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Tomorrow I start arava, 5 tablets =100mg. for three Sundays than 20mg every other day. I'm not happy about this, but my doctor says I have so much inflammation and I need something stronger, so I chose arava out the list of possible drugs. Do you think I'm doing the right thing?. I'm thinking I could still take the minocin the other days, or just take 2 arava's a week. Maybe if I get this inflammation down the minocin could then penetrate the cells. I don't want too give up on the antibiotic . I know it will work. But I know my doctor is losing patients with me.What do you think? I don't know what I would do without the roadback to turn too.
Thanks! Heather
[user=2022]Cherie[/user] wrote:
Maybe if I get this inflammation down the minocin could then penetrate the cells. I don't want too give up on the antibiotic . I know it will work. But I know my doctor is losing patients with me.What do you think? I don't know what I would do without the roadback to turn too.
Hi Heather,
Sorry to hear you're facing this difficult decision, but it is important to bring down inflammation to enable better penetration of the mino. But, why Arava? Why not something less harmful, like plaquenil? Plaquenil has some nice anti-inflammatory properties (not thought to be immune-suppressive) and also some nice anti-microbial action (it's an anti-protozoal).
My best suggestion is to look up Arava and really research it's potential side-effects. It can cause myelosuppression (bone marrow suppression) in some folk, which can lead to aplastic anemia, amongst other problems. It's quite a heavy-hitter and something less toxic, like plaquenil, might afford you a better chance at reducing inflam, without the immune-suppression. It's a commonly-used rheumatologic drug and so your rheumy should not be dismayed if you ask for this instead. It's also commonly used by Lyme doctors, who absolutely believe in infectious causes and they generally do not believe in immune-suppression, so you can rest a little easier that it might be a better choice. The only thing with plaquenil is that it's recommended to get baseline eye testing by an opthalmologist and then to have check-ups every 6 months, but eye probs are rare to non-existant with plaquenil use and it's just a precautionary measure. It will also likely be much easier to wean from, once your AP kicks in, and you feel ready to slowly drop it.
Maybe worth asking your rheumy about?
Peace, Maz
PS Would it help to send you Dr S's contact info? He is very open to speaking with patients by phone and email and you could ask him about your current dosing regimen and what he might suggest in the way of tweaking your protocol for better effect. 😉
Hi Maz, Thanks for writing back.The answer to your question is that he gave me a list of drugs to try,(1. Imuran, 2.Arava,and 3. Methotrexate. I've already tried M.T.X and it did'nt work, so I only had two left to choose. I thought that arava was less harmful. My last visit I asked him for a low dose of prednisone and he said no. I don't see him again till September so if this does'nt work after six months I'll ask for the plaquenil.
Also Maz, would the Minocin still work on the days I don't take the Arava, maybe if I'm responding well to it, I could take it twice a week instead of three times a week. I appreciate any response you give as I know your a patient as well. Yes Maz, please send Dr. S's contact information. When I started minocin I was doing really,really well even the doctor was surprised, but at that time and he pointed this out I was weaning my self from the M.T.X so my inflammation was down and I'm thinking the minocin was penetrating the cells.
Thanks, very , very much.
[user=2022]Cherie[/user] wrote:
Hi Maz, Thanks for writing back.The answer to your question is that he gave me a list of drugs to try,(1. Imuran, 2.Arava,and 3. Methotrexate. I've already tried M.T.X and it did'nt work, so I only had two left to choose. I thought that arava was less harmful. My last visit I asked him for a low dose of prednisone and he said no. I don't see him again till September so if this does'nt work after six months I'll ask for the plaquenil.
Also Maz, would the Minocin still work on the days I don't take the Arava, maybe if I'm responding well to it, I could take it twice a week instead of three times a week. I appreciate any response you give as I know your a patient as well. Yes Maz, please send Dr. S's contact information. When I started minocin I was doing really,really well even the doctor was surprised, but at that time and he pointed this out I was weaning my self from the M.T.X so my inflammation was down and I'm thinking the minocin was penetrating the cells.
Thanks, very , very much.
