Another Methotrexate question!

[EeneeBee]

Hi, I’m currently taking 5&1/2mg prednisone doing a very slow taper and MTX 15mg weekly. My liver enzyme ALT is at the highest level and I would really like to stop taking it. Do you have any advice how I can do this? Maybe take the preds back up to 7 whilst I stop the MTX or reduce the MTX gradually. Your help would be much appreciated, thank you.

[PMRpro Ambassador]

If you are stopping mtx you don't need to taper it, you can stop from one week to the next.

Has your doctor said you need to stop the mtx because of the liver results? You do need to discuss it with the consultant, or at least the rheumatology nurse.

[EeneeBee in reply to PMRpro]

The last time I asked about 3 months ago they said I should carry on with it but cut down my alcohol intake which is hard tho I have reduced to about 3 units/day.

[PMRpro Ambassador in reply to EeneeBee]

To be fair - there are other reasons besides alcohol. What other medications are you on?

[MrsNails]

Hi EeneeBee

What is your ALT Level? I have had high levels & had my MTX Stopped but another Consultant had said it should have been monitored much more carefully before a decision was made.

In the Drug Information Leaflet it advises against Alcohol & l gave up as soon as l started MTX. The second time l was prescribed it, l’d just finished treatment for aggressive breast cancer so l still had the odd glass or two but since my return to MTX for a third time l do not drink alcohol at all & have also lost two stone in weight by reducing Carbs as l was threatening Type2 Diabetes......

The Liver is very forgiving until it’s not! It pretty much will always recover it’s self but it’s very much down to you.

As Pro says you can simply stop MTX no tapering required. You won’t feel any impact as it takes about 12weeks for its effects to diminish but if you want to be kind to your liver think about a few alcohol free weeks.

Kind Regards

MrsN

[piglette]

Has your doctor diagnosed why you have a high ALT level?

You probably already know but you can help to lower ALT level with diet as well.

. avoid fruits and vegetables served with high-calorie sauces or added sugar and salt

. eat fish at least twice a week, ideally those high in omega-3 fatty acids, such as salmon or trout

. opt for fat-free or low-fat milk and dairy products

. replace saturated and trans fats with monounsaturated and polyunsaturated fats

. choose fiber-rich whole grains

. opt for lean animal proteins, such as skinless chicken or fish

. swap fried foods for baked or roasted ones

Of course if you could cut out alcohol you should see a good reduction in a few weeks.

[EeneeBee]

Thanks for your help. I’ll take it all on board and do my best with drink and diet. 😊

[yorkieme]

Like you I am on MXT but probably for different reasons want to come off it. I spoke to the senior rheumy nurse who then spoke to the rheumatologist who has told me to come off of them immediately, no problems.

However they are talking about Lefuminide ? and sending me a leaflet to read up on,from what I read it could be just as bad ??? Hope not.

[PMRpro Ambassador in reply to yorkieme]

Maybe - but different bad. Or good. You have to try to find out!

[123-go in reply to yorkieme]

I'm starting Leflunomide in a couple of days (and had my last glass of wine this evening) after weeks of gearing myself up to take the drug. I know I need it as I have very active vasculitis and have to reduce the inflammation. We may be comparing notes if you go down the same road.🙂

[Jan_Noack in reply to yorkieme]

me too. I'm off what was only a small amount of methotrextae I took 4 times? I think over 2 trials!.. I definitely didn't agree with me, but it did have some good effects. It seemed to make me able to feel my muscles like they were normal again and not weak or not there? if that makes sense and now I can walk uphill? No change to PMR pain when I try to taper though, and it just made me feel dreadful..really red eyes..I looked really old and unwell and felt it,very fatigued. Could not do anything much. Couldn't think things out... My problem as always is I can't describe it I have been offered leflunomide too, but I need to get my liver checked out first as I've had elevated enzymes since at least 2011 on blood tests.. but I suspect since 1995 when I was put on all those psych drugs for about 5 years? I do recall my liver enzymes went up then but the stupid GP said not to worry, that means the liver is working well! as did the psychiatrist!! later. So how I cannot take any new drug without fear I guess one would call it (or is it PTSD?).... the first case I read is a death from liver failure after ONe dose of leflunomide, later I read of a success but most have not a lot of effect and a lot end up on tocilizumab after trialling lefluomide and a lot of those seemed helped...or that is my summary from a brief look...

we seem to be following a similar path