Laxatives And Methotrexate: Safe Mix?

can I take laxatives with methotrexate

Methotrexate is a drug used to treat rheumatoid arthritis and other inflammatory conditions. It is known to cause severe drug interactions when taken with many types of medications, including laxatives. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin should be avoided while taking methotrexate as they can affect kidney function and increase the risk of serious side effects. It is important to consult a doctor or pharmacist before taking any new medications or supplements, including laxatives, while on methotrexate to avoid adverse effects and ensure the benefits outweigh the risks.

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Can laxatives be taken with methotrexate?

Laxatives are not listed among the drugs that are known to interact with methotrexate. However, there are many medicines that affect the way methotrexate works, and it is important to inform your doctor or pharmacist if you are taking any other medications, including herbal remedies, vitamins, or supplements.

Methotrexate is a drug used to treat rheumatoid arthritis and other inflammatory conditions. It is also used in the treatment of severe psoriasis and some types of cancer, such as breast cancer, lung cancer, lymphoma, and leukemia. The drug can be taken orally, intravenously, intramuscularly, or intrathecally, but oral therapy is preferred, especially for low dosages. It is typically taken once a week and can be taken with or without food. However, food delays absorption and reduces peak concentrations.

It is important to note that methotrexate may cause serious or life-threatening side effects, including liver damage, lung damage, and damage to the lining of the mouth, stomach, or intestines. It can also decrease the activity of the immune system, making individuals more susceptible to infections. Therefore, it is crucial to discuss any other medications or supplements with a doctor or pharmacist before taking them concurrently with methotrexate.

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What are the side effects of methotrexate?

Methotrexate can cause a wide range of side effects, from nausea to nerve cell damage. It's important to note that not everyone experiences these side effects, and many patients on methotrexate have few or none at all. However, it is crucial to be aware of the possible side effects so that you can report them to your doctor promptly and take appropriate action if necessary. Here are some of the common and serious side effects associated with methotrexate:

Common side effects:

  • Sensitivity to sunlight: Methotrexate can make your skin very sensitive to sunlight, leading to reactions that resemble sunburn.
  • Feeling sick or vomiting: Eat simple meals, avoid rich or spicy food, and try taking small, frequent sips of water to prevent dehydration.
  • Stomach pain or indigestion: Rest, eat and drink slowly, and try using a heat pad or hot water bottle for stomach aches.
  • Feeling tired or drowsy: Avoid driving, cycling, or operating machinery if you feel tired or drowsy.
  • Hair loss or thinning: This is typically dose-related and may be less likely if you take folic acid alongside methotrexate.
  • Mouth sores: These can spread to the oesophagus or stomach and cause pain, discomfort, or sensitivity when eating, chewing, or swallowing.
  • Diarrhoea: Minor cases can be managed at home, but contact your healthcare provider if you experience a fever, increased bowel movements, prolonged diarrhoea, or bleeding or soreness in your rectal area.
  • Skin problems: Low doses of methotrexate have been associated with rashes and other skin issues.

Serious side effects:

  • Liver problems: Methotrexate can cause liver damage, especially with long-term use or in those with a history of alcohol consumption. Your doctor should monitor liver function regularly.
  • Lung damage: Pulmonary toxicity can occur, with symptoms such as a persistent dry cough or shortness of breath.
  • Kidney damage: Methotrexate can cause kidney problems, especially in those with pre-existing kidney issues. Watch for worsening side effects and monitor kidney function through lab tests.
  • Blood cell effects: Methotrexate may cause myelosuppression, leading to a reduced production of red blood cells, white blood cells, and platelets, increasing the risk of infection and fatigue.
  • Nerve cell damage: In rare cases, methotrexate can cause brain or spinal cord problems, resulting in seizures, confusion, or blindness.
  • Serious allergic reaction: Although rare, anaphylaxis can occur, requiring immediate medical attention.
  • Embryo-fetal toxicity: Methotrexate can cause embryo-fetal toxicity and fetal death. It is contraindicated during pregnancy, and effective contraception is advised during and after treatment.
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What are the benefits of methotrexate?

Methotrexate is a disease-modifying anti-rheumatic drug (DMARD) that is used to treat rheumatoid arthritis, psoriatic arthritis, and other autoimmune and inflammatory conditions. It is one of the most commonly prescribed arthritis medicines, with around 900,000 people in the US taking it, often as a first-line treatment. It is also used at much higher doses to treat some forms of cancer.

Reducing Inflammation

Methotrexate is an immunosuppressant, which means it suppresses the activity of the immune system. This helps to reduce inflammation, pain, and swelling associated with arthritis and other autoimmune conditions. It does so by causing cells to release adenosine, a molecule that blocks inflammation-promoting chemicals. Methotrexate also slows down the production of cytokines, which are proteins that promote inflammation.

Assisting Tissue Repair

Methotrexate helps white blood cells repair damaged tissues, which can be beneficial in reducing the symptoms of arthritis and preventing further joint damage.

Slowing Disease Progression

As a DMARD, methotrexate does more than just treat symptoms; it also slows down the progression of the disease. This can help prevent long-term damage to the joints and improve long-term outcomes.

Cost-Effectiveness

Methotrexate is one of the most cost-effective medicines available for rheumatoid arthritis. Its relatively low cost makes it accessible to a large number of patients.

Safety Profile

Methotrexate has a milder side-effect profile than other medicines used for rheumatoid arthritis. It is generally safe when taken at the recommended dosages, and serious side effects are less common. However, it is important to monitor liver function and overall health through regular blood tests while taking this medication.

