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methotrexate questions

Hi Everyone,

I recently began weekly low-dose Methotrexate (for Sarcoidosis, but I am not finding a lot about it on those forums). I'm currently doing 5mg a week and will soon be worked up to 15mg. I know that MTX can be hard on the liver and I'm concerned about accidentally doing something that might damage my liver or throw off my monthly blood work. I was hoping to just run a few substances by the forum and get a yay or nay on whether they would be okay while on MTX. I apologize in advance if this has already been covered elsewhere on the forum.

1. Valerian root tea.
2. Neurotransmitter supplements like Gaba or 5-htp
3. Over the counter pain medication like Ibuprofen or Acetaminophen. If those are a no go, are there any safe alternatives for the occasional headache?
4. Biotin supplements.

This isn't specifically a liver question, but I've also heard mixed things about caffeine and MTX. Any thoughts on that would also be greatly appreciated.

Thanks so much!

  1. I can't speak to those items on your list, but I can tell you that any alcohol potentiates the MTX, so you need to exclude alcohol altogether.


    I would use Tylenol for headaches.

    1. Hi - thanks for commenting! We cannot give medical advice over the internet, for your safety. So I would ask that all commenters share their own personal experience of what they took that has or hasn't helped rather than give you advice. The reason for this also is that with RA, there isn't a one-size-fits-all approach and what worked for some, might not work for others based on their unique personal medical history. So just something to consider! But thanks for asking your question and I'm sure other community members will weigh in soon. - Reggie (RheumatoidArthritis.net Team)

      1. Your best option is to ask your doctor what testing they have planned while you are using MTX. I am guessing that they will have a specific testing protocol.

        1. Hi . As Reggie mentioned, the effects of treatments can vary widely by individual. In fact, sometimes for the same individual. My wife, Kelly Mack (a contributor here), took methotrexate successfully for many years. At one point her doctor added hydroxycloroquine to her regimen and her bloodwork monitoring her liver went through the roof. This was in spite of the fact that she had successfully taken the two drugs together many years earlier. This example also illustrates the importance of getting regular blood work to monitor the impact of medications, as Rick mentioned. One of our other contributors wrote here about methotrexate side effects and his experience on the drug, including the fact that folic acid is often prescribed to help mitigate some of the side effects: https://rheumatoidarthritis.net/living/methotrexate-the-ra-drug-many-love-to-hate. I hope this helps some with your questions and your doctor should be able to provide further guidance. Best, Richard (RheumatoidArthritis.net Team)

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