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Pain medication with methotrexate?

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  • Pain medication with methotrexate?

    I'm on methotrexate and so cannot also take asprin, NSAIDS or paracetamol as these all cause methotrexate toxicity (which my rheumatologist never told me - I had to ask the drug companies. Thank goodness I did!)

    Luckily the meth has worked extremely well on my pains although my arthritic hips are slowly getting worse, so at some point I'll be needing pain medication again.

    Does anyone have a suggestion for over the counter pain help that can safely be taken with methotrexate? Failing that a prescription medication?



  • #2
    Hi Duncan,

    I'm wondering if the drug companies were covering their backsides? Something they will do with every caution We have plenty of people here who take Metho and take anti-inflammatories and also aspirin with it and some of them see top Lupus docs, so I'm not sure where they plucked that from.

    It would depend on your individual circumstances though, NSAIDS are not advisable if you have certain conditions, same with aspirin. But if it's just the Methotrexate in conjunction with them then there's usually not a problem.

    I'd discuss it with your Rheumy he knows your situation best and what your other issues are, therefore he can prescribe something which would probably give you some extra relief. Many of us are on a cocktail of Lupus meds and pain meds to help manage our condition. What works or is suitable for one may not be for another.



    • #3

      I am on methotrexate and take 81 mg aspirin, nsaid and two different pain meds.

      I am hoping to get off of my one pain med soon as the methotrexate kicks in. I am having a lot of joint issues that lupus is attacking.

      My doctor knows all the meds that I am on. I have a computer print out of a list of meds and all the lables that I have. I take that list to every doctor that I see.

      Good Luck,


      • #4
        Hello Duncan
        I'm afraid I have to agree with Lily about the drug company covering themselves. I know from experience of calling them with questions that they are very very cautious when it comes to comments that might be interpreted as giving medical advice. If you called the manufacturers of Plaquenil and asked about taking Plaquenil when pregnant they would advise against whereas it is in common use during pregnancy

        Probably your doctor didn't mention it because it isn't normally an issue
        This is what has to say

        Methotrexate ..................
        and stomach/intestinal disease (e.g., bleeding) when used at the same time as non-steroidal anti-inflammatory drugs (NSAIDs such as indomethacin, ketoprofen). Therefore, NSAIDs should not be used with high-dose methotrexate. Caution is advised if you also take aspirin. NSAIDs/aspirin may be used with low-dose methotrexate such as for the treatment of rheumatoid arthritis if directed by your doctor. If you are using low-dose aspirin (81-325 mg per day) for heart attack or stroke prevention, continue to take it unless directed otherwise. Consult your doctor regarding safe use of these drugs (e.g., close monitoring by your doctor, maintaining stable doses of NSAID


        • #5
          Hello Duncan,
          I am not sure on this one. I am on 20mgms MTX, I take Paracetamol sometimes, or cold and flu remedies. I have not had any problem.

          Usually I stick to my Prescription meds.
          One interesting thing I found out when I had a stomach upset was that you must not take Alka Seltzer if you are on higher doses of MTX than about 15 mgms.

          Hope you are not in too much pain Duncan,
          x Lola


          • #6
            I was on MTX for over a year and I was told I could take aspirin or Aleve and my rheumy gave me a prescription for Naproxen (a stronger version of Aleve) to take daily, if need be. I had read that these drugs should not be taken with MTX, but many doctors don't agree. I don't take the pain killers often, but when I do, there's no problem at all.

            Talk to your doctor about your individual needs. He should be giving you some guidance as to pain relief. Unfortunately, most of us find that our drugs don't stop all of the pain all of the time and we need something else.


            • #7
              Have you thought of things like lcy hot and other creams or patches for relief? It maybe a short term fix but it could get you through for the time being. I would really ask the doctor about the pain pills and the meth and see what they think. You could speak with your pharmacy about the over the counter items that you can safely take with your other medicines. There are so many avenues of help out there that we sometimes forget about. Good luck with finding some help for your pain. I hope you are healthy.


              • #8
                Thanks, everyone. I shall discuss this with my doctor this morning and the pharmacist.
                It'll be good if I can take NSAIDS, paracetamol, etc with the methotrexate as I have a huge bag of them left over from when I needed them every day last year!!



                • #9
                  I found the answer

                  Well, here's some interesting news for those of you who thought you were safe. I spoke to two pharmacists and my GP. They all said the same: Paracetamol is fine with Methotrexate, but Ibuprofen and Asprin cause methotrexate toxicity. Ie they cause the methotrexate to stay in your system. You can use them but you'd have to reduce your methotrexate to below 5mg a week and have more frequent blood tests.

                  I'll just take the pain. Far safer!
                  My lupus doc said they can prescribe safe pain meds with the methotrexate but didn't say what until I needed it.



                  • #10
                    Hi Duncan,

                    Often these warnings relate to the higher doses of Methotrexate used by cancer patients and the risk is more rare with the lower doses used by Lupus patients.

                    The problem with the drug leaflets and general information available to pharmacists and GP's who don't treat thousands of Lupus patients is that Methotrexate (and some of our other drugs) were originally developed for different uses and later found to be effective in much smaller doses for the treatment of Lupus. We 'borrow' a lot of treatments and the literature is written for their original use at much higher doses. The Rheumatologists who deal with Lupus on a daily basis realise that the interaction rate is tiny for the two drugs taken together, years of experience has taught them this.

                    in the interactions section:

                    METHOTREXATE (in Methotrexate Tablets) may interact with IBUPROFEN (in Ibuprofen Capsules)
                    Although the cause of this interaction is not completely understood, ibuprofen may reduce the clearance of methotrexate from the body via the urine. If this occurs, ibuprofen may increase the risk of serious side effects or toxicity from methotrexate, especially with high doses of methotrexate that are typically used for cancer. This interaction is more rare when low doses of methotrexate are used to treat other diseases. If ibuprofen and methotrexate are used together, your doctor may want to monitor your kidney function more closely and look for signs of side effects from methotrexate.Ask your healthcare provider about these drugs and this potential interaction as soon as possible.
                    I also put in Naproxen and got the same warning, but interestingly enough there doesn't appear to be a problem with the well known Mobic, another NSAID, so that's something to remember if you do need pain control in the future.

                    Just as a side note Ibuprofen is generally not the NSAID of choice for Lupus as there are many more suitable ones in that class with a much much lower risk of side effects and allergies. I personally couldn't tolerate Ibuprofen (it actually made my symptoms worse :wink2 but I am fine with other NSAIDS. Frankly I can't function without them, I am unable to get around at as with all drugs it's a risk versus benefit calculation that has to be weighed up between doc and patient.

                    Same with the Aspirin scenario and things like Metho...........some Lupus patients also have APS and are on Metho too. Without the Aspirin their lives are at risk from clotting events and they obviously need the Metho to help damp down their Lupus. In that scenario there is little choice.

                    There appears to be little in the way of interaction of acetaminophen (Panadol) and Methotrexate in the medical literature.



                    • #11
                      Hi there,

                      I am not on Meth yet but will be soon. My Rheumy also perscribed Tramadol to take on going for severe wide spread chronic pain. He said it is safe to take with Methotrexate.

                      Don't know if this helps but I hope it does. Nothing worse then being in pain.

                      Feel better soon.