Is taking Methotrexate the same as starting chemotherapy?
For those that know my story (if not, join the mailing list!) I ‘went it alone’ without drug treatment for close to two years. A big part of that decision was due to what was written on my latest prescription from the rheumatologist: Methotrexate, 20mg.
You see, I didn’t actually read “Methotrexate 20mg”. I read:
“Chemotherapy: take until hair falls out, violent nausea takes hold and you become a CANCER patient.”
Looking back, I see this as a complete over-reaction, but it is a knee-jerk response that many people with inflammatory diseases like Still’s Disease have when the doctor starts to talk about Methotrexate as a treatment. The purpose of this post is to clear up some of the misunderstandings about methotrexate and give you a few key tips if you are about to start taking methotrexate.
1. One brick does not make the Taj Mahal.
The first thing that needs to be cleared up is this: Methotrexate is not chemotherapy.
Methotrexate is one of many drugs that can make up a chemotherapy treatment regime. Even so, let’s put this into perspective: When Methotrexate is prescribed for Still’s Disease it is prescribed as a Disease-Modifying-Anti-Rheumatic-Drug (DMARD) in relatively low doses. To start you off, your rheumatologist will prescribe you 10mg (or less) of Methotrexate per week. If your response is promising, your doctor may increase your dose over time to a maximum of 30mg per week. Compare this with the usual dose for Methotrexate in chemotherapy where the prescription is more along the lines of 500mg per week.,and you’ll see that it is like eating one M&M versus eating the whole bag.
Methotrexate is a toxic and dangerous drug, but as a DMARD the chances that you will bruise, lose your hair and become violently ill is about as slim as slim can be.
2. Methotrexate is not like shaving.
The most important thing to remember about Methotrexate as a treatment for Still’s Disease is that it is not a drug that you take every day. The cardinal rule is that Methotrexate must be taken only once a week. Choose a day for your Methotrexate dose, set an alarm or write it in your diary and stick to it.
When choosing your Methotrexate day, consider your lifestyle. Methotrexate can make you a bit ill the next day, so consider your commitments and choose your dose-day accordingly. My biggest tip with choosing your dose day is to avoid the weekends. It is really important that you have some quality time each week to spend with your friends and family. You don’t want to battle through the week only to be spending every Sunday feeling lousy because of your medication.
3. “I’ll have my martini VERY dry…”
And by ‘dry’ I actually mean ‘non-existent’. Methotrexate and alcohol does not mix.
Methotrexate is stored in the liver and puts you at greater risk of developing cirrhosis and fibrosis of the liver. Any alcohol consumption makes it even harded for your organs to do their job properly. When your doctor puts you on Methotrexate, they will also schedule you blood tests every six to eight weeks to monitor your liver and kidney functions to make sure that everything is staying within their normal levels, but your alchohol rules of thumb will probably be:
- No alcohol on your dose day or on the days either side;
- Your doctor may allow you one or two standard drinks per week and only on your non-dose days;
- You may not get drunk, pissy, sloshed or tipsy, ever. (Sorry)
4. Other Methotrexate sponsored stop signs
Methotrexate as a treatment for Still’s disease has some other important contraindications, namely:
- You may not use sulfa-based antibiotics while you are taking Methotrexate. Because you are a good patient that never self-medicates, it is important that you only take the drugs that you are prescribed, and if you are on any other medication, it is absolutely critical that your doctor knows about them before you start on Methotrexate.
- If you are sexually active, and could get pregnant (or get your partner pregnant), you need to be using reliable contaception like condoms or the birth-control pill. Methotrexate has been linked to birth defects and may also cause damage to sperm, so if you are planning a family, you need to talk to your doctor before starting on Methotrexate.
- Being on Methotrexate can make it more difficult for your body to fight infections and in very rare cases lead to life-threatening infections in your lungs. If you develop ulcers in your mouth, or you develop a sore throat or chest infection, let your doctor know straight away.
5. “Lean on me, when you’re not strong…”
Methotrexate can lead to folic acid deficiency which has some pretty crummy side effects including mood changes, depression, irritability, nausea and gastro-intestinal problems. As a result, your doctor will probably prescribe you a folic acid supplement to take daily which significantly reduces the side effects of the methotrexate treatment.
Folic acid supplementation generally does not have side effects, but in rare cases can cause nausea and insomnia as well as abdominal bloating and loss of appetite. As folic acid can also lead to vitamin B12 deficiency, you are also well served taking a good quality multi-vitamin to further support your medication regime.
6. Patience is a virtue
Finally, it is important that you are patient with your Methotrexate treatment. With illnesses like Still’s Disease it can take 6-8 weeks to see any improvement and up to three months to see the full effect.
In addition to playing the waiting game, your doctor may also start you on double or even triple therapy to make the Methotrexate more effective. Certain drugs when combined have increased effect upon each other. Commonly Plaquenil (hydroxychloroquine), Salazopyrin (Sulfasalazine), and Neoral (Cyclosporin) are prescribed to increase the effectiveness of the Methotrexate. This is done with the hope to reduce the reliance on corticosteroids with the ultimate goal of removing steroids as a treatment.
Be patient, take your blood tests and you will likely find that Methotrexate is a tolerable and effective medication.
Please remember that this is general advice only, and you should always talk to your doctor about any new medication that you may be starting. In the Medication section of this website you can learn more about Methotrexate by watching the short video that is posted there.
If you are starting Methotrexate, you may also be able to save big bucks on your medication costs by considering a generic brand. If you are interested, you can learn more about buying Methotrexate online by clicking here.
What has been your experience with Methotrexate? Please leave a comment below.
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