6 reasons why I stop Methotrexate
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?Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.