Methotrexate vs plaquenil side effects long term and short term

[mysteria]

I was recently diagnosed with an autoimmune disease that mainly fuses my joints together, but causes severe pain and fatigue. The only problem is the Plaquenil causes severe headaches that interfer with my daily activities also. But the Dr suggested I try Methotrexate instead. I'm scared to death since I know it is for cancer patients. What are the short term side effects vs the long term for both of these meds. If you were me, would you deal with the headaches and nasua or try the methotrexate?

[AuntieLeela]

The MTX dose for autoimmune disease is about 1/1000 the dose they use in cancer patients. MTX also has a long clinical history, which makes it a trustworthy drug, they'll be no "surprise" side effects.

All immunosuppressant medications increase your risk of infection.


Still, MTX does have side effects - doesn't mean you personally have any of them, a few lucky ones get away scot free - but most folks have some trouble at least at the beginning of treatment: nausea, stomach troubles, hair shedding (mild to moderate hair loss that grows back, Plaquenil can cause this too, but having any chronic inflammatory condition can cause hair shedding), anemia (again, any chronic inflammatory condition can also cause anemia) and fatigue. You can take what's called a "methotrexate rescue", a drug that binds to MTX in your blood and sweeps the unused MTX out of your system. It's this MTX that "hangs around" that causes most of the side effects. The rescue drugs are Leucovorin or simple high dose folic acid supplements.

My question would be, how well is Plaq working for you?

If you do continue taking Plaquenil, you'll need to have your eyes checked on a regular basis (every 6 months to a year) to avoid a rare side effect that can damage your vision.

[mysteria]

Thanks so much for the feedback! Plaquenil works really good except for the migranes. I think I'll try mtx and see if headaches go away. Hair shedding, oh no, I've always had terrible hair till now, I have long dark thick healthy hair, me and my husband both will be sad if I lose much of it. It does fall out daily, a lot, but haven't noticed it thinning too much yet. I have noticed dramatic change in my vision but I thought it was from the headaches.Better go see eye doc again. Thanks again! I know I can't function without something it feels like I have rolled down a mountain and been shoved in a suitcase for a week if I don't take anything. So I guess its a matter of the lesser of the evils.

[jennybyc]

Hi Mysteria....I spent about 7 years on Plaquenil and 5 years on MTX and just recently went off both as I see just how well another drug works. Plaquenil caused worse hair loss with me than the MTX...about half my hair fell out but I'll take bald over pain any day. But I had to stop as I developed eye problems. They turned out to have NOTHING to do with Plaquenil....rheumatoid optic neuropathy. Other than the hair loss, I had no side effects. And the MTX did cause some stomach problems but I switched to injecting it once a week and that was solved. But I was tired the first 24 hours after taking it.

In case your doc hasn't told you, you take MTX in one dose, once a week. You usually have to take folic acid to keep from getting too anemic. The other drug Auntie Leela mentioned, Leucovorin, you take at 8-10 hours after the dose of MTX to stop it's effects. But it really does help.

But I have to mention that the side effects you are having may be from your disease. I post on the Spinal Cord Disorders board and the number of folks with cervical spine arthritis with severe headaches and nausea is astounding. If you are fusing joints, how are the vertebrae in your neck? Arthritis there could be causing the headaches or since you mentioned migraines, people with migraines have reported a big increase with neck problems. Something to consider if they continue with the change in meds.

MTX is very safe and well studied. It's been used as a first line drug for over 30+ years so the studies are there to support it's safety. You usually start at a low dose and work up with lots of blood work in between. My doc insists on blood work every 4 weeks with MTX.

I hope MTX will help you. I know Plaquenil takes a good 6 months to really kick in so if you don't feel good while waiting...go on to something that works faster. And if that doesn't work, there are lots of new drugs out there that are doing miracles for many. But insurance companies won't pay for them until you've been on all the other stuff that is cheap. These biologic drugs cost about $2000 per month to take compared to $30 for a 3 month supply of MTX.

And sometimes, what works best is a combination of drugs. I've stopped everything to go on Orencia(a biologic) and I think he'll add either Plaquenil or MTX back on later this month to control what is left.

We are here for support and to share our experiences. Any questions, we will try to answer. Let us know how it goes.

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

[dorice]

Originally Posted by mysteria

I was recently diagnosed with an autoimmune disease that mainly fuses my joints together, but causes severe pain and fatigue. The only problem is the Plaquenil causes severe headaches that interfer with my daily activities also. But the Dr suggested I try Methotrexate instead. I'm scared to death since I know it is for cancer patients. What are the short term side effects vs the long term for both of these meds. If you were me, would you deal with the headaches and nasua or try the methotrexate?

Hi I've been on Methotrexate for the past 10 months - it's giving me an excellent quality of life while I've been diagnosed with RA- however I have dreadful side effects of nusea, which is getting me down. I have started having Methotrexate in injection form, and so far this hasn't made any difference. I have an appoitment with my GP soon and will definately be asking for an alternative.
Hope this helps. Best regards.