About Ulcerative Colitis · Treatments

Methotrexate and IBD

Hello friends,

I thought I would provide you all some of my insight of a common drug used to treat chronic illnesses, Methotrexate. I have been on it now for a month, so I felt it was an appropriate time to provide this update!

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What is it?

Methotrexate is used to treat a variety of things including certain cancers such as leukemia, non-Hodgkin’s lymphoma, breast cancer, head and neck cancer, stomach cancer, bladder cancer, bone cancer, and choriocarcinoma (a type of uterine cancer). In addition to this it has also been used to treat rheumatoid arthritis, psoriatic arthritis, psoriasis, and more recently Crohns and ulcerative colitis.

For IBD’s it works as an immunosuppressant, taming down the amount of activity happening in the colon by reducing how hard your immune system works. In turn, inflammation in the colon should go down. It is important to then be aware that you are more susceptible to other infections, especially because usually methotrexate is taken in combination with other medications for your IBD. For example, I am also on Remicade (every 4 weeks) and Cortiment (a steroid).

When and How Do I Take It?

Methotrexate is taken once weekly on the same day. It can either be taken orally through a tablet or through an injection. I am using an injection. The injections can be easily administered by yourself! It is injected into your muscles either around your stomach or thighs. Personally, stomach hurts the least for me and is easy to maneuver. However, if you are super squeamish I am sure you can ask a family doctor/nurse to help you administer it. Similar to Humira, always make sure to rotate the sites so there is no build up or scarring. From my understanding, you should not take it if you are more than 3 days late but always double check with your specialist or pharmacist of you are unsure, especially depending on your other medications.

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Folic Acid

I don’t now how many people, nurses, doctors and pharmacists have told me that it is super important I take folic acid while on Methotrexate. How often you take it will vary depending on your case and doctor. For myself, I take it everyday except on the day I take Methotrexate. It’s important you do not take it on the day of because it can make it less effective. Methotrexate actually depletes your body’s natural creation of folic acid, which is important in the generation, reparation, and functioning of DNA in your cells.

Side Effects & Precautions

Precautions

  • Anemia: Known to reduce your red blood cell count.
  • Bleeding: can reduce the amount of platelets in your blood meaning it could take a little longer for cuts to stop bleeding.
  • Dizziness/Fatigue: there is a warning that you should ensure you do not experience this. Always give yourself a couple hours before driving or operating heavy machinery until you know how your body reacts.
  • Hepatitis B and C infection: Methotrexate can cause reactivation of hepatitis B and C infections or worsening of existing infections.
  • Kidney function: Reduced kidney function or kidney disease may cause this medication to build up in the body.
  • Liver problems: Methotrexate can cause liver problems. Your doctor will check your liver function with blood tests before starting this medication and regularly during treatment. Do not drink alcohol while you are taking this medication as this can increase the chance of liver problems. It is also recommended to always talk to a pharmacist before taking certain cold or cough medications as they may have alcohol products in them as well.
  • Lung problems: Lung inflammation (interstitial lung disease), causing difficulty breathing has occurred in some people taking this medication. This complication can be serious and sometimes fatal. If you experience new or worsening shortness of breath or non-productive cough (with or without fever) at any time while you are taking methotrexate, contact your doctor immediately.
  • Nausea: Methotrexate may sometimes cause nausea. If you feel ill after taking methotrexate, do not stop taking the medication without first talking with your doctor. Your doctor or pharmacist may be able to help you with ways to reduce the nausea associated with taking this medication.
  • Sun sensitivity: You may be more sensitive to the sun while using this medication. Avoid excessive sun exposure and do not use sunlamps or sun beds until you know how this medication affects your skin.
  • Tumour Lysis Syndrome: Methotrexate, like many other cancer medications, causes many cancer cells to be suddenly killed when treatment is first started. This can overwhelm the body with waste products from the cells. As a result, the body may not be able to keep up with getting rid of all the waste. When this happens, you may experience nausea, shortness of breath, cloudy urine, or joint pain. This is called tumour lysis syndrome. Your doctor may prescribe medications to help your body get rid of the waste products. Make sure you understand how to use these medications and report any of these signs or symptoms to your doctor immediately.
  • Vaccines: Vaccines may be ineffective if given during treatment with methotrexate. Like most immunosuppressants, live vaccines are not recommended
  • Pregnancy: There is a possibility of birth defects if either partner is using methotrexate at the time of conception. If it is used during pregnancy, methotrexate may also cause birth defects or harm the baby. Talk to your doctor about how long you should wait to become pregnant after you or your partner stop taking methotrexate. If you become pregnant while taking this medication, contact your doctor immediately.

Side Effects

  • decreased blood pressure
  • dizziness
  • fatigue
  • hair loss- was not impressed with this one again
  • head aches
  • loss of appetite
  • nausea
  • upset stomach
  • diarrhea

More serious side effects (Check with Doctor as soon as possible)

  • blurred vision
  • confusion
  • cough
  • fever or chills
  • mood changes
  • mouth sores
  • red spots on skin
  • signs of anemia
  • signs of clotting problem
  • signs of infections
  • signs of kidney problems
  • signs of liver problems
  • skin rash
  • sore eyes
  • stomach pain
  • weight loss

Stop taking it if you experience

  • An allergic reaction (hives, difficulty breathing, swelling of the face, mouth, tongue, or throat)
  • Severe skin reaction (blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort)
  • convulsions (seizures)
  • signs of bleeding in the stomach (e.g., bloody, black, or tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)

What should you be aware of while on it?

  • Make sure you are getting routine blood work and liver tests done to monitor how the medication is effecting your liver and blood count.
  • Always review what vaccines you have had and may need to take before starting the medication
  • Go to the hospital for any sign of infection. Even minor infections while on Methotrexate can become serious.
  • Be aware of any medications/vitamins/or even natural products that could interact with the medication. There is a list of known medications that interact with it on the following site: https://www.rexall.ca/articles/view/870/Methotrexate. Whenever in doubt, talk to a pharmacist.

Information was found on:

Crohn’s & Colitis

Rexall

My personal experience? So far not so bad. Haven’t really had nausea but my appetite is pretty down. Sometimes I get dizzy and shaky and the fatigue kicks my ass. Honestly the hardest part is mentally preparing myself to inject myself. I would have been the worst drug user. Poking yourself with a needle is creepy to me. I mean the needle isn’t actually that big and it hurts way less than Humira. It feels a little tender after the injection where the medication is settling. Is it working? Well I seem to be on enough medication to keep me mostly stable right now. I have been told it can take up to 3 months for methotrexate to take full effects. Some people are on it for months, while others have been on it for years. It all depends!

But I hope you all found this useful!

Love,

Bee

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