CVS Freaked me out! | Arthritis Information

 

I do think a lot of this is related to the nature of the disease - and this is a 'warn everybody' cover your butt sheet.  But DAMN!

 

Pip

P.S.  Research the MTX and Ibru combination.  I do know this sheet says nothing about apirin and thyroid meds...but you can't mix those either.  If somebody on a board hadn't warned me, I would have never known I was having a 'reaction'. 

I lasted only about 2 weeks - I just couldn't stand it any more, I was stiff and just miserable. I started taking OTC naprosyn at prescription doses. It took quite a lot of pressure to get him prescribing again. I really would have to be on pred without nsaids.[QUOTE=janlee]Hey Pip, I was just going to post something about Ibuprofen, I got my Mtx filled today at the same pharmacy I always use but this time a drug interaction warning came with it. My pharmacist explained that I should not be taking ibuprofen with the Mtx, said it could really damage the kidneys. the warning stated that incidence of toxicity may be increased. My Rd rx both together. just wandering if anyone has been prescribed same together.[/QUOTE] Did I post a thread about not taking aspirin with thyroid meds as it'll take us hypothyroid?  My head was so messed up last week that thought I did.  If not, it needs a new thread. Lovie, my pharmacist recommended  not to take IUB the same day as Mtx. I will be speaking to Rd about it. the warning said observe patient for signs of toxicity.it may be necessary to decrease the dose of MTX. I don't know if it's a new finding,but I have both filled at the same time when I first got dignosed. that was in Aug 07.I've read that MTX should not be used with NSAIDS, yet my RD gave me a prescription for Naproxen.  I think this sort of thing happens all the time because the doctors believe the drug companies are being overly cautious for legal reasons.  I've only taken the Naproxen a few times with the MTX with no ill effects, so far. It's very common to be told to take ibuprofen with MTX. I think a lot of those drug contradictions with MTX are when people are taking high doses for cancer therapy, not low doses like RAers are on. That said, aside from my first couple months I've had to use very little NSAIDs and I attribute that to my daily use of high doses of fish oil. Fish oil has amazing anti-iflammatory properties. By high doses I mean 10 grams equalling 3 grams of EPA/DHA, the same amount of fatty fish oil you would get eating fish twice a day.All NSAIDs now carry that warning, even those that have never been shown to increase risk of cardiac troubles.  There are some studies which indicate naproxen may be cardioprotective; however, it must bear the standard NSAID warnings for cardiac and GI problems.

Definitely make sure to consult with your physican(s) and pharmacist with any concerns or questions.  Also, you should use the same pharmacy for all your scripts, so they will be able to double-check for interactions, allergic reactions, etc.

MTX can cause liver or kidney damage in combinatin with the various NSAIDS> that is one of the reasons we have blood work monitoring.

No, that's the first time it ever was in the 'bag'.  And, reading I was like...ok, some of this makes no sense.  Cutting inflammation decreases our chance of heart attacks and stroke.  So, what is this, more chicken/egg stuff? [QUOTE=Pip!]No, that's the first time it ever was in the 'bag'.  And, reading I was like...ok, some of this makes no sense.  Cutting inflammation decreases our chance of heart attacks and stroke.  So, what is this, more chicken/egg stuff? God, you guys are funny tonight!

I've always had the information sheet given to me when I picked up my NSAID.  I stopped taking NSAIDs about a year ago and it took my body a little while to adjust but I felt it was one of the drugs I could safely drop from my regimen, I could live without it. 

A similar thing happened to a friend of mine when he took Vioxx.  He ended up in the hospital and on BP meds as well.  That was about a month before it was withdrawn.

I get heart palpitations when I take ibuprofen.  Naproxen doesn't give me any palpitations or blood pressure spikes, though it does irritate my stomach if I have to take it regularly for more than a week or so.  Luckily I haven't had to take it at all lately, except for a day or so when "Aunt Flo" stops by. The warning with any NSAID and MTX is because NSAIDS decrease prostoglandin synthesis. Prostoglandins are needed in order to dialate the afferent arteriole in the kidney leading to a higher glomerular filtration rate and a faster elimination rate of drugs that are renally excreted (ex. MTX). If prostoglandins are not present or decreased then the afferent arteriole constricts and you get much less filtration (hence when taking methotrexate you are unable to clear it from the body as quickly and it builds up leading to toxicity). This interaction however is only a concern when the doses of MTX you are using are very high, such as used in chemotherapy (as gimpy pointed out). RA doses are ~100x less so you can still use NSAIDS with it. You can always increase the rate of clearance of the MTX by increasing your fluid intake on the day that you take it, and it is always recommeneded that people taking high dose long term NSAIDS drink plenty of fluids. Most NSAIDS decrease your risk of cardiovascular problems (with the exception of Celebrex which increases it). The reason for this is that the majority of NSAIDS are inhibiting COX1 (Ibuprofen) or partially inhibiting it (ex. Etodolac or Aspirin -50%COXI, 50%COXII) which is cardioprotective. The reason for this cardioprotection is theorized to be a battle between two compounds. Protacyclin vs. Thromboxane A2. These are produced in different inflammatory pathways in the body. If COX1 is inhibited you don't get a buildup of TXA2 which causes platelets to aggregate, and the prostacyclin is dominant (which decreases blood clotting leading to cardioprotection). If COX2 is inhibited then the prostacyclin production is decreased and TXA2 builds up leading to increased risk of heart attack or stroke. Sorry for the long post, I hope this helps. Rx2Heal2008-03-14 21:30:02I'm not aware of this interaction. The aplastic anemia and bone marrow suppression are generally found with the methotrexate use. From what I understand high doses of methotrexate cause cellular death and usually the bone marrow is affected because it has very rapidly dividing cells that uptake the methotrexate quickly and die. The bone marrow is then unable to produce new blood cells at a quick enough rate. At the doses we take for RA we are not actually causing cellular death, instead we are inhibiting abnormal signals and growth (such as abnormal growth of the synovium) as well as decreasing the activity of T lymphocytes. Most doctors do not actually have good explanations as to how the MTX is working for us, and perhaps a lot is still unknown about it's role in the treatment of RA. Rx2Heal2008-03-14 21:40:33RX - then why all the concern about apoptosis (spelling) from these meds? Pip it's a balancing act between COX I and II which are two different inflammatory pathways. Aspirin is cardioprotective because it has antiplatelet effects and inhibits thromboxane A2. The moral of the story is if you inhibit COX2 and allow the other pathway t to go unchecked then thromboxane A2 builds up you get platelet aggregation and risk of subsequent heart attack (Vioxx etc.). Rx2Heal2008-03-14 21:51:34Snow Owl:
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