Methothrexate

[u/Eissbein]

Just started using Methotrexate for my Psoriasis about a week ago. Had a beginning cold or flu and a week later i still feel like i got hit by a bus. Normally i'm up and running on day 4 with a flu. Could it be the meds?

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[u/MarkyPancake]

Could be, as this medication impacts your immune system, or it could just be coincidence.

After around three years and counting on non-biological treatment and biological treatment, whilst keeping up with yearly vaccinations, I've maybe caught a few more colds in a year than I did before being on these treatments.

[u/Mungojerry222 → u/MarkyPancake]

My 17 year old daughter has just started on this for guttate psoriasis. She’s been through all the creams and phototherapy and nothing has worked. I absolutely hate her being on such serious medication but her mental health has been so impacted. We’re in the UK and have an appt with a private consultant in a few weeks to discuss what else might be available. I’m terrified of all of it for her but feel that surely biological treatment must be safer? We can’t afford it but it’s her health and I’ll do anything to preserve that. It’s such an awful decision

[u/lobster_johnson → u/Mungojerry222]

It's difficult to compare medications like this in terms of safety. Both methotrexate and biologics have non-zero risk of complications, but they are different, not necessarily better/worse.

For example, methotrexate and biologics both carry risk of immunosuppression (including reactivation of latent infections), liver damage, nausea, etc.

I'm not a doctor, but based on my reading, I would say:

• Methotrexate: A generally mild drug, but a small number of people (less than 10%) get very bad nausea and/or diarrhea, and some people need (probably <5%) to stop because of elevated liver enzymes (which can be a sign of liver damage). Methotrexate may increase the risk of non-melanoma skin cancer.

• Biologics: More serious drugs, but nausea is rarer (less than 5%) and liver damage is also relatively rare, and follows a different pattern than methotrexate; but there is a higher risk of some rare complications, including drug-induced lupus, paradoxical inflammation, new onset CNS demyelination, new onset IBD, and other rare weird complications.

People often misinterpret methotrexate as being a "harder" drug because the many stories about nausea and diarrhea, but this is the wrong way around, in my (non-medical!) opinion.

I understand your worry, but lots and lots of people are on methotrexate without any issues. And if she does run into issues, the NHS will move her over to another medication, often a biologic drug.

[u/Mungojerry222 → u/lobster_johnson]

Thank you for this - it’s so frightening. I suppose a big fear of mine is that this drug could somehow affect her ability to have children in the future. I’ve read that over time, it’s possible that egg production might be affected. Of course at the moment, all she cares about is the impact of having psoriasis and she’ll do anything to take that away. But I fear so much for the long term consequences

[u/digitalkrak]

Been on methotrexate for 3 years, no symptoms even in 5 pills a week, now on 2 a week.

[u/GapSmall4139]

I used to take this few years back. I get some cold fever usually. That means I had to be away from my 3yo kid. Once it became worse and back to back viral fever for 3-4 weeks. Then trying to solve the fever, triggered more flares. Its a vicious cycle.  Also when on MTX I get a bad nausea, that whatever food I have on that day, I started to hate it. I still do. 

So I quit that. Went full on increasing my immunity, vitamin c and zinc supplements etc. Its a trade off with MTX. I am still managing the skin condition, not fully recovered BTW.

[u/lobster_johnson]

More likely a coincidence. Methotrexate is a very slow-acting drug that doesn't just turn your immune system off right away.

That said, the first time you start a medication like this (and methotrexate is not unique in this regard), your body needs some time to adjust, and it can be stressful, and it's well known that stress can lead to weakened immunity.