Anyone use AP with methotrexate?

[mj47]

Hi all.
It’s been a long time since I wrote on here (on behalf of my husband). He’s been on AP for years to manage his Psoriatic Arthritis. It’s been helpful for sure, but this winter he’s been having a horrible flare that’s got him on crutches and icing his joints as much as possible everyday. His quality of life is suffering and he’s ready to try something else. His dr recommended he try methotrexate again. He used it when he was first diagnosed (orally) and it worked amazingly well for him…so well, he thought he didn’t need it and stopped taking it. Then he flared again and went back on it at a higher dose (again orally) and had terrible side effects so he stopped. That’s when he found AP and has been on it since.
His dr seems to think injectable methotrexate (MTX) could be used at a lower dosage than his last oral dose since it’s more efficacious when injected and that the side effects will be far less. Problem is, he also told him doxy (which is what my husband takes since mino eventually gave him bad reactions) is contraindicated with MTX use. So he’s been off AP for 6 days now to clear out his system. But I’m curious if anyone has taken low dose doxy with MTX…all the articles I’m seeing online discuss high dose MTX with antibiotics.
Thanks all!!

[Lynne G.SD]

Hey MJ;
So nice to hear from you.For the first 4 years of my AP journey I was taking 7.5mg of MTX while on Mino,no problem at all and I have never seen any contraindication for doing so.Originally I was on a much higher dose of MTX and nearly went into liver failure so my doc took me off of it and all really bad symptoms came back.Tried Cellcept and that was no better as it made me sick as a dog.I must have tried 5 or 6 drugs for SD and nothing helped except for MTX so my rheumy put me back on it at low dose which hardly did anything but that is when I found AP so I stayed on it.It took around 2 years to slowly ween off of it and scared me so much thinking the SD would come back full force.It did not and I reached full remission including uncurling my hands and obliterating my lung fibrosis.MTX is well known for causing lung problems so it was kind of a toss up between the SD and the lungs.Make sure to have regular liver enzyme tests.

[lynnie_sydney]

See this article by Dr David Trentham on the main site here:

Clearly minocycline can provide adjunctive therapy for RA. In other words, minocycline can be combined with any other available agent. There are no exceptions! Examples include Plaquenil, methotrexate, Arava, anti-TNF compounds like Enbrel & Humira and the new intravenous drug, abetacept (Orencia). Decreased doses of one or both agents may help to avoid gastrointestinal side effects. This regimen usually reflects a desire to obtain additional improvement or to gradually convert to the safer drug, minocycline. Examples include 1. Not having to increase the dose of methotrexate and 2. By increasing the dose of minocycline additional improvement and /or stability may be gained. Perhaps use of two oral drugs might preclude the necessity for an injectable and more expensive drug. Obviously judging the net effect of either drug is difficult or impossible. The same impasse may arise if a clinical or laboratory side effect occurs.

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[mj47]

Lynne,
Thank you so much for your response! Nice to hear from you as well. I appreciate hearing that you were able to be on a lower dose of MTX and use mino to help. It’s a relieve to hear. Actually, right after I posted this I found that doxycycline (which is what my husband is on) is contraindicated with MTX because is has sulpha in it…but that minocycline is ok. So it’s nice to hear that someone had success with it. The problem is that my husband developed a bad sensitivity to mino after a long time of taking it, so he’s wary to add it in as he’s attempting his 3rd try at MTX. This time he’s taking an injection of MTX to avoid side effects (gastro and others) that he had the last time, and should be able to take a lower dose since it’s not going through the digestion tract. I wonder if, like Lynnie_Sydney noted, he could use both at lower doses to have relief.
Still wondering if anyone has tried doxy with MTX as all articles I’ve found online discuss high doses of MTX with doxy being bad. Apparently doxy increases toxicity of MTX, but I’m wondering if that’s only at high doses.
Regardless, it’s good to know that you were able to take MTX and mino for years. Thanks again!

[mj47]

Lynnie,

Thanks for your reply and quote. As I mentioned in my reply to Lynne, I discovered after posting that mino is fine with MTX. It’s the doxy that my husband takes that’s contraindicated. I noticed in your sig line that you stopped taking mino because you can’t tolerate tetracyclines. I’m wondering if that’s what happened to my husband. He was on mino for a long while and eventually started feeling terrible and we discovered it was the mino. He switched to doxy and has had good success managing until this recent flare.
He’s now stopped the doxy (day 7) to clear his system out before his first injection of MTX. I told him last night that mino is ok to use with MTX but he’s reluctant to try it because it made him feel so bad. I wonder if the long period of not taking the mino would serve as a wash out period that might allow him to tolerate it in a lower dose along w the MTX…or if once you develop a sensitivity to mino, you have it no matter what. Any thoughts on that?
Thanks again!

[Maz]

Hi MJ,

If you scroll down the following link in the RA Research section of this site, you’ll find the O’Dell, etal, Nebraska studies, one of which found that the combination of doxycycline with methotrexate was superior than methotrexate alone for treating RA.

RA/Tetracycline Research

The two meds can safely be used together but as with any med, toxicity will ramp up in a dose-dependent kind of way.

Hope your hubby feels better soon! Has he considered seeing an experienced AP doc to see if he can change up his AP? Sometimes adding in a secondary antibiotic does the trick. Also, any other changes happened since his return of symptoms? E.g., a flu, stress, poor diet (has he tried starch reduction, for example?), or even a generic doxy switch?

[Lynne G.SD]

I have been using doxy for the last few years because of blue spots but not much has happened in that regard.I take one tablet every other daynormally but if I get that old burning sensation in my hands it will be every day until it goes away.There can’t be too much sulpha in it as I have a serious allergy to it.Last episode was 20 or so years ago and I have avoided it at all cost.I know that allergies can come and go but never thought of finding out if I still have it.

[Simba1992]

Hello, You mentioned that the doc had said Mtx and doxy cannot be used together? This is really strange since I have read several studies that show that this combination in fact is very effective(?)

[mj47]

Hi Simba,
Yes, the pharmacy called & said they couldn’t fill the rx for the MTX until they heard from the doctor because doxy & MTX came up as contraindicated in their system. Then his dr wrote to him telling him he needs to quit. Doxy is listed on MTX’s website as a drug that interacts with MTX. The argument is that it can cause MTX toxicity in patients.

[Maz]

Hi MJ,

It’s odd as this is the first time this has come up here, because as mentioned above in studies the combination was found safe and improved efficacy of mtx in RA patients. I am wondering, however, if the pharmacy isn’t recognizing dosing differences for rheumatic disease and cancer patients. It might have come up as an alert due to this? Certainly there are some studies with the use of high dose mtx and doxy causing enterohepatic issues due to how the gut microbiome and liver circulation are affected in those cases. However, low dose mtx and doxy are frequently used safely by rheumatics here.

If you are finding otherwise in the info received from your hubby’s doc, we’d be interested to hear the rationale as it could be new info. Thanks

[mj47]

Hi Maz,
I had the same thoughts re: dosing of MTX for cancer vs rheumatic disease because all I could find online was regarding high dose MTX.
I’ll have to look at the email from the dr that ordered him to not take them together to see if he provided any other info on it.
I would love to hear from anyone who has actually used doxy with MTX, or lead me to a thread regarding it (I couldn’t find anything in my search), because my husband is really starting to have pain after not being on the doxy for over a week in the midst of this flare so that he can start MTX.

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