Skipping a dose of Methotrexate

[lkcreedon]

Hi All, I have a question re. Is it ok to skip a dose of Methotrexate for 1 week?I am on 10mgs. Not too many symptoms apart from some cramping a day or so later and soft stools. Not much help either. Appointment with Rhumatoligist on 30th May at which point I'll probably tell her I want to come off it unless she can convince me otherwise.

Ss I'm abroad next at a wedding I really don't want to be sick at all so I'd like to skip next Sundays dose. Just wondering if anyone else has done anything like this beforehand if it's safe to do so?

I have left a message on the phone for the rheumatologist to this end but not heard back yet!

Thanks in advance 😊

[lkcreedon]

Using the MTX as a steroid sparing drug

[PMRpro Ambassador]

You should have been told to skip a dose if you are ill with any infection, especially if you need antibiotics so skipping a dose to ensure a better day at something as important as a wedding should be absolutely fine. I didn't seek permission - though I had agreed with my rheumy that I might stop it to go to an international meeting in South Korea about a month later, By that stage I felt so ill, especially fatigue but also muscle and joint pain, that I couldn't have made the trip if I hadn't stopped it! By the time I got back I was feeling just about back to normal so never started it again. He was fine about it.

[lkcreedon in reply to PMRpro]

Thanks PMPro that reassures me. I'm happy to skip the dose. Can't be sick at the wedding. Better not to go if that's the case AND that's not an option really. Thank you again 🙏

[Oxfordboy2]

I am on 15mg MTX only ,no steroids.The rheumatologist advice when having covid vaccine is to skip the 2 doses after the injection.I have done this for the last 3 jabs with no problems so from a personal point of view I have no worries not taking it for a short time.

[lkcreedon in reply to Oxfordboy2]

Thanks Oxfordboy 2. I feel more comfortable now just skipping the 1 week. I will go back on it again once home and until I meet with the Rheumatologist on the 30th May. I hope to come off it then as I seem not to be having much help from it in reducing the steroid. I'm on 10mg pred and can't drop as still having pmr aches early in the day so feel it best not to try and taper now. Did the MTX help you get off steroids or were you not on steroids anyway?

[Oxfordboy2]

I originally had pmr/gca for which steroids were prescribed and after a time I came off them.3 months later the hospital thought I may have another condition and after a pet scan diagnosed gca/vasculitis. At this time I was not on any meds and they prescribe mtx only. It took some time to get used to but my latest pet scan showed a marked improvement so I am persevering.

[lkcreedon in reply to Oxfordboy2]

Glad there is an improvement for you Oxfordboy2. Unsure if the MTX will help me however. Nautious for the last few days now and blaming it on that 🙄. Seeing the rheumatologist end of May so will wait till then to here what she has to say. Tnx for your response

[Oxfordboy2 in reply to lkcreedon]

I don’t know if this will help you as it did me.I was very nauseous when I first went on MTX.I used to take it directly after breakfast.This was my regime for the next 15 months when for some unknown reason I took it later in the day,mid morning to be exact.The effect was miraculous,no nausea that day so I took it at this time for the next few weeks and felt so much better so I have stuck to that time.I do wonder if it interacted with my breakfast orange juice.May be worth a try if your taking it at a different time.

[lkcreedon in reply to Oxfordboy2]

Tnx Oxfordboy2. I will have a chat with the rhumy when I meet her end of May. I feel tho that I should have some relief at this point but haven't had any to be fair. Maybe I'm just impatient and need to persevere a bit more! See how it goes.

[PMRpro Ambassador in reply to lkcreedon]

My rheumy recommends taking half the MTX dose before bed, the rest the next morning and says he finds it reduces the nausea - that was about the only adverse effect is DIDN'T have.

[lkcreedon in reply to PMRpro]

Hadn't thought of that! Overall so far it hasn't been helpful. On 11th dose now and no sign of a kick in. I doubt it will miraculously kick on after the 12 th dose which I will take the week after I come back from Italy.The nausea has passed now TG. I woke up this am with aches in my upper arms, mostly right arm. Quite sore. PMR I imagine. Moved of fast enough. Feeling btr today. So the PMR is lingering therefore I can't taper really. Feels like I'm stuck on 10mg pred.

I find the Paracetamol Extra helps with the stiffness later in the day. Usually take 2 mid morning.

Overall feeling much btr today.

Thanks for your response

[PMRrunner]

I've skipped doses after COVID vaccinations, when I had shingles and again last weekend as I managed to catch COVID for the third time.

[lkcreedon in reply to PMRrunner]

Oh dear. I haven't taken the latest Covid jab. I took the flu one and the pneumonia one. Tnx for your response

[Ozziedays]

Towards the end of my time on MTX I had occasional slightly raised liver enzymes and would be advised to stop for 2 weeks to re do bloods. The last time this happened I was on 10mg weekly and we just agreed I’d stop completely, a few months ahead of the original time plan for stopping. I’d been on it for about 2 years, the first in tandem with tapering pred to zero, the second on its own. Didn’t notice any side effects on it, nor anything when I stopped.

[lkcreedon in reply to Ozziedays]

Lucky Ozziedays not to have had any side effects. I was ok up till the 11th dose but sick now. Wonder if the effects are cumulative 🤔

[Shyandretiring]

It will be fine to do that as I have had to not take it for over two weeks and be fine.

[lkcreedon in reply to Shyandretiring]

Thanks Shyandretiring. Good to know. Can't be sick while away. Not sure if I will go back on it however. If there is an alternative I might check it out. Was on hydroxychloroquin before that for 12 weeks +. Nothing really.

[Nomadan]

I used to regularly skip the odd week, as long as you don't do more that 3. I also told my Dr I wanted to come off as I wasn't getting any symptoms...been off Methotrexate for 6 months now, and feel loads better...still no symptoms

[lkcreedon in reply to Nomadan]

Feeling like that too. Want iff if it's not helping. I will give it a few more weeks however till I meet the rhumy. Thanks Nomadan 🤗

[Allotmental]

Like Nomadon, I occasionally skip doses with no adverse effects. I’ve always assumed that because it builds up slowly, the impact also wears off slowly, hence why missing the odd dose is ok.

[lkcreedon in reply to Allotmental]

Good to hear. No point in being miserable really. Not convinced tho that it will help. After 12 weeks, nothing really. Tnx Allotmental