Methexotrate withdrawal

[Magster54]

Hi all, my rheumy put me on 15mg Methotrexate on 1 st March to help me gradually reduce Prednisolone. I had tapered down to 5.5mg, using Dead Slow Nearly Stop method. I'm currently on 5mg.

I'm finding MTX side effects impossible to bare and don't feel any benefit from taking it and have decided to stop taking it. I've emailed my Rheumy team to advise them and will have weekly blood tests, which the Rheumy Team monitor closely. I've got a follow up appointment with my rheumy early October.

My question is, is it safe to stop taking MTX or do I need to taper?

[GOOD_GRIEF]

There's no need to taper MTX. It works differently from Pred. You can just stop.

[MrsNails]

As GOOD_GRIEF says you can just stop it as if you have an infection you can stop for a week or two & recommence.If, however you’ve been on MTX for some time ie well over 12weeks you will gradually notice the benefits (if you have any) reducing & similarly it’ll take a while up to a month or so for any effects (good or bad) to subside.

Regards

MrsN

[Magster54 in reply to MrsNails]

Thank you. TBH, it stopped me functioning for 2 or 3 days after I took it every week. Its been 4 months and I don't feel any benefit.

[PMRpro Ambassador]

You can just stop - I did. What on earth did he want to put you on MTX when you'd got to 5mg on your own?

[Magster54 in reply to PMRpro]

Because my ESR and CRP levels were creeping up. TBH I didn't really research it that much, just put my faith in him. So relieved at the thought of not taking it again. Thank you for your reply

[PMRpro Ambassador in reply to Magster54]

That was a sign you were now at marginally too low a dose - but 1mg of pred, maybe even 1/2mg of pred more would probably have done the job - instead of adding another powerful drug with its own layer of adverse effects which you are now experiencing.

They seem to believe that MTX is pretty innocuous but a study found that about a third of RA patients couldn't tolerate it, for another third it didn't work so they stopped it. In PMR there is no guarantee it will work even to reduce the dose of pred - it might but it might not. So when the patient has managed to get to a physiological dose on their own - there isn't much justification for trying it. Another matter when you are stuck at 10mg or above. But you weren't.

[Magster54 in reply to PMRpro]

I'm having ongoing shoulder and neck pain, bad enough to keep me awake . It's not bilateral , so could be osteoarthritis, as i have it in my hands and I'm 68. I think I will increase pred by 1mg and see if that eases the pain.

[PMRpro Ambassador in reply to Magster54]

Or myofascial pain syndrome affecting the shoulder and neck muscles, especially the sternocleidomastoid muscle.

[Blackcat1M]

Hello Magster, I am on 20mg of mtx, a few weeks ago I had to take antibiotics for three weeks,so could not take mtx and I was fine.In the past I have had to miss mtx because of taking antibiotics ,and I have always been fine.

I hope this helps

[Magster54 in reply to Blackcat1M]

Thanks. Pleased MTX is working for you

[Coffeebeans]

Nope, I just stopped it straight away for similar reasons.

I started feeling much better after 3 weeks off the injections. I've felt the PMR has niggled a bit but then the additional aches and pains I got from MTX have gone (like we need more 😂)

Good luck.

[PMRpro Ambassador in reply to Coffeebeans]

Well quite!!!!!! What got me even more was having pred side effects I'd never had before!

[Coffeebeans in reply to PMRpro]

Very true!