Mtx and pantoprazol?

[krillemy]

I really need to take some pantoprazole; however, it seems to not go well with MTX in particular. Before I started MTX (20 mg), I sometimes took pantoprazole 40 mg for 2-3 days to get rid of pain from reflux. It would settle, and I would be fine for a long time.

Any experience with pantoprazole while taking MTX?

[PMRpro Ambassador]

In what way does it not go well with MTX?

I had a month of 40mg pantoprazole after my cardiac ablation - horrible, brain fog, was so glad when I finished the course!

[krillemy in reply to PMRpro]

It says on the internet that there’s interaction. Also in the MTX patient information leaflet. It is not contraindicated though. Just that it can aggravate the toxicity of mtx

[PMRpro Ambassador in reply to krillemy]

Right - had time to look now. The pantoprazole slows the rate at which the body excretes the MTX so potentially you may get the effects of a higher dose than you were given. However, this is primarily when MTX is used at high doses in oncology (cancer treatment) where they are using much higher doses such as 1g per square metre body surface area and that can be starting at about 2.5g at a time - compared to 25mg maximum in rheumatology that is a thousand times as much.

So with low dose MTX in rheumatology it shouldn't be too much of a problem.

[krillemy in reply to PMRpro]

Thanks!! 😀