Methotrexate and infections

[Smithie49]

Hi. I started taking methotrexate as a steroid sparer at the end of Dec 2023. I have recently picked up a throat/chest infection and am coughing madly. Should I take this week's dose of methotrexate or leave it ? If leave it, for how long?

[MrsNails]

I always used to stop my MTX if l had a cough or a cold as per Rheumatologist Instructions

Check In with your Rheumatology Nurse for confirmation.

I stayed off it until l was better or had finished my Antibiotics.

Get Well Soon 🌷

[Smithie49 in reply to MrsNails]

Thanks MrsNails. I've tried to contact the rheum advice line and asked for a call back. We'll see. Meanwhile I'll follow your advice 😀

[MrsNails in reply to Smithie49]

They are usually in Clinic a morning & pick up the calls when they return, same in an Afternoon.

[Smithie49 in reply to MrsNails]

Thanks again

[PMRpro Ambassador]

The usual introduction to MTX tells you to omit the dose if you have any infection and do so until the infection has cleared and/or you are off antibiotics.

[Smithie49 in reply to PMRpro]

Many thanks. I'll do that and presumably move the blood test back a week as well. What would we do without this forum? 😀

[SheffieldJane]

I would love it until definitely on the mend. Run your decision by your doctor.

[Sallyaches]

I developed sepsis on Methiotrexate, as it caused me to stop producing enough white blood cells. Not to scare you as this is rare but I do think in your shoes I would be in touch with the G.P. for possible antibiotics and then you are in the system if things don’t improve.

[Bella59]

I myself have chest infection and i have missed two metojet injections.I am on second round of antibiotics.

[PMRCanada]

As others have said, I was advised from the start that if I had an infection that required antibiotics, to hold my weekly injection until the ABX were completed. If you're taking methotrexate and need to receive antibiotics, it's a good idea to use caution and speak to your physician. Penicillin antibiotics, like amoxicillin (Amoxil), can prevent your kidneys from getting rid of methotrexate efficiently.

I’ve also have monthly bloodwork as well to monitor my progress. Of note you are further immunosuppressed while taking both pred and MTX. This can result in getting more infections (which happened to me last winter). I’ve since lowered my MTX and pred dose and it’s been better although there is a nasty chest cold circulating (which I suspect I’ve recently caught).

Hope you feel better soon!

[Smithie49 in reply to PMRCanada]

Very many thanks. The rheumy nurse phoned me back this morning and verified everything you've all been saying - I.e. to stop taking methotrexate until the bug clears up. I haven't been for antibiotics as the gunk I'm coughing up is not much coloured but my chest rattles before I have a go at clearing it so maybe I should have. If I'm not dead by Monday and it hasn't cleared up, then I'll try and get some. The nurse also recommended that I take 3x 5mg folic acid a week instead of the 1 x 5mg originally prescribed to combat the deathly fatigue I get for a couple of days after taking methotrexate. Time will tell if that works 😕

[PMRCanada in reply to Smithie49]

You are quite welcome.

I actually take 5mg folic acid every day except my injection day (30mg a week). I’ve been fortunate to have no side effects from MTX thus far, and started off with injections weekly rather than oral tablets as I was told there was less side effects with that route.

Of note, I was also advised to hold my MTX for two weeks after receiving vaccinations/boosters (to allow for a better immune response/overall effectiveness, I believe).

[PMRpro Ambassador in reply to Smithie49]

You can take up to 6x5mg and some people need that.

[PuttyPenguin]

Stop the metatrexate now! That's what I've done in the past and that is what you should have been told to do. As the others have said, wait until the infection has gone before venturing back on to it again. Good luck and I hope you heal quickly xxx

[PMRrunner]

My rheumatologist advised me not to take methotrexate until I felt better both when I had shingles and covid. I've followed the same advice since xmas when I've been unwell with a nasty non-covid virus.

[WaltzG]

Hi I got a cough etc which lasted a week or so then worsened badly and turned out to be a chest infection with possibility of pneumonia..I had continued the methotrexate because my only medication....the Dr said I should not be taking it if ill since had worsened the infection.....had not been warned by rheumy....the antibiotics warn against taking it .....its the devil or the deep blue sea !!!

[PMRpro Ambassador in reply to WaltzG]

It takes at least a few weeks for MTX to be out of the system so relapses are quite unusual even if you drop it for a couple of weeks.