Methotrexate/Minocycline

[Maz]

Hi All,

I was researching possible drug interactions of minocycline and methotrexate for my mother-in-law in the UK who has psoriatic arthritis and ankylosing spondylitis (age 78). At her age, palliative relief is her main concern, having had these diseases now for many years. However, she was asking her GP about the possibility of adding minocycline to her current regimen of methotrexate. Her GP wasn't averse, except for her concern about possible drug interactions.

According to the following website, the tetracyclines can elevate serum concentrations of methotrexate and the recommendation is that minocycline be avoided when high doses of methotrexate are being used. Fortunately, she is on a low dose of methotrexate, so this shouldn't be a problem for her.

https://www.changehealthcare.com/rx_brands/drug_interactions/9394

“Generally avoid – Major drug interaction with Methotrexate, Methotrexate Sodium, Methotrexate Sodium, Preservative Free, Rheumatrex Dose Pack, and Trexall

[*]
[/*]GENERALLY AVOID: Concomitant use of tetracyclines may elevate serum methotrexate concentrations. The mechanism may involve displacement of methotrexate from its binding to plasma proteins. Individual cases of methotrexate toxicity have been reported with doxycycline and tetracycline. MANAGEMENT: Concomitant use of tetracyclines should be avoided in patients on high-dose methotrexate regimens. If broad-spectrum antibiotic coverage is needed during high-dose methotrexate therapy, the use of an alternate anti-infective is recommended. If these drugs must be used together, close monitoring for evidence of serious methotrexate toxicity is recommended. “

As part of a fact-finding mission to help my elderly mother-in-law, she was wondering how many people who contribute on this support forum take both methotrexate and minocycline, their doses and how they are managing on both. She'd be most grateful if people would be so kind as to share regarding this so that she can take this info back to her GP.

Many thanks!

Peace, Maz

 

[lynnie_sydney]

Maz – cant really help with your question (except to say that methotrexate is always used in low doses for RA). Just wanted to say good on your MIL for being willing to try mino at her age.

On another score, it is long term use of pred that is probably the most troubling in terms of what it does to the bones. Am attaching an article on this re an 81 year old woman that you may find interesting. This was the one that at last got my Mother and Father's attention. Lynnie 

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)

[Maz]

Hi Lynnie,

Thanks for your input – mother-in-law is suffering now from a lot of bone loss due to repeated cortisone shots into her spine over the years. Her rheumy wanted to increase her dose of methotrexate recently, which she deferred on, because she had a very bad joint infection in her toes. They didn't know if it was fungal or bacterial :shock:, so she was being treated for both.

At her last visit to the US, I mentioned AP again to her – she'd already given the book I'd sent her to her GP, but the GP didn't have time to read it, nice as she is. She's the one who will likely prescribe mino, once she gets the okay from her rheumy (which is doubtful), so I think she just wants to hear from others that they are doing okay on the methotrexate/minocycline combo.

Such a shame to see her now – hands very deformed and hunched over from spinal degeneration. I feel pretty sure that fungus is a large component of her problems, as well as years of leaky gut, as she's so sensitive to certain foods, like the nightshades. Her gut would take a lot of healing before she'd probably see much benefit from AP, but at her age she's just looking for palliative relief. If she could get some anti-inflammatory benefit from mino that might be something…certainly better than upping the methotrexate.

Thanks for your kind thoughts, Lynnie!

Peace, Maz

[Eva Holloway]

Maz,

I have looked into ther diet for ankylosing spondylitis since my dr. has diagnosed me recently. There is a site to go to: KickAS.org. The diet is to go low or no starch diet. I have been working on it for just a little while. There is a section where people post their recipes and it is very interesting.My hands look less red and less scaly. maybe also the antibiotics, l-lysine and diet working together.:X

The blood test actually stated that some of the foods which are not good are actually not good for AS. So that is probably why the doctor figured I had AS.

I am still taking the manuka honey and I have started to take l-lysine which helps with connective tissue problems, since I also have Celiac all this goes hand in hand.

Hope you had a nice holiday and the best for 2009. 😀

Best wishe,

Eva

 

Eva Holloway

[Texas T.]