Hi Heather,
I wasn't sure of the exact half life of Arava, but according to this RX List site it is a long half-life.
http://www.rxlist.com/arava-drug.htm
“Loading Dose
Due to the long half-life in patients with RA and recommended dosing interval (24 hours), a loading dose is needed to provide steady-state concentrations more rapidly. It is recommended that ARAVA therapy be initiated with a loading dose of one 100 mg tablet per day for 3 days.Elimination of the loading dose regimen may decrease the risk of adverse events. This could be especially important for patients at increased risk of hematologic or hepatic toxicity, such as those receiving concomitant treatment with methotrexate or other immunosuppressive agents or on such medications in the recent past. (See WARNINGS – Hepatotoxicity).”
The following site states that Arava's half life is 2 weeks:
http://www.painstudy.com/PainDrugs/arava.htm
Sounds like your doc is giving you a larger than usual loading dose – 500mg rather than 300mg. Also, due to the long half life, meaning how long the drug remains in your system, this drug will be affording you longer immune-suppression. In this sort of context, without a functioning immune system, it is likely that your mino will be acting less for its antibacterial properties and more for its immune-modulating properties. This is because the tetras do not do any bug-killing, they merely disable the bugs (called “bacteriostatic”), and we need a functioning immune system to go for the kill and to clean up dead pathogens. You will still get some immune-modulation, but not a great deal from a low, pulsed dose and Dr. S. may well suggest that if you do go on Arava that you increase your mino dose to daily dosing, twice a day.
There are some hepatotoxicity issues with Arava, too, so it will be important to monitor your liver regularly for any elevations in liver enzymes, which may become an issue if you do switch to an increased mino dose. So, something to also ask Dr. S when you connect with him.
I'll send you his contact info in a PM (private message)…just look to top right of this page and click where it will say, “You have 1 new message.”
Do hope Dr. S will be able to give you some good insight to help you discuss your options further. 🙂 Please come and let us know how you get on.
Peace, Maz
Hi Heather,
I wanted to share my experience with MTX and Arava. Mtx did not help me either. Then in January of this year I went on Arava (20mg daily) Unlike your doctor, my doctor did not give me a loading dose. At 2mos my sed rate went from 67 to 38. At 4mos it went from 38 to 17 and my swelling is much less. After filling the prescription for Arava, I almost didn?t start taking it after reading about the side effects. I remember one of the side effects was sores in the mouth; I also read that Arava can stay in the body for months after discontinuing it. Nevertheless, I started Arava and am still taking it. When I started Arava, I didn?t know about antibiotic treatment of RA.
During my last visit to my doctor, I asked if I could take Arava every other day and add minocycline. He said that 20mg of Arava every other day might not be enough, but said I could take it Monday thru Friday and skip it on the weekend. This week I just started taking 100mg of minocycline twice a day in addition to the Arava 5 days a week. Like you, I really don?t want to be taking Arava for any longer than necessary, but unless the loading dose jump starts the process, it can easily take a couple of months to significantly reduce the swelling. Did your doctor say how long it might be before Arava would give you some relief from the inflammation? Certainly, as Maz suggested, Plaquenil may be a safer alternative. During almost 5 mos on Arava, the only side effects I have noticed are a queasy stomach especially when its not full, some initial weight loss (5 or 6 pounds) which I have since gained back, and a very dry mouth. My liver enzymes have risen some, but are well within the normal range. Of course not everyone reacts the same to these potent drugs. That said, my goal is to eliminate Arava and switch to something with less threatening side effects (e.g., minocycline). I wish you well with whatever med(s) you decide to take.
Bob
I had side effects with every med I've taken, but the Arava side effects were the most serious. After 5 weeks my liver enzymes had risen quite high (marker for liver damage starting to occur). I stopped the medication right away. But then I started losing hair. Luckily I have thick hair, because when I look back at pictures taken at that time, it had thinned to about half the amount I had prior to taking Arava. But once my system cleared the drug, my hair came back.
Obviously, the same side effects may not happen to you. I did feel quite good on the medication and was sorry to have to go off it.
