and then with dose changes, the interval between blood tests can increase once the therapy has stabilized."

If you google "monitoring methotrexate" you will get a link to the NICE recommendations - I can't see what they are as it is only available in the UK.

[SusyTe in reply to PMRpro]

Gosh! None of this was mentioned to me. Thanks for that - will get the tests done as soon as I get back.

[SnazzyD in reply to SusyTe]

Sorry to say, this is one thing you can't put off because other things come up. It can be life threatening.

Feeling rubbish can be par for the course but knowing when it is time to call for help is important. Have a read of this too

patient.info/medicine/metho...

[SusyTe in reply to SnazzyD]

Thanks. I wish I had realised before. I do have to go away today and am not back until Friday evening but will call the surgery tomorrow anyway.

[SnazzyD in reply to SusyTe]

To be fair to you, it really should have been spelled out. I'd assumed you had been given the book, had baseline bloods and been read the riot act. Taught me not to assume too!

[Hidden in reply to SusyTe]

Suzy,

I also had a Chest X-ray before I started MXT then the baseline bloods, as l increased the dose the l had blood tests as l described earlier.

I had to stop my MXT while on Chemo but when l restarted it I had another Chest X-ray & BaseLine Bloods again. Are you taking Folic Acid on non Methotrexate days?

Mrs N x

[Hidden in reply to Hidden]

PS I also had to sign a Consent Form before I started MXT (similar to the one l signed for Chemo)

[SusyTe]

Thank you for all your replies. I am taking folate the day after the MTX, Mrs Nails. Snazzy, I checked with my husband who was there at my last appt to see if I was just not listening or something - but he confirmed that all that was said was that I should start the MTX the next day, the folate the day after and arrange for blood tests through my GP. But no sense of urgency or having them before starting the MTX. Maybe Dr H mentally put me in the low risk category or something. Will call the doc surgery tomorrow and arrange to have them done after Bank Holiday when am back home. Thanks very much for the advice and support.

[Sallyaches]

I took MTX by injection for about 18 months. I had a yellow card issued by the rheumatology department and blood tests were every two weeks initially, then eventually monthly. Even following this I developed bone marrow suppression and ended up in ITU with septic shock. I really don't think anyone is low risk, I felt fine most of the time, my hair did thin a lot but it did help me with reducing my Prednisilone. I would never advise anyone not to give it a try.

But please have the blood tests done as a matter of urgency before you leave home. If the G.P. has not be told how frequently the blood tests are due the surgery can ring and find out.

[SusyTe in reply to Sallyaches]

Thanks, Sally. I am a bit worried but I can't get an appt for the blood test until the 11th May! I rang this morning about it. I am seeing my rheumatologist on the 8th May anyway but have taken the 11th May appt.

[1602]

Hi there = my rheumy had my bloods done every 2 weeks for the first 3months on MTX and pred and then every month. When he upped my MTX in Feb we went back to every 2 weeks for 3 months before resuming monthly xxx

[SusyTe]

Thank you. I have been daft And have obviously dropped the ball here. I should have got these tests done much sooner after starting the MTX. I just didn't know how urgent and important it was and have had so much going on I didn't follow up on the email I sent to the surgery (the day after I went on MTX) asking about it. Just hope it hasn't done any damage.