For anyone on methotrexate (presently or in the past), if you've had infections what antibiotics have you been prescribed?
My sister has a UTI (symptoms only started today) but she took her methotrexate last night (she has rheumatoid arthritis so will also post on that site), and she's been prescribed nitrofurantoin but there's so much conflicting information that I can't tell whether it is safe or not.
Anyone got any experience?
Usually you are told to stop the MTX for the duration of the antibiotic therapy at least and until the infection has cleared if it takes longer. That is pretty much standard practice and communicated before ever starting MTX. Your body needs to have the immunosuppressant effect removed.
Thanks for replying - the problem is she took her weekly dose last night, so cannot technically stop it for another 6 days as it'll be in her system. Concerned about toxicity but also her not getting v. sick with the infection.
That is a problem! But again - usually you are told to not take the MTX if you have an infection - delaying it until you have seen the GP is not a problem.
Rats - can't edit replies at the moment! Nitrofurantoin can be a horrid abx but I don't think toxicity is a problem at rheumatological doses for MTX. Might be with the massive doses they use in oncology.
Thank you again for replying, appreciate it!
Has she had a urine culture to identify the organism? If not it would be a good idea to get one sent. If an organism is identified that is not not sensitive to nitrofurantoin then you would have to choose another option and the sooner that is known the better. As a retired gp we were encouraged to give nitrofurantoin because of its good safety profile. I do not have any experience of its use with methotrexate. If anyone had asked me what to do I would have said take the nitrofurantoin despite the methotrexate. The worst case scenario would be an uncontrolled infection if no antibiotics were given. The taking of methotrexate increases the risk of infection and nitrofurantoin reduces it. This is my own personal feeling and is in the end guess work.
Thank you for responding. They’ve confirmed infection but not thoroughly enough to detect the organism. We know that trimethoprim and methotrexate are a bad mix but weren’t sure about nitrofurantoin but responses seem to suggest it is an antibiotic with a good safety profile and much lower risk of toxicity.
I take methotrexate and was given doxycycline antibiotic for my UTI recently.
i was on methotrexate i didn’t really have any side effects but i decided to stop taking it because of th possible side effects they then put me on a kind of kemo therapy pulse which i have had to stop due to illnesses at the moment i am weaning of prednisone down from 20 ml to 2ml per day am waiting to
get off prednisone completely to see where i am on th vascilitus front
I take a weekly dose of MTX and I also have UTI problems. My doctor prescribed Trimethoprim 300mg medication in lots of 4 x 7tablets each I also take a daily dose of Hiprex that is available at most chemists. I certainly would not cease the MTX without speaking to your doctor as stopping the MTX could cause a nasty flare in your Vasculitis.
It is standard protocol for rheumatology MTX patients - so it always needs discussing with the rheumy when it becomes a chronic problem. Once you have been on MTX for a few months, it takes weeks for the effect to wear of so the likelihood of a flare because of dropping one or even 2 doses is small.
hiya Iv been given that before had to have two lots of it cos it didn’t work but I was ok no reaction
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