Sierra
I also used Arava in conjunction with the Mino and lost half my hair. It initially brought down my inflammation but then the side affects were too much and I had to stop. But everyone will react differently .
Glenda
[user=2292]Songwriter[/user] wrote:
Hi Heather,
I wanted to share my experience with MTX and Arava. Mtx did not help me either. Then in January of this year I went on Arava (20mg daily) Unlike your doctor, my doctor did not give me a loading dose. At 2mos my sed rate went from 67 to 38. At 4mos it went from 38 to 17 and my swelling is much less. After filling the prescription for Arava, I almost didn?t start taking it after reading about the side effects. I remember one of the side effects was sores in the mouth; I also read that Arava can stay in the body for months after discontinuing it. Nevertheless, I started Arava and am still taking it. When I started Arava, I didn?t know about antibiotic treatment of RA.
During my last visit to my doctor, I asked if I could take Arava every other day and add minocycline. He said that 20mg of Arava every other day might not be enough, but said I could take it Monday thru Friday and skip it on the weekend. This week I just started taking 100mg of minocycline twice a day in addition to the Arava 5 days a week. Like you, I really don?t want to be taking Arava for any longer than necessary, but unless the loading dose jump starts the process, it can easily take a couple of months to significantly reduce the swelling. Did your doctor say how long it might be before Arava would give you some relief from the inflammation? Certainly, as Maz suggested, Plaquenil may be a safer alternative. During almost 5 mos on Arava, the only side effects I have noticed are a queasy stomach especially when its not full, some initial weight loss (5 or 6 pounds) which I have since gained back, and a very dry mouth. My liver enzymes have risen some, but are well within the normal range. Of course not everyone reacts the same to these potent drugs. That said, my goal is to eliminate Arava and switch to something with less threatening side effects (e.g., minocycline). I wish you well with whatever med(s) you decide to take.
Bob
Thanks so much for your feed back, Bob every little bit of info. helps. Are you taking any other pain medication with arava? Your right the loading dose rational was to jump start it, than after 20mg. three times a week. What kind of arthritis have you got if you don”t mind me asking? and is it the inflammatory type. My doctor said it should begin to start working in 6 weeks. If it does'nt work I'll try plaquenil next. When I first started minocin it was working for me but I was weaning from the M.T.X and my inflammation was down, so the minocin was able to penetrate the cells. I hope the minocin works for you on the weekend. Maybe I'll try that. I don't see my doc till September and if it's not working, I'm off it than.
Heather
Hi Sierra, so sorry the arava did'nt work for you. Could you tell me how long it took for your body to clear it out of your system? Did it really work well for the inflammation, and were you on the antibiotic at the same time?
P.S I'm glad your hair grew back.
Thanks Heather
Hi Glenda, Wow that's incredible and you were using the Mino. I think you answered my question.
Thanks Heather
Hi Heather,
My diagnosis was that I have Rheumatoid Arthritis. My rheumatoid factor was 68 when I was diagnosed. My RA is definitely the inflammatory type. Before getting some relief from the inflammation, my knees and ankles were swollen big time. My right wrist was also swollen and very painful. I was counting on the Mtx to help, so I was not taking any medication for pain, except an occasional dose of Advil. Currently I am not taking any pain medication because I don't have much pain right now. If I am not mistaken I believe that the information that comes with Arava and Mtx cautions against taking NSAIDs or aspirin.
Heather, September seems to be a long time to go w/o seeing your doctor, particularly when you are starting a new med that potentially can have serious side effects. My RA doctor orders standard RA lab tests about every two months or so before each appointment to monitor my liver enzymes and other markers of my health and progress.
Bob
I have a poor memory about such things, but I believe it was 4-6 weeks. I started the antibiotic after Arava failed me. I'm doing well on minocycline after more than 4 years. I see the doc on Thursday–after a year!
Sierra
Thanks for the feed back. I won't be taking this drug any longer, I woke up Monday to an allergic reaction. I got an appointment to see doc, will switch to plaquenil if I can.
Thanks again!
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