Maz,

My (no longer seeing him) rheumy declined to give me Doxy or Mino while on MTX as it is contraindicated.  I hounded him for several months to no avail UNTIL I pointed him to Dr. O'd's (in Omaha, NE) AP studies.  My (then) rheumy emailed Dr. O and Dr. O's response was this (exact from his email response).

Dated August 1, 2007:

Subject: Can you combine MTX and Minocycline?

Yes, we use that combination a lot.  We have published on the combination of MTX and Doxycycline (dox adds to the benefit of mtx) Arth Rheum 2006 54:621.  We have also done a study of mtx + mino – finished but not published yet – bottom line mino adds to benefit of mtx.  The only note of caution is that all the work on mino benefit has been done on RF+ patients.

Again, we use it a lot with good results.  Hyper-pigmentation is a long-term side effect but generally well tolerated.

End Dr. O'd's response.

Perhaps you can do some research on Dr. O'd (of Omaha) – find his published studies online?

I no longer see my rheumy because when he FINALLY agreed to give me Mino or Doxy he also required me to take the MTX.  I choose instead to see Dr. R.K. of Lufkin, TX.  She has me on Doxy and Zith, probiotics, fish oil and I'm doing remarkably well.  So much so I sometimes forget I have arthritis.  You can see how long I've been on each in my signature line.

I read here more often than I post, but felt I could perhaps provide some assistance on this one.  I can fax you the email if you'd like – just send me an IM with your fax number.

Here's to a healthy and happy new year to all in 2009!

For the newbies – YES AP CAN & DOES WORK!!!

 

[Texas T.]

Take a look here for info on Dr. J. O'D of Omaha:

http://nebraska.edu/media-resource-center/pioneering-new-frontiers/pioneers/1107-james-odell-md.html

 

[Eva Holloway]

Teresa,

I also see Dr. R.K in Lufkin. I have been seeing her for a year and I really like her. I have read about the Dr. in Omaha just a few months ago. Maybe he will keep pushing the info out into the media. Since Dr. Browns book is out that is the only other person stating that Rheumatoid Arthrits etc. can be helped with antibiotics. I take Biaxin and Minocylen.

 

Take care,

Eva 😀

Eva Holloway

[hollybell]

THANKS FOR THE INFO

[Maz]

[user=206]Texas T.[/user] wrote:

I read here more often than I post, but felt I could perhaps provide some assistance on this one.  I can fax you the email if you'd like – just send me an IM with your fax number.

Teresa, many thanks for taking the time to post! This is much appreciated and should be very helpful to my Mum-in-law for making her case to her GP. Thank you very much!

I wish I had a FAX machine so you could FAX the letter directly to me. Perhaps I could have my friend receive it on her FAX? I'll give her a quick call and ask if she'd mind first, before I PM you the info.

You know, I really should have also looked on the main website…you'd think I'd know to do this myself by now! I came across this info, too. The two articles are a little contradictory, though, one is from the PDR:

Treatment of Early RA with Minocycline – The O'Dell Study

https://www.roadback.org/index.cfm/fuseaction/education.display/display_id/117.html

The note at the very bottom says:

“The presently available data on minocycline therapy in RA suggest that such treatment may be considered along with DMARDs such as methotrexate, sulfasalazine, gold salts, and hydroxychloroquine.” FC Breedveld

But the physician's desktop ref contraindicates this somewhat ❓

Some Common Arthritic Drugs that Are Contraindicated for Use with Antibiotics

https://www.roadback.org/index.cfm/fuseaction/education.display/display_id/119.html

Methotrexate (MTX)  

• increases gut permeability which is already a problem for many arthritics [/*:1bbhxco7]
• antibiotics destroy the gut flora which are necessary for breaking down MTX, increasing the possibility of liver toxicity in the patient [/*:1bbhxco7]
• effects of aspirin are potentiated by MTX, pancytopenia may occur [/*:1bbhxco7]
• CSA and MTX interfere with each others renal elimination, which may result in increased liver toxicity [/*:1bbhxco7]
• high doses of penicillins compete with MTX for transport and reduce renal tublular secretion.

[/*]
 

It's the two first points which are probably the most pertinent…gut permeability and gut flora needed for breaking down methotrexate. I'm sure as Lynnie pointed out, lower doses of methotrexate used in combo with AP are usually just fine…point being that the goal is to ultimately wean off the methotrexate, anyway.

