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Answers tagged methotrexate: Page 1 of 3
Ammar from Alberta asks: Biologics are expensive! How do I make sure the cost is covered?
Biologics are expensive! They can range from $10,000 to $25,000 per year. No one can afford that, which is why having insurance coverage for these medications is important. Most insurance plans have rules which must be followed to have these medications covered. Most of these rules are reasonable. For instance, for rheumatology problems, biologics must be prescribed by a rheumatologist. You must have a disease that we know is treatable by a biologic. You must have tried other medications first which we know may work as well (e.g. methotrexate) before trying a biologic. And finally, we must show that the condition has improved on a biologic. Working with your rheumatologist, there is nearly always a solution to finding funding for biologics. If you are having troubles, make sure your rheumatologist knows.
Brenda from Edmonton asks: Can I get the MMR vaccine while on methotrexate?
In most cases, we feel getting MMR on methotrexate is ok, even though it is an attenuated live vaccine. MMR should not be given to those on biologics however. For a full list of our vaccination recommendations, please visit our vaccine webpage!
Hayley from Calgary asks: I have recently gotten sick and need to know if I should continue my methotrexate injections or hold them while I am sick ?
As a general rule, it’s ok to continue traditional DMARDs (examples: methotrexate, plaquenil, sulfasalazine, leflunomide) when sick, particularly anything mild without a fever or needing antibiotics. For those on biologics, we generally recommend that they are held, particularly if you have a fever or require antibiotics, until you are feeling better. However, during the COVID19 pandemic, we are often a little more cautious and it would be reasonable to hold any DMARD – traditional or biologic – until you are feeling better. In most cases for methotrexate, this would mean missing one dose, which wouldn’t impact arthritis control for most individuals.
Michael from St. Albert asks: I am having terrible stomach and gut issues with the initial medication I started from AS. Do I have to continue as I’d rather suffer with AS.
The simple answer is you should not continue a medication if it’s giving you side effects that are not acceptable to you. You should discuss your concerns with your rheumatologist who may have ways to settle the problem, or may suggest another medication instead. If you cannot get hold of your rheumatologist’s office and you are suffering, in many cases it is ok to stop your medication while you are waiting for advice from your rheumatologist. We have information on most medications on our website which can help you to make sure it is safe to just stop.
Ashley from Edmonton asks: Should I hold methotrexate before having a COVID19 shot or flu shot?
From a safety perspective, it is very safe to continue methotrexate while getting either of these vaccines. There is some data to suggest that holding your methotrexate for 1-2 weeks AFTER the flu shot, and maybe the COVID shot, will make these vaccines work better. Check with your rheumatologist if this is right for you, as there is a need to balance vaccine efficacy with disease control, and this balance may be different for every individual.
Jean from Alberta asks: Is it safe to take methotrexate with sulfasalazine?
If you review medication interactions for methotrexate, the list appears long, but in fact, is not entirely accurate. There are many medications listed that you should not take with methotrexate, but most of them are only theoretical, whereas we have years of experience knowing these combinations are in fact safe.
It is very common to use methotrexate and sulfasalazine together, and it is considered safe. Similarly, some texts suggest methotrexate should not be used with anti-inflammatories (NSAIDs) or stomach protector medications called proton pump inhibitors (PPIs). Again, these combinations are used frequently. In fact, it is not uncommon that some arthritis patients are on methotrexate, sulfasalazine, ibuprofen and omeprazole (a PPI) all at the same time.
We do recommend holding methotrexate if you require a sulfa-based or penicillin-based antibiotic, but these are really the only interactions we watch for.
Many people are asking: I have rheumatoid arthritis. Will I be able to get the COVID-19 vaccine when it becomes available?
As we answer this (Dec/2020), we do not fully know the answer yet. It is a complicated question as it relates to both the safety of the vaccine, and how well it works. Safety is really the key part, and because the technology being used to develop the COVID19 vaccines is mostly new, we do not have the experience to know for sure if it’s safe. That said, there is currently no reason to think it won’t be safe, as they are not LIVE vaccines, which are contraindicated for many individuals with arthritis because of the medications they are on. As we get closer to having vaccine available, we expect more data to also come out which will help inform this decision. Stay tuned as we learn more, and check with your rheumatologist for your particular situation.
Marieanne from Sarnia asks: I was recently diagnosed with rheumatoid arthritis. I was started on a tapering dose of Prednisone, methotrexate, and hydroxychloroquine. It has been nearly 3 months and I am still noticing increasing pain and worsening symptoms if I lower my prednisone dose. Is this normal?
The goal in the treatment of rheumatoid arthritis is to eliminate joint pain, stiffness and swelling while improving function and preventing joint damage. DMARDs, including methotrexate and hydroxychloroquine, are the class of medications which are used to achieve this goal. However, they do not always work as well as we want. It is important to work with your rheumatologist to find the right combination of DMARDs that work for you. Fortunately, there are many options available, and many patients are able to find success with the right combination. Until that combination is found, treatment also needs to focus on ensuring best control of your symptoms. That may include pain relievers, anti-inflammatories, or glucocorticoids such as Prednisone.
The process to find the right treatment combination can be slow in some patients. That can be frustrating as it sometimes can feel like your health care team will never find the right treatments. A positive attitude, education around your disease, and working with your rheumatologist and health care team members will help you achieve your goals.
Iris from Edmonton asks: I have been getting gold injections for rheumatoid arthritis for 35 years, with great results. I think I want to quit. Is it safe for me to quit the gold injections “cold turkey?”
When it comes to quitting most medications for arthritis, it is considered safe to just stop them. You do not need to do it slowly over time. This would apply to gold, which was the literal “gold standard” for treating RA years ago, but also to options like methotrexate, hydroxychloroquine, leflunomide, and the biologics. The only one to be very cautious with is prednisone, which in most cases should NOT be stopped suddenly without input from your physician.
All that said, it is usually best to discuss with your rheumatologist prior to making this decision. While safe, stopping medication does not mean there will not be consequences. In particular, your rheumatologist can discuss with you the risk of your RA becoming active again when you stop your medication, and perhaps can provide strategies to help reduce those risks.
Sherry from Calgary asks: I was just diagnosed with Rheumatoid Arthritis. I was prescribed methotrexate and hydroxychloroquine. I am currently in a flare so need to continue with diclofenac to control the pain. Is this drug combination safe?
There are animal based studies that suggest a concern about using methotrexate and any anti-inflammatory, including diclofenac, together. However, this combination is used commonly in patients with rheumatoid arthritis without any significant concerns. It is an appropriate way to control symptoms while waiting for the disease modifying agents, such as methotrexate and hydroxychloroquine, to start working. While all these medications have potential side effects, there are no significant increased risks when used together.