Hi everyone!
I did a resharch project on mtx and i mentioned i would make a post about my findings...sorry it took so long i've just been so busy. all the information i got was from professional journals and books. I used 13 different journals (all were peer-reviewed articles), and 2 books.
mtx was approved by the FDA in 1988 for the treatment of RA. It's used as a base for which other drugs are added for the specific individualised treatment.
Mtx is taken once a week orally or by injection. the dose is usually 3 pills (2.5 mg each) for 7.5mg total. it is taken all at once or in divided doses over a 24hr period. it may also be given by IM injection once a week for people who can't tolerate the med orally.
side effects include mainly GI symptoms including; nausea, vomiting, anorexia, mouth sores, diarrhea, upset stomach, ulcers. other side effects include decrease in blood counts, liver and kidney damage
the med works by altering the way your body used folic acid, it also decreases inflammation. it takes 2-6 months to establish a therapeutic blood level so patients can see and feel its effects. it has also been found to alter the basic disease and has been classified as a second-DEMARD. it results in fewer erosions and less narrowing of joint space and less disaility.
mothly blood work is required to monitor the effects on the liver, kidney and bone marrow. a CBC with differential is used to monitor a dec in RBC, WBC and plts. serum asparate aminotrasnferase (AST) and serum albumin for liver along with blood urea nitrogen and creatine levels for kidneys
origionall in higher doses mtx is used for chemotherapy. in 1988 it was approved in the lower doses for RA. many other autoimmune disorders also use this drug. they include lupus, chrones, and asthma for its steroid sparing properties. other drugs for RA that are used with mtx most commonly include sulfasalizine, and plaquinil. its use with other DEMARDS is effective because the disease itself is so individualized that in combo it increases the effectiveness of each med to get the desired effect
for people who don't tolerate or can't take mtx alternatives include, pinicillamine, gold compounds, azathipine, cyclosponin and steroids. resions for not tolerating are; age, adverse effects, other diseases that comprimise the kidneys or liver
medication errors and cost/ year along with adherance are major concers. med errors follow 3 catagories. one includes misread directions by the pt. second is attributed to the prescriber and the third involved the dispencer. adherence with mtx is highest among all meds for RA pts. cost in 199 was estimated at 8.8 billion. 4.8 for medical management and 4.0 for oppertunistic disability
the factors that influence economic cost are not only the cost of the med iteslf but also the associated monitoring and disease progression. the monthly cost for the med is estimated at 6.83. maitness monitoring and doctors visits add another 3. (these numbers are without any insurance coverage) the high monthly cost has been the major influence of noncomplience.
I wish i had a way of putting up the charts and graphs i copied out of the medical journals. I hope this was somewhat helpful, for my project i had to cover all the bases. If you want to know somthing i didn't include please ask...i would love to be a source of answers and not just questions!
-Jessica
JessicaJessica,
You did a lot of research - thanks for posting the info!
In Australia, mtx is avail. in a 10mg pill as well as the 2.5 mg size. We are fortunate to have it on the Pharm. Benefits List, which means that we can access it at a much lower cost. The cost of meds and medical treatment generally in the USA horrifies me.
I've generally been on a 10 mg a week dose but have had it upped to 25 and 27.5 some years ago when the RA ws rather vicious. When first commencing it, I did feel slightly nauseous and not quite steady when walking thru doorways - but that settled down after a while. Each person reacts differently to the meds, which is why for some folk the very thought of mtx makes them heave
When first dx'd I was put on penacillamine + 5 mg of pred. a day. the pen. eventually did a number on my gut and I ended up in hospital for a couple of days while the docs tried to find out why I felt like there were a whole heap of fish bones in my stomach
Lorraine
thinkthin- (with my version of chemistry-way simplified), the folic acid combines with mtx and both are changed into a new compound (all have big long names i can't pronounce) that causes it to have an effect that causes another effect and so on untill the process is done. i'm going to have to look for this picture that explains it better. but mtx uses the folic acid sort of like a boat to get to an island (the island being inside your joints). the reasion people have to take folic acid is because it gets used up and doesn't function in the body any more (with the normal amounts you injest with food.) one of the articles also said that the bad GI side effects could be from the lack of folic acid (aparently they can resolve once people take extra folic acid). all i know about blood work is some things take a while to become measurable enough to have a result, and with the somewhat dangerous things it can do to the systems of your body it seems like a good idea to keep track.
Lorraine- its nice to hear that mtx works for you, thats what my ra doctor want to eventually put me on, which is what inspired me to use it for my project. Its nice hearing that your liver is doing good (i think its so funny to talk about organs) however my doctor was telling me that its really really toxic to the liver, even one drink can put you into liver failure...and reading that some drs say one drink is ok, and others have wrote that they drink and their fine makes me wonder what the real deal is, my resharch didn't say much on alochol consumption. What are some other differences with medications and the medical prossess in Australia. I've noticed over the years a lot of medical studies are done and the findings compaired to other country's.
-Jessica
Jess,
I've spent a few hrs at computer and it is time to devote the rest of my day to hub and house - but will check out a few things for you and get back to you in next few days.
L.