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What Antibiotics Can Be Taken With Methotrexate

Other Foods And Beverages

Methotrexate Mnemonic for Nursing Pharmacology (NCLEX)

Some research has shown that those who drink grapefruit juice regularly should speak to their healthcare provider prior to starting methotrexate. It has also been found that taking willow bark while on methotrexate could lead to adverse interactions. People taking methotrexate should also avoid acidic diet cola since it can lead to a buildup of the drug in the body by hindering the body’s ability to expel it.

What Happened When I Stopped Methotrexate

Fortunately, the antibiotics killed my infection. Unfortunately, the RA mischiefs decided that it would be a good time to act up a bit.

The pain started with an extra stiffness in my left hand. I thought that maybe I was typing too much or playing too many computer games where I hold my hand in a loose fist and typically use just one finger.

But after a few days, it was my left foot that joined in the party. Moving my toes became a practice in slow motion. When my boyfriend offered a foot rub , I couldnt stand the pressure or even the gentle movement of my toes.

Seriously, who turns down a foot rub?

Since starting methotrexate in 2007 and Rituxan in 2009, I have been blessed with relatively low disease activity. But even with Rituxan in my system, I absolutely need to continue taking methotrexate. If I skip a dose, I can feel it.

What About Side Effects

Methotrexate can cause mouth ulcers in a few patients, in the beginning of treatment. This should go away with time. Another possible side effect is nausea and vomiting. Methotrexate can also cause hair thinning or hair loss. In rare cases some people may develop lung problems.

Methotrexate can cause mild liver irritation. Please tell your doctor if you have a history of any alcohol abuse, hepatitis, yellow jaundice, or liver disease. While on methotrexate you must limit yourself to 2 alcoholic beverages per week. Blood work will be done every 4-12 weeks to check your liver function. This blood work will also include a complete blood count since methotrexate can also cause a decrease in blood counts. This blood work is very important. It allows the rheumatologist to make timely changes to your dose of methotrexate if there is ever problem.

Methotrexate is known to cause birth defects in the children of both men and women taking this drug. If you are pregnant, considering having a child, or nursing, discuss this with your rheumatologist before beginning this medication. You must use an effective form of birth control while taking methotrexate and for at least 3 months after the methotrexate is stopped. Your rheumatologist or nurse can give you additional guidance.

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Warnings For Other Groups

For pregnant women: Methotrexate can cause serious harm to a pregnancy. It can also cause fertility problems . People with RA or psoriasis should not use this drug during pregnancy.

If youre a woman of childbearing age, your doctor will likely give you a pregnancy test to make sure youre not pregnant before starting this drug. You should use effective birth control during your treatment and for at least one menstrual cycle after stopping treatment with this drug. Call your doctor right away if you:

  • think your birth control didnt work
  • become pregnant while taking this drug

If youre a man, you should use effective birth control during your treatment and for at least 3 months after your treatment ends.

For women who are breastfeeding: Methotrexate passes through breast milk and can cause side effects in a child who is breastfed. Do not breastfeed while taking methotrexate. Talk with your doctor about the best way to feed your child.

For seniors: Youre more likely to have problems with their liver, kidneys, or bone marrow while taking methotrexate. Youre also more likely to have low folic acid levels. Your doctor should monitor you for these and other side effects.

For children: For psoriasis: This medication has not been studied in children with psoriasis. It should not be used to treat this condition in children younger than 18 years.

For polyarticular juvenile idiopathic arthritis: This medication has been studied in children ages 216 years with this condition.

How Long After Taking Antibiotics Can You Take Methotrexate

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If you are diagnosed with an infection that requires antibiotics, wait at least 12 hours after taking methotrexate to allow most of the methotrexate to clear the kidneys. You may wish to talk to your rheumatologist about their recommended protocol before you get an infection so you know what to do in advance.

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Interactions Between Methotrexate And Antibiotics

It is very important to avoid taking antibiotics and methotrexate at the same time for the following reason.

Methotrexate can be very effective in treating RA. However, it should be administered with care, as there is a of the drug.

It may have an interaction with other medications. For instance, a number of antibiotics affect how quickly methotrexate is absorbed in the body, thuspotentially leading to a buildup, which may become toxic.

Antibiotics that can interact with methotrexate include the following:

These antibiotics interact with the way methotrexate is metabolized in the kidneys, potentially reducing the rate with which it is processed. This can lead to a buildup that can slowly cause toxicity.

If you are diagnosed with an infection that requires antibiotics, wait at least 12 hours after taking methotrexate to allow most of the methotrexate to clear the kidneys.

You may wish to talk to your rheumatologist about their recommended protocol before you get an infection so you know what to do in advance.

