methotraxate and adrenal insufficiency

[bBarnabus]

Just a quick question. Does Methotrexate have any effect on the adrenals. I just saw my rheumatologist who suggested I could drop from 8 to 5 mgs pred immediately, as I was on 15mgs methotrexate the adrenals would not suffer. I feel knocked out with fatigue at the moment. Any comments

[DorsetLady PMRGCAuk volunteer]

Well dropping from 8mg to 5mg of Pred certainly isn't going to do you, or your adrenals much good..

[PMRpro Ambassador]

Someone else who slept through their pharmacy lectures - if they ever turned up!

Dropping from 8 to 5mg in one go isn't only a potential adrenal problem - it's a flare problem. I have no idea how they think MTX works but you couldn't do that even on Actemra which DOES work for PMR and MTX may or may not work for you, there is no guarantee that it will get you to a lower pred dose at any point and it can take up to a year to show a difference, 15mg MTX is also a low dose in rheumatology.

NOTHING encourages the adrenals to take up their duties and produce cortisol except being able to remain at a lower dose of pred - but you have to get there first. MTX does not have ANY adrenal-supportive features at all. Either the adrenals produce enough cortisol for you to function or you need to supplement it with corticosteroids. While youa re taking the steroids - the production of cortisol is suppressed, totally at higher doses, partially at lower doses and it can take up to a year after stopping pred entirely for normal service to be reliably resumed.

Please don't drop that much all at once - even on MTX ...

[Charlie1boy in reply to PMRpro]

Just like to confirm your final sentence. Have been off pred now for very nearly 11 months, and still getting the odd day of nausea, and fatigue. Not so often as previously, but certainly, I can’t say I’m 100% free of probable adrenal issues.

[DorsetLady PMRGCAuk volunteer in reply to Charlie1boy]

Just wish some doctors knew that… fingers crossed you’ll soon be up and running -well in moderation of course 😉

[bBarnabus in reply to DorsetLady]

Thanks I would be be lost without all of you

[DorsetLady PMRGCAuk volunteer in reply to bBarnabus]

Why we are here… 😊

[Charlie1boy in reply to DorsetLady]

Thank you. And just as well we have this Forum, as you have made me aware of the time it can take the adrenals to recover. I knew what to expect, so my expectations were realistic.

Thank you again.

Paddy

[bBarnabus in reply to PMRpro]

Thanks. you are invaluable I’ll go back up to where I was before and hope I recover soon.

[SnazzyD]

How does he work that one out? The adrenal bit isn’t helped by Methotrexate. I’m not surprised you feel whacked.

[bBarnabus]

thanks to all your replies and so quickly. So heipful

[Allotmental]

Agree with all of the above. I take both and my rheumatologist has been really clear that the MTX has no impact at all on the adrenal function when tapering off Pred.

I would also agree that that is a huge (and potentially risky) reduction at those levels.