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Old 08-23-2010, 03:00 PM   #1
Join Date: May 2009
Location: Calgary AB Canada
Posts: 148
Sensitivo HB UserSensitivo HB User
Baseline eye exam and Methotrexate

I received my first prescription for Methotrexate today. My physician asked that I get a baseline eye exam, since my most recent exam was one year ago. It's the busy "get ready for school" season, and I can't be fit in for a little more than a week. Having waited more than a month for my medical appointment already, with a noticeable deterioration in the function of my joints every week, I'm desperate to start the Methotrexate as soon as possible. Does anyone know if it would be OK to take one dose this week before the eye exam? Surely things with my eyes can't change that quickly.

Old 08-23-2010, 06:18 PM   #2
Join Date: Feb 2009
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jennybyc HB Userjennybyc HB Userjennybyc HB User
Re: Baseline eye exam and Methotrexate

Unless your doc said not to start it before the eye exam, you should be able to start it okay. Plaquenil is the one drug that you need the eye exam prior to starting the drug as they really need that baseline. If it's going to affect your eyes, tends to do so in the first 6 months. but I don't think MTX is the doc hasn't made me get it prior to treatment but he is adamant about yearly eye exams.

You do know it takes time for MTX to work. They start you on a low dose and work you up slowly. How much is your starting dose? And did you get a script or told to take folic acid daily?

If you find that MTX bothers your stomach, you can take the pills over the span of an entire day rather than taking them all at once. If you are starting on something like 3 pills a week, then you can probably take all 3 at once without a stomach problem but I took one with each meal just to be sure. As it went up, I added an extra pill at the breakfast and then dinner and then lunch so as to give the greatest amount of time between doses. It's just important to take them all on the same day. Now I just do a shot and no stomach problems unless I get up above 20mgs/day. Then I do 2gms of folic acid a day instead of 1gm.

So chug away and let me know how it goes.


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Old 08-24-2010, 08:55 AM   #3
Join Date: May 2009
Location: Calgary AB Canada
Posts: 148
Sensitivo HB UserSensitivo HB User
Re: Baseline eye exam and Methotrexate

Thanks, Jenny, for your quick response. My doctor didn't specifically mention having the eye exam before starting. I checked for internet articles and found one that said that only 30-some percent of rheumatologists routinely prescribe a baseline eye exam before Methotrexate, and that the same percentage (high 30's) never do. I'm wondering if my doc wants the baseline in case I have to add something like Plaquenil, or because we'll be discussing switching to a more potent osteoporosis medication at my next visit. I understand some of these can affect the eyes.

I'll be starting with 10 mg (4 pills) MTX. I was also given a prescription for 5 mg daily folic acid. This is more folic acid than most references I've found, although I did find one from a reputable source that recommended this amount. Perhaps my doc has done this due to my usually high likelihood of severe side effects on medications. Regardless, from what I've read, high doses of folic acid aren't dangerous. I'll discuss whether to split the MTX dose with the pharmacist. Thanks for suggesting this.

Old 08-24-2010, 02:27 PM   #4
Join Date: Feb 2009
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jennybyc HB Userjennybyc HB Userjennybyc HB User
Re: Baseline eye exam and Methotrexate

I like the idea of the 5gms. of folic acid. I know you have other problems too and you need some protection from the drug but also need it's benefits.

$ pills might upset your stomach but if you take 2 with breakfast, 1 with lunch and the last with dinner, you should be fine. It's not that important to take them all at once but that you take them all within a certain time over 8 hours. I know when I had to use Leucovorin to stop MTX from working due to it causing stomach ulcers(again), I had to take it 8 hours after taking the MTX so I did have to take it all at once or over the period of a hour. That was when I switched to the shots. That I can do all at once. Insulin syringe is all you need and then you pop it into the thigh or tummy. Don't feel a thing and it saved my stomach. so if the pills bother you, there is an alternative.

BTW, 4 pills is a pretty normal starting amount. The maximum they are supposed to give you is 25mgs. I think most people find a good level around 15-20mgs. I'm at 7 pills or 17 1/2mgs or .7 milliliters on the syringe.

Let me know who it goes.

gentle hugs..............Jenny

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