Treatment And Clinical Interpretation

Methotrexate and TMP-SMX were stopped on day 3 of admission, and therapy with folinic acid was given to antagonize the effects of MTX and reverse the patients marrow suppression. The prednisone taper was continued, and valacyclovir was initiated for the empiric management of stomatitis. Buccal swabs were negative for Candida, while a lip swab later grew herpes simplex in culture.

The white blood cell, hemoglobin, and platelet concentrations returned to baseline 5 days after folinic acid was initiated . The patients creatinine level normalized, and her diarrhea subsided. She was discharged from hospital when she was able to eat without pain. At her follow-up appointment with the gastroenterologist, she was started on infliximab for treatment of her Crohn disease.

Change in the patients blood parameters over time:After TMP-SMX is initiated, the patients white blood cell and platelet counts fall dramatically.

Once MTX and TMP-SMX are discontinued and folinic acid is administered, both the white blood cell and platelet counts recover as expected.

IVintravenous, MTXmethotrexate, TMP-SMXtrimethoprim-sulfamethoxazole.

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Methotrexate Selects For De Novo Trimethoprim Resistance

We further examined whether exposure to MTX could lead to de novo TMPR evolution. We selected spontaneous mutants from overnight cultures with and without exposure to MTX, plated on selective agar at high MTX concentrations and tested for TMP cross-resistance . E. coli K56-2 isolated at 16 and 32 mg/mL MTX displayed increased MICs of TMP close to or above the clinical breakpoint , clearly demonstrating selection for TMPR by MTX. DNA sequencing of the resistant isolates revealed two different mutations in the folA promoter, previously reported to result in TMPR , as well as a single mutation in the gene .

Finally, we asked if exposure to sub-MICs of MTX close to the estimated MSCs would select for de novo TMPR mutations in a susceptible E. coli population. Starting from 1,000 cells to minimize the probability of pre-existing mutants, we grew 10 independent lineages of the E. coli K56-2 strain at 400 g/mL MTX for 500 generations. The frequency of TMPR was determined every 50 generations. TMPR ascended in frequency in 2/10 lineages at different rates and time-points during the first 250 generations before they were outcompeted by a different set of mutants with reduced susceptibility to MTX and no cross-resistance to TMP . These experiments show that MTX exposure can select for de novo TMPR, both at high and sub-MIC concentrations.


What Happens If I Overdose

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Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of methotrexate can be fatal.

Overdose symptoms may include bruising or unusual bleeding, mouth sores, vomiting, little or no urination, bloody or tarry stools, or coughing up blood or vomit that looks like coffee grounds.

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What Side Effects Can This Medication Cause

Methotrexate may cause side effects. Tell your doctor if any of the following symptoms are severe or do not go away:

  • Irregular menstrual periods
  • Swollen, tender gums

Some side effects can be serious. If you experience any of the following symptoms or any symptoms listed in the important warning section of the medication insert, call your doctor immediately:

  • Difficulty moving one or both sides of the body
  • Difficulty speaking or slurred speech
  • Pain or redness of one leg only
  • Urgent or frequent need to urinate
  • Weakness or numbness of an arm or leg

Methotrexate may cause other side effects. Tell your doctor if you have any unusual problems while you are taking this medication.

What Happens When You Stop Taking Methotrexate For Rheumatoid Arthritis

Patients who stopped taking methotrexate reported having substantially more gastrointestinal issues including nausea, abdominal pain, and loss of appetite from methotrexate than current users did. Just 26 percent of current MTX users reported nausea, compared with 40 percent of those who used it previously.

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The Fear Of Flaring Rheumatoid Arthritis While Off Methotrexate

The fear of not finding relief becomes so great that it is hard to look at. The fear of what this disease wants to do if left unchecked can become powerful. The fear of losing a grasp on remission was the greatest unspoken fear I experienced during this time. I was anxious to get back on all my meds again.

Getting back to my meds proved to be effective. It wasnt immediate, but the pain and swelling did recede.

My body returned to normal after a couple of weeks and I was able to move on. But I wonder about this type of transient flare-up and I wonder about the remission which only sustains while continuing medication.

Is it a ?

I dont know the honest answer to that question and will ask my rheumatologist during our next visit. What I do know is that the fear of RA coming back full-force is real.

Thankfully, my experience was a temporary one. Not everyone is so fortunate and I know Im lucky.

What Should I Know About Storage And Disposal Of This Medication

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Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.

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Questions To Ask Your Doctor

  • Is methotrexate the best medicine for my condition?
  • What do I need to do before I start taking methotrexate?
  • How long will I need to take it?
  • What are the risks involved in taking it?
  • What are serious side effects I should watch for?
  • What happens if my partner or I become pregnant while taking methotrexate?

