By Dr Irwin Lim, Rheumatologist
If you've been a reader of this blog, you'll know that Methotrexate is a go-to drug for rheumatologists (read the reasons why).
It's considered safe, in the hands of rheumatologists and with monitoring.
It's considered the cornerstone of effective treatment for rheumatoid arthritis, it's a standard medication for psoriatic arthritis, and we often use it for it's "steroid-sparing" effect (to reduce the need for steroid).
But, not everyone can tolerate it.
It's important patients know this. There are alternatives and I don't expect my patients to accept side effects which are significant to them, or to me.
When I think about it, the reasons/situations I would stop Methotrexate include:
- Side effects that worry a patient. Such as nausea or hair loss.
- Serious side effects that worry me. For eg, a rare reaction such as lung irritation/inflammation.
- Abnormal blood tests. Usually worsening liver function tests over time.
- Infections. I would normally withhold Methotrexate if there is a significant infection eg a pneumonia, and I would stop the drug permanently if recurrent infections occur.
- Patient Concern. Some worry so much about the drug, and even though I may not agree with the degree of worry, I don't think it's worth persisting with a medication if a patient is experiencing mental anguish.
- Inefficacy. There's no point persisting with a therapy that does not seem to be working (except that Methotrexate may be useful in combination with other drugs).
Have you had to stop Methotrexate for any other reason?