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Answers tagged methotrexate: Page 2 of 3
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Donna from the USA asks: Do I need to continue taking folic acid if I have stopped methotrexate?

Folic acid’s role is to reduce the risk of side effects from methotrexate.  It does not help treat rheumatic conditions itself.  Therefore, in most cases, if the only reason a patient was taking folic acid was because they had been on methotrexate, it would be considered appropriate and safe to stop the folic acid.

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Cathy from the Unites States asks: I am losing my hair from methotrexate.  Is there anything I can do?

While not common, hair loss is a known side effect from methotrexate.  Usually, complete hair loss is not seen at the doses used to treat inflammatory joint and skin conditions, although it certainly can be concerning for individual patients.  Options to reduce this side effect include ensuring you are taking appropriate doses of folic acid, even up to 10 mg per day.  A related medication, called folinic acid, can sometimes be helpful, but should be discussed with your physician.  A dose reduction in methotrexate can also be helpful.  If none of these are effective, have a discussion with your physician to review alternate treatment options.

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Dallas from Edmonton asks: My fiancée and I are getting married in less than a month and we have starting talking about having a family. I’m currently taking Methotrexate injections once a week. We are worried that the methotrexate could increase the chance of birth defects. Has there been any studies done regarding the effects of methotrexate in men when trying to have a baby?

Certainly females should not get pregnant while on methotrexate, with recommendations suggesting that women should stop methotrexate at least 3 months before trying to become pregnant.  The data for men is less clear.  There are rheumatologists who recommend the same for men, avoidance of methotrexate for at least 3 months before trying to conceive.  There are suggestions that methotrexate could affect sperm, however, no study has clearly shown any harmful effects.

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Jen from Edmonton asks: My methotrexate vial says “for intramuscular, intravenous, and intra-arterial use only”, but I am supposed to inject it subcutaneously. Should I be concerned?

Methotrexate use for rheumatic diseases, including rheumatoid arthritis, can be given as a tablet or injection.  For those receiving methotrexate by injection, self-injection is done subcutaneously – under the skin.  An intramuscular injection can also be done, although usually cannot be self-administered.  Methotrexate should not be put directly in a vein or artery for rheumatic diseases.  To learn more about how to do methotrexate self injections, visit our video here.

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Dallas from Alberta asks: I have been on methotrexate for 5 months and started to notice that I am losing my hair.  What should I do?

While not a common occurrence for most people on methotrexate for their arthritis, hair loss certainly is a known side effect.  Certainly this should be discussed with your rheumatologist to determine the best option in any particular case.  For some, increasing folic acid intake may be quite helpful at reversing the hair loss.  For others, lowering methotrexate or considering an alternative may be necessary.  Making the appropriate adjustments with your rheumatologist will ensure the best chance of reducing any side effects while still ensuring your arthritis is, or becomes, under good control.  Keep in mind, even if the hair loss stops, it unfortunately can take months before you notice the improvement.  Hair loss from methotrexate is usually reversible; hair will grow back.

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Audra from Edmonton asks: I am on methotrexate.  Is it safe to get the shingles vaccine?  What about pneumonia?

Vaccines, or immunizations, come in two broad forms.  Most are ok to receive when you have an underlying rheumatic disease and on treatment for it, including methotrexate or even biologics.   For that reason, rheumatologists generally encourage their patients to get the annual flu shot, and to receive the pneumonia vaccine as well.  However, for those vaccines that may have a live component to them, patients may need to be cautious depending on which medication they are on, as you may be at increased risk for developing the condition you are trying to protect yourself from.  While less concerning, these vaccines also may be less effective when on these medications.  If you are able to receive the vaccine before starting them, all the better.  It’s important to discuss the details of any live attenuated vaccine with your rheumatologist to ensure it’s right for you.

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John from Prince George asks: I have been diagnosed with rheumatoid arthritis and have developed nodules on my elbows, hands and feet.  Is this normal?

One of the manifestations of rheumatoid arthritis outside the joint is the development of rheumatoid nodules.  These occur in just under 10% of patients with rheumatoid arthritis and is one of the more common skin manifestation of rheumatoid arthritis.  They often occur on pressure surfaces e.g. elbow, but can occur elsewhere as well.  For most individuals, they are asymptomatic and specific treatment is not necessary for them.  Steroid injections or surgical removal is sometimes considered, although control of the inflammatory arthritis often improves the nodules too.  Paradoxically, in some patients treated with methotrexate – the gold standard for rheumatoid arthritis treatment – the nodules can worsen, and stopping methotrexate can lead to improvement.

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Anne from Calgary asks: I have recently been diagnosed with rheumatoid arthritis.  I also have a lung disease.   I was started on hydroxychloroquine, but shouldn’t I be on methotrexate?

With some types of lung disease, rheumatologists may be cautious using certain typical rheumatoid arthritis medications, particularly methotrexate.  One of the rare side effects of methotrexate is to cause lung damage, something in particular to be avoided in an a patient with bad lungs in the first place.  Fortunately, there are many other good options available to treat rheumatoid arthritis which are relatively safer from a lung point of view.  Hydroxychloroquine is one of these options.  In mild cases of rheumatoid arthritis, this may be an excellent option.  For moderate to severe cases, further discussion with a rheumatologist should lead to an optimal treatment plan.

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Carmen from Edmonton asks: Can I safely take Tylenol for pain while receiving Methotrexate injections?

Over the counter pain relievers such as acetominophen (Tylenol), ibuprofen (Advil, Motrin) and naproxen (Aleve) are all generally safe to take with methotrexate.



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