Should I Drink Lots Of Water With Methotrexate

Methotrexate may cause kidney damage. Be sure to drink plenty of fluids during your treatment with methotrexate, especially if you exercise or are physically active. Call your doctor if you think you might be dehydrated. You may become dehydrated if you sweat excessively or if you vomit, have diarrhea or have a fever.

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What Painkillers Can You Take With Methotrexate

You can usually carry on taking painkillers like paracetamol if needed, unless your doctor advises otherwise. Avoid taking non-steroidal anti-inflammatory drugs , including aspirin or ibuprofen, or medicines containing NSAIDs, such as over-the-counter cold medication, without first speaking to your doctor.

Who Can And Cannot Take Methotrexate

How long does it take for Methotrexate to work?

Methotrexate can be used by adults and children.

Methotrexate is not suitable for some people.Tell your doctor before taking methotrexate if you:

  • have ever had an allergic reaction to methotrexate or any other medicine
  • are pregnant, trying to get pregnant or are breastfeeding
  • have severe liver, kidney, or blood disease
  • have an infection
  • have mouth ulcers, or have been diagnosed with a stomach ulcer or duodenal ulcer
  • are due to have a “live” vaccine

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Cautions With Other Medicines

There are many medicines that affect the way methotrexate works.

Children taking methotrexate must not have a “live” flu vaccine . Adults are given an “inactivated” flu vaccine and this usually does not cause problems with methotrexate.

Tell your doctor if you’re taking these medicines before you start methotrexate:

These are not all the medicines that may affect methotrexate.

Dosage For Rheumatoid Arthritis

Adult dosage

  • Typical starting dosage: 7.5 mg once per week.

Child dosage

This drug is not approved to treat RA in children.

Senior dosage

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug may stay in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

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Methotrexate Resistance Determinants Invade When Rare In E Coli Populations

Exploring MTX-selective dynamics further, we asked if TMPR determinants could invade the population at lower initial densities to exclude potential bias from the 1:1 ratio in the competition experiments. We started competition experiments from frequencies as low as 104 of the TMPR strains, at concentrations slightly above the estimated MSC of MTX and followed the change in ratios over 30 generations of growth . Both chromosomal and plasmid mediated TMPR determinants were able to invade, even when initially rare in their respective populations, strongly suggesting that the MTX-selective effects are independent on initial frequencies of resistant and susceptible strains during competition experiments.

The change in TMPR:TMPS ratios over 30 generations of growth at MTX concentrations slightly above the MSCs where E. coli MG1655 harbors two folA mutations , and the pG06-VIM-1 plasmid were competed against a differently tagged, isogenic susceptible strain at 1:1, 1:102, 1:103 and 1:104 starting ratios. Error bars represent the standard deviation of the average ratio.

How Should This Medicine Be Used

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Methotrexate comes as a tablet to take by mouth. Your doctor will tell you how often you should take methotrexate. The schedule depends on the condition you have and on how your body responds to the medication.

Your doctor may tell you to take methotrexate on a rotating schedule that alternates several days when you take methotrexate with several days or weeks when you do not take the medication. Follow these directions carefully and ask your doctor or pharmacist if you do not know when to take your medication.

If you are taking methotrexate to treat psoriasis or rheumatoid arthritis, your doctor may tell you to take the medication once a week. Pay close attention to your doctor’s directions. Some people who mistakenly took methotrexate once daily instead of once weekly experienced very severe side effects or died.

Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take methotrexate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you are taking methotrexate to treat psoriasis or rheumatoid arthritis, your doctor may start you on a low dose of the medication and gradually increase your dose. Follow these directions carefully.

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Fertility Pregnancy And Breastfeeding

Women using this drug should use contraception or encourage their partner to. Talk to your doctor as soon as possible if youre planning to start a family.

You shouldn’t take methotrexate if you’re pregnant or trying for a baby, as it can affect how an unborn baby develops.

Methotrexate should be stopped three months before you become pregnant. If you become pregnant while taking methotrexate or if you’ve had less than a three-month break from the drug, it’s important to speak to your doctor as soon as possible.

It used to be recommended that men stop methotrexate three months before trying for a baby, but research now shows it’s fine for men to continue taking methotrexate when trying for a baby with their partner.

If you are planning to try for a baby it’s important to take folic acid to support the health of you and your baby.

You shouldnt breastfeed if youre on methotrexate, as the drug could pass into breast milk, and we yet dont know what effects this could have on a baby.

Your doctors will usually recommend going straight back onto methotrexate once youve finished breastfeeding. This is because the sooner you can get back onto your medication, the lower the risk of having a flare.

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