Potential Potency of Methotrexate taken by Metoject.

[Rachmaninov2]

Firstly apologies for a convoluted question. I am taking 7.5mg of methotrexate by Metoject, the nurse who instructed me advised that this method could increase the potency significantly as it goes straight into the blood stream rather than being metabolised as tablets are. As my rheumatologist has told me that he may increase my dose but only to a maximum of 10mg (I think this is because I have decreased kidney function stable at 50 eGFR), I wonder if there is a way of knowing (ie a blood test) how efficient the dose is. As I read this back I’m not sure it makes sense, I hope I’ve managed to explain what I mean. 🥹

[MrsNails]

l know what you mean - yes the Injectable Form of MTX can be more efficient.

I am on 25mg MTX- that is the same dose as l was on in tablet form. My Nurse explained that by moving to Metoject the dose would actually be better as they believe when on higher doses of the tablets the body doesn’t always absorb it all. (I think it’s around 10% more but can’t honestly remember)

Your Nurse will be happy to explain it to you more fully - l’m not sure if there’s a specific test to check but again drinking the extra water will help with the Kidneys. How often do you have your Bloods taken?

My Kidney function has been up n down but it’s my Liver (ALT) we keep a close check on, l have a higher limit that’s acceptable but it’s well below that these days.

Are you a Member of PMRGCAuk? - there was an interesting article on MTX written by Dr Sarah Mackie in the latest addition. There was also an article l wrote on My PMR Story……

There are a lot of articles in Google (l can’t share the BMJ one) and most of the comparisons are for great efficacy in RA but the principal is still the same.

[Rachmaninov2 in reply to MrsNails]

Thank you so much for this info. Mrs Nails.

I have my Methotrexate blood tests every 3 months, last one in November next one in February. I’m waiting to hear from the hospital what date in February as they organise the tests. I’m also having a blood test for Full Blood Count (FBC) TQH and Liver Profile, Renal Profile (UE incl eGFR) in the next few days initiated by my GP.

I know next to nothing about the kidneys and liver as it was just mentioned in passing at my last rheumatologist appointment. No advice or real information, I’m trying to research and really value your help. I also dip into the Renal forum from time to time. So has your liver function has improved? I understand this can happen, unlike the kidneys.

No I’m not a member, I joined when I was first diagnosed with PMR but didn’t renew my subscription when my diagnosis was changed to inflammatory arthritis. Since the diagnosis has changed back to PMR I have decided to rejoin and will email Fran Benson.

[MrsNails in reply to Rachmaninov2]

There’s a fair bit to learn, yes my renal function & my liver function have improved; DrD will allow my ALT Levels to go higher than normal but as l said before they are much better.

Take it easy on the Carbs & drink alcohol in moderation (l had a very fatty liver but it’s much improved now). I never drank at all the first time l was on MTX but the 2nd time l did have a glass of wine following what l’d been through with my Cancer Diagnosis; My Blood Results remained very similar until the fatty liver showed it’s hand!

MrsN

[Rachmaninov2 in reply to MrsNails]

I hope you are in less pain and have a better day today MrsNails.

Glad to know that both your renal and liver function have improved! I was under the impression that once you have under functioning kidneys this can’t be changed.

Yes, carbs are my weakness, but I don’t have any alcohol. I bet the wine tasted wonderful after having that awful diagnosis. I used to like the occasional glass of white wine. 🥂

[MrsNails in reply to Rachmaninov2]

I’ll message you later as MasterT has just arrived 👦🏻

[PMRpro Ambassador in reply to Rachmaninov2]

"I was under the impression that once you have under functioning kidneys this can’t be changed."

Depends what is causing it.

[Rachmaninov2 in reply to PMRpro]

Oh, not cut and dried.

[PMRpro Ambassador in reply to Rachmaninov2]

Any actual damage can't be reversed but function can be maintained and improved by various lifestyle, diet and medication adjustments,

health.harvard.edu/diseases...

[Rachmaninov2 in reply to PMRpro]

That’s very interesting and gives hope. Thank you for the link. I have asked my GP to refer me to a dietician in order to come up with a diet to cater for my (increasing) conditions.

[PMRpro Ambassador]

pubmed.ncbi.nlm.nih.gov/389....

"The absolute systemic bioavailability of the oral tablets was 36% (+/- 10%). After im administration, the systemic bioavailability was 93% (+/- 14%). Dose-dependent gastrointestinal absorption is suggested as the mechanism for the low availability of the oral tablets."

Bioavailability:

"The ability of a drug or other substance to be absorbed and used by the body. Orally bioavailable means that a drug or other substance that is taken by mouth can be absorbed and used by the body."

"Bioavailability is the extent to which absorption occurs. In other words, bioavailability is the fraction of the administered drug that reaches the systemic circulation in the unchanged form."

So injections get more than double the amount into the body to be used than tablets do,

[Rachmaninov2 in reply to PMRpro]

I’m grateful for this information PMRpro. Having had my second injection on Tuesday I felt awful yesterday. So I’m thinking that if ‘injections get more than double the amount into the body to be used than tablets do’, then side effects might increase too. Hopefully temporarily. 🤞

[PMRpro Ambassador in reply to Rachmaninov2]

Most adverse reactions are dose-related

[Rachmaninov2 in reply to PMRpro]

Must admit I felt a bit down yesterday as the pain came back too. So a double whammy.

[PMRpro Ambassador in reply to Rachmaninov2]

MTX is supposed to potentiate the anti-inflammatory effect of pred. I found it potentiated other effects of pred more! I had effects that are attributed to pred but I had never experienced before MTX such as joint and muscle pain and hunger!

I think it is a like the little girl with the curl on her forehead! When it works it can be very very good - but when it is bad, it's horrid ...

[Rachmaninov2 in reply to PMRpro]

Ah, I know some of my joint pain has increased after both injections.

I remember that rhyme from way back! I can imagine the little girl stamping her feet and empathise.