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Methotrexate and metronidazole

Posted , 3 users are following.

Paula2212
Paula2212

hello everyone.

does anyone have experience of having to take metronidazole ( antibiotic) whilst on methotrexate? My mum has just been increased to 20mg MXT and remains presently on 2.5mg alternate days of prednisolone. She has been prescribe drugs up the dentist, metronidazole, for a sore gum which may be infected. She has to take them and go back in 10 days time. The dentist and pharmacist said it was ok to take the metronidazole whilst on MXT but just to be sure, I checked with the rheumatoid nurse who says absolutely not to take MXT whilst on the antibiotics. I'm now worried about which is the right advice but also, if mum has to miss a dose of MXT, that she may have a bad flare up again. So grateful for any experiences others can share on this one.

paula.

0 likes, 9 replies

9 Replies

  • EileenH
    EileenH Paula2212

    Posted

    This is from a site called rheuminfo

    "What should I avoid while taking Methotrexate?

    Use alcohol in moderation (1 drink per week or less).

    Do not get pregnant.

    Do not take antibiotics containing sulfa (Bactrim or Septra)."

    That suggests that other abx are OK so your pharmacist was right in that sense.

    However, what happens is there is an issue of toxicity of the methotrexate as antibiotics tend to prevent the complete break down of MTX.  If MTX can’t be broken down appropriately, higher amounts may be found in the body and that can lead to increased side-effects. 

    Is she due her MTX dose soon or was it just a day or so ago? That would mean she'd be able to take her next dose just a bit late. Or could she up her dose of pred for the 10 days? That is what many of us who use pred do and that should also deal with the risk of a flare I think.

    Perhaps calling your local hospital pharmacy might elicit a more informed reply than the local chemist gave?

    • EileenH
      EileenH

      Posted

      PS  In case you haven't seen it, I'm sending you link for a methotrexate leaflet from the NHS which also mentions just the 2 specific antibiotics
    • Paula2212
      Paula2212 EileenH

      Posted

      Thanks ever so Eileen. 

      Mum started the antibiotics yesterday and is due her MXT today. By the time of the next MXT dose, she will just have finished the antibiotics so that should be ok. Thanks for the 

      leaflet too.

      best wishes.

      paula.

    • EileenH
      EileenH Paula2212

      Posted

      So she'll just miss the one? That shouldn't lead to a flare. Hope it all works out OK and the abcess heals.
    • Paula2212
      Paula2212 EileenH

      Posted

      Yes, just the one Eileen so fingers crossed!

      thanks again.

      paula.

  • ann19155
    ann19155 Paula2212

    Posted

    Hi Paula as you know mtx is an auto immune suppressant so when your mum's rhuemy

    Nurse said do not take mtx along with the anti biotic I think what she was really

    Saying if your mum takes the two meds together it will take longer to clear

    Up the infection in her mouth so ideally to miss one dose of mtx will not unless

    Incredibly unlucky cause a flare up what she means is to miss a dose of mtx

    Will just give her body a bit of a boost to clear up infection however at the

    End of the day it's up to your mum and how she feels about it either way it won't

    Cause any dire effects and all that's likely to happen by staying on mtx is

    That she will need a repeat script for anti biotics to clear infection I should

    No have had R.A for 10 years and learnt all this through trial and error

    I hope this helps

    Regards

    Ann

    • Paula2212
      Paula2212 ann19155

      Posted

      Hello Ann and many thanks to you for replying and sharing experiences. What you have said makes sense to me. We have missed yesterday's dose and hopefully all will be well. I've been looking after mum recently but have to go back to work Monday week so hope no flare ups for her as its hard for her when I have to leave her on her own during the day.

      hope all is well with you.

      paula.

  • ann19155
    ann19155 Paula2212

    Posted

    Hi Paula glad to have been of help anything else I can give advise to just give

    Me a shout iv been taking mtx now 20m for ten yrs now unfortunately its been

    Giving me a lot of side effects which I can't cope with the injections made

    Me very sick so I'm just on steroids to control ( try) the pain and I'm waiting

    To hear from hospital to see what else they are going to give me but the

    Overwhelming tiredness I get is unbearable its like hitting a brick wall but I'm

    Sure your mum's told you that anyway I'm glad I could be of help

    Regards

    Ann

    • Paula2212
      Paula2212 ann19155

      Posted

      I do hope that the hospital can find something to help with your pain Ann, that doesn't give you side effect problems. I can only sense how bad RA pain is from my own mums face when it's a particularly bad day and she is not one to complain. As for tiredness, yes indeed, my mum sleeps almost as much as my father did and he had renal failure and was on dialysis years ago before he passed away. I'm sure if I didn't wake my mum she would be asleep in the chair most of the time!

      take care and thanks once again.

      paula

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