Methotrexate and Pantoprazole contra indicated

[Bramble2000]

Hi,

My first Methotrexate injections are due to arrive today.

i read the information leaflet that my Consultant gave me about Methotrexate. In it, it says you can’t take M with Pantoprazole, or any PPI. I need these having had a sleeve gastrectomy a year ago and I have Barrett’s Oesophagus so it’s really important to keep on top of stomach acid. What is the alternative, if there is one? Thanks!

[DorsetLady PMRGCAuk volunteer]

I think there are others on here who do take MTX and a PPI, sure MrsNails will advise shortly- she’s an expert on all things MTX

[SheffieldJane]

Hi Bramble2000, I don’t think this is a question that we can safely answer. It needs to be your prescribing doctor. Good luck with the Methotrexate, I hope you are one of those it really helps.

[MrsNails]

Just got in from town! Will check my MTX Info - l have a Contraindication List l can send you.

I take a a PPI & have done before & since l started MTX in 2014

I’ll check for you

MrsN

This is the List l use:-

bnf.nice.org.uk/interaction...

It’s HIGH DOSE MTX that there maybe an interaction with BUT Please Check with your Dispensing Pharmacist and/or The Rheumatology Nurses Helpline -

Methotrexate as we take it is a DMARD & is Low Dose Methotrexate, many of the side effects attributed to it are from High Dose Methotrexate as used in Chemotherapy..

[piglette in reply to MrsNails]

Bariatric surgery results in anatomical changes to the GI tract, and thus it can affect absorption and metabolism of oral medications, so it could be a problem.

[MrsNails in reply to piglette]

However, Bramble2000 is starting MTX Injections - not Oral Tablets…..

But l recommend consulting the Rheumatology Team as they are the Experts.

[piglette in reply to MrsNails]

Ah did not realise she was having injections.

[PMRpro Ambassador]

ncbi.nlm.nih.gov/pmc/articl...

says

"There is evidence to suggest that concomitant use of methotrexate (primarily at high doses) with PPIs such as omeprazole, esomeprazole, and pantoprazole may decrease methotrexate clearance, leading to elevated serum levels of methotrexate and/or its metabolite hydroxymethotrexate, possibly leading to methotrexate toxicities. In several case reports, no methotrexate toxicity was found when a histamine H2 blocker was substituted for a PPI. Based on the reviewed data, the FDA updated the methotrexate label to include the possible drug–drug interaction between high-dose methotrexate and PPIs. Physicians should be alerted to this potential drug–drug interaction in patients receiving concomitant high-dose methotrexate and PPIs."

So as already mentioned, it is HIGH DOSE MTX as used in chemotherapy. However, it seems the use of an H2 antagonist such as famotidine, cimetidine or nizatidine (famotidine is the most potent) is not associated with the problem.

[Bramble2000 in reply to PMRpro]

thanks