Thursday, March 31, 2011

Such A Good Patient

Being the model patient that I am, (all right - quit snickering, you guys) last night I settled in to read the six sheets of patient information that were tucked into the bag with my new prescriptions, methotrexate and cyclosporine.

I began with the methotrexate stack. For the most part, I anticipated the usual warnings, list of side effects, contraindications, dosage, etc.


Yeah, yeah, yeah.....Take only as directed, drink plenty of fluids, do not take if pregnant, may cause loss of appetite, nausea, tiredness, and vomiting. Let's see....what else....


Alcohol increases the risk of liver damage for people taking methotrexate.
The increased risk of liver damage is significant for people who are drinking alcohol while taking methotrexate. Ideally, you should not drink alcohol if you take methotrexate. At most, with your doctor's permission, you should have no more than two drinks per month.
Well. I was prepared for all that gastro-intestinal stuff, and I'm tired all the time already. more mango margaritas?


I suppose I like my liver better than any frozen drink. Aw, gee... The thought occurred to me that actually, the things I like best about mango margaritas aren't the alcohol. I like the tangy, cold, smooth, and sweet things about it.

How alcohol-free mango margarita? It's such a crazy idea that it just might work.

Why, yes, yes it does. Mmmmm.........


Leslie at SugarAndSpiceADK. said...

Oh Julia--my rheumy keeps talking to me about Methotrexate, but I really think there is no life for me without my 5 o'clock glass o' wine, while I'm starting dinner!

Andrea said...

Hi Julia

I really hope the injection is working wonders on your pinkie? I started on methotrexate 3 weeks ago and some wonderful people from the Lupus forum shared lots of helpful tips with me, which I thought I would pass on:

1. Take your mtx at night after a decent meal to greatly lessen the chance of nausea (I have had no nausea whatsoever - a really pleasant surprise!). If you are worried about possible nausea, have a script for an anti-nausea drug ready and waiting.

2. Folic acid greatly reduces the side effects of mtx and your rheumy has probably prescribed this anyway. Mine recommends taking 5 mg 24 hours before the mtx and not again during the week.I have a big note on the fridge to remind me that Tues is folic acid night and Wed is mtx night. Some rheumies recommend taking the folic acid every day EXCEPT the mtx day.

3. Some people have also said they take B12 and this has greatly lessened their side effects too. Maybe check this with your Dr. I have been injecting B12 daily for several years anyway (prescribed by my Dr when I was first so fatigued) - so maybe this is why I have been lucky with side effects.

4. Do expect to be tired the day after mtx and possibly the second day - and try to plan around this. I have to say it is a 'different' type of fatigue than autoimmune fatigue and I can tell that it is coming from a different source. In fact, I don't think it is anywhere near as bad as autoimmune fatigue -just like some fatigue icing on the cake! The mtx fatigue certainly lessended with the 3rd dose. Interestingly, my rheumy says that if mtx is for me, then it wil significantly improve the autoimmune fatigue long-term. Now that would be one almighty blessing!

5. The mtx can cause increased joint and muscle pain as a side effect. This has lasted 2 days after each dose for me, but less with this last dose. Apparently, the level of pain is dependent on the level of inflammation in your body at the time - so this can vary a lot. I have been told the pain is the result of accumulated dead inflammatory cells (killed by the mtx) in your joints and to help flush them out by drinking plenty of water. I have tried to be especially mindful of drinking filtered water, green tea and eating lots of vegies and fruit all during the week, but especially Tues - Thurs. I figure anything to support my body is a smart move.

6. Choose whatever day for taking the mtx that suits you and your lifestyle best. I work by myself from home so chose Wednesday, thinking that I can get 3 days work done and if Thursday is a bad day, I can get away with it and be back on track to wrap-up the week by Friday. I didn't want to take it on a Friday night and risk losing the weekend and time with my family. As it has turned out, it probably wouldn't matter what night I take it on - I hope the same is true for you.

I don't have anything to report on effectiveness yet - haven't seen any signs of different things happening in my body after 3 doses. Apparently, after about 4-6 weeks you should know if it's going to be effective.

All the best.


Julia Oleinik said...

Andrea - what a great list of suggestions! Thanks much! I will definitely look into them. My dr. wants me to take folic acid six days a week.

Anonymous said...

...I don't drink alcohol, at all, and thus have sort of grinned at the mango margaritas and been glad you like them. Now I'm curious what the non-alcoholic ones are actually like. :)