Quick Onset of Action

Methotrexate can start to reduce arthritis symptoms within 3 to 6 weeks of starting the medication, with full benefits seen within 12 weeks. This is faster than many other arthritis medications.

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What medications should be avoided when taking methotrexate?

Methotrexate is a drug used to treat severe psoriasis, rheumatoid arthritis, and some types of cancer. It is known to cause severe drug interactions when taken with many types of medications.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. These medications can affect kidney function and increase the risk of bone marrow suppression, anaemia, and damage to the stomach and intestinal lining when taken with methotrexate.
  • Antibiotics for bacterial infections, such as co-trimoxazole, trimethoprim, and amoxicillin. Antibiotics can reduce the absorption of methotrexate, leading to a buildup of the drug in the body over time and causing toxicity.
  • Epilepsy medicines such as phenytoin and levetiracetam.
  • Diuretics, such as indapamide and bendroflumethiazide. Methotrexate may hinder the actions of diuretics, reducing their therapeutic effect.
  • Proton pump inhibitors, such as omeprazole, esomeprazole, and lansoprazole, which are used to treat indigestion.
  • Folic acid or vitamin supplements containing folic acid (folate). However, your doctor may prescribe folic acid to be taken with methotrexate.
  • Alcohol. Drinking alcohol while taking methotrexate can increase the risk of liver toxicity.
  • Live vaccines.
  • Anticonvulsants, such as fosphenytoin, levetiracetam, or phenytoin.
  • Other medications that may affect the liver, such as azathioprine.
  • Penicillins, such as amoxicillin or carbenicillin.
  • Tetracycline antibiotics.
  • Sulfonamides, such as sulfasalazine.
  • Vaccinations, such as BCG or live vaccines.

This list is not exhaustive, and it is important to consult with a healthcare professional before taking any new medications or supplements while on methotrexate.

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What precautions should be taken when taking methotrexate?

Methotrexate is a strong medication that can cause very serious, life-threatening side effects. It should only be taken to treat cancer or certain other severe conditions that cannot be treated with other medications.

  • Tell your doctor if you have or have ever had kidney disease, excess fluid in your stomach or lungs, liver disease, lung disease, stomach ulcers, ulcerative colitis, or any infection. Also, inform them if you are taking any other medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or antibiotics.
  • Methotrexate may decrease bone marrow function, so inform your doctor if you have or have ever had low blood cell counts or any other blood cell problems. Contact your doctor immediately if you experience any signs of infection, unusual bruising or bleeding, excessive tiredness, or shortness of breath.
  • The drug may cause liver damage, especially with long-term use or in those who are elderly, obese, or have diabetes. Your doctor may order liver biopsies before and during treatment. Avoid alcohol, as it may increase the risk of liver damage.
  • Methotrexate may cause lung damage. Report any dry cough, fever, or shortness of breath to your doctor immediately.
  • The medication may damage the lining of the mouth, stomach, or intestines. Stop taking methotrexate and contact your doctor if you experience mouth sores, diarrhea, bloody stools, or vomit that resembles coffee grounds.
  • It may increase the risk of developing lymphoma.
  • Methotrexate suppresses the immune system, so you may be more susceptible to infections. Inform your doctor if you have any type of infection or a condition that affects your immune system. Avoid crowded areas and sick people, and wash your hands frequently.
  • Do not become pregnant while taking methotrexate, as it can cause birth defects or death in unborn babies. Women of childbearing age should use reliable birth control while taking methotrexate and for at least three months after stopping. Men taking methotrexate should continue using condoms for at least three months after stopping treatment.
  • Do not breastfeed while taking methotrexate, as it passes into breast milk and may harm the infant.
  • Avoid prolonged sun exposure and use protective clothing and sunscreen, as methotrexate may increase sun sensitivity and make your skin more prone to sun damage.
  • Do not take any over-the-counter NSAIDs, including aspirin, or any vitamin supplements without your doctor's permission.
  • Keep all appointments with your doctor and laboratory to monitor your body's response to methotrexate and treat any side effects.
  • Stay hydrated while taking methotrexate.
  • Use a soft toothbrush and mouthwash to prevent mouth sores.
  • Avoid alcohol or keep intake to a minimum while taking methotrexate.
  • Inform all healthcare providers that you are taking methotrexate, and do not receive any live vaccines during treatment.
  • If you are a caregiver, wear gloves when handling body fluids, contaminated laundry, or diapers, as methotrexate can be transferred through these substances.
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Frequently asked questions

It is not clear whether laxatives can be taken with methotrexate. However, methotrexate is known to have severe interactions with many types of medications, so it is important to consult a doctor or pharmacist before taking any other medicines or supplements alongside methotrexate.

Methotrexate can cause mouth ulcers, nausea, vomiting, hair thinning or hair loss, and in rare cases, lung problems. It can also cause mild liver irritation and decrease blood counts. In some cases, it may cause serious or life-threatening skin reactions, bone marrow suppression, anaemia, and damage to the stomach and intestinal lining.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin should be avoided when taking methotrexate as they can affect kidney function and increase the risk of serious side effects. Antibiotics containing trimethoprim-sulfa, such as Bactrim, Sulfatrim, and Septra, should also be avoided as they can reduce the absorption of methotrexate in the body and lead to a buildup of the medication over time.

Alcohol should be avoided or kept to a minimum when taking methotrexate as it can increase the risk of liver toxicity. Grapefruit juice may also cause adverse interactions and should be discussed with a healthcare provider.

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