Many thanks again for your kind response and just taking the time! 😀

Peace, Maz

 

 

 

 

[Maz]

[user=236]Eva Holloway[/user] wrote:

Maz,

I have looked into ther diet for ankylosing spondylitis since my dr. has diagnosed me recently. There is a site to go to: KickAS.org. The diet is to go low or no starch diet. I have been working on it for just a little while. There is a section where people post their recipes and it is very interesting.My hands look less red and less scaly. maybe also the antibiotics, l-lysine and diet working together.:X

Eva, thank you for your kind reply also. I will pass this info on to my Mum-in-law. She's pretty aware of being sensitive to nightshades, as every time she eats a potato, tomato or pepper, her fingers won't let her forget, poor thing. :crying: I know that starch avoidance is really important, too, for AS, so perhaps the kickAS website will help her a bit in that dept. She's 78, though, so web navigation is a little difficult for her.

Thanks for your kindness and sharing your thoughts with me! Sounds like you're feeling a bit better in some ways – I quite agree – let's make 2009 the year of wellness for us all!!

Peace, Maz 

[kat]

Hi Maz!

I have never taken MTX or mino, let alone together, but I do have AS. I have tried the low and no starch approach with no difference in my symptoms. I am not saying its not valid for some or many people, but it certainly does not work for everyone with AS. What I can tell you, for me, is that clindamycin is a miracle. Even the oral clindy helps me much and the IVs are truly amazing. I start to get relief in 24 hours with the IVs and by the time I reach the end, most, if not all, of my symptoms are gone.

I was completely bedridden a year ago. I am far from that now.

I have taken many different abx that have helped some, but none of them does what the clindamycin does. Nor have I had a herx with clindy so I avoid the painful suffering of that, as well.

I suppose none of this is very helpful for your MIL's situation but thought I would share it, just in case.

[Texas T.]

Maz,

I can make a copy and mail it to you the old fashioned way if you'd like?  Just send your “snail mail” address via IM and I will send it along to you.  That way you will have a copy to present to you MIL's doctor.

I'm not a pharmacologist, but I believe MTX and Mino is contraindicated when the MTX is prescribed at much higher doses for cancer treatment. 

I only took MTX for 4 months – and overlaid it with Doxy for about 1 month.  Dr. R.K. in Lufkin got me off the MTX and PRED right away.  I do take a NSAID each day – currently Mobic – but I'm thinking of cutting that in half and see how it goes.  My wish for 2009 is to get off the NSAID for good.  Don't need the PRED – it would be sooooo good to get off the NSAID as well.

I'm thankful every day for finding this web site early on – I know it has made 100% difference in my outcome.  My thumb on my left hand does not work very well – opening a bag of potato chips is a chore without scissors, walking down stairs is ouchy due to left knee – but up stairs is no problem.  If that's my biggest complaint from this wicked disease – I'd say I'm very blessed indeed.

It's too bad the studies being done in Omaha are focused on RH+ arthritis.  I'm RH- and I can say the Doxy is doing it's job.  So to all you newbies STAY WITH AP!!!  It takes a while and we all want an instant cure.  I'm so thankful I am not on the toxic drugs and I am doing very well.

Here's wishing each of you a 2009 of renewed health, smiles, and happy days!

[Maz]

Kat, thanks muchly for your insights. I'm logging all the responses and will pass all info along to my MIL…I know she will be most grateful and thank you for sharing your experience on clindamycin, both oral and IV. If my MIL could get to Dr H (the one AP doc in the UK) she might have a much easier time of this, but at her age making a physician change is not so easy (you know – doctors are gods mentality). IVs would certainly be to her benefit, as she's been sick for so long, but oral clindy might be an option, too. The question is whether clindy might be harder on her gut than mino, along with the mtx? According to the PDR quote above, gut permeability is a problem on mtx and abx can exacerbate this, elevating toxicity with compromised gut bacteria. 😕

Certainly a good thought to ponder…thanks, Kat!

Peace, Maz

[Maz]

[user=206]Texas T.[/user] wrote:

I can make a copy and mail it to you the old fashioned way if you'd like?  Just send your “snail mail” address via IM and I will send it along to you.  That way you will have a copy to present to you MIL's doctor.

I'm not a pharmacologist, but I believe MTX and Mino is contraindicated when the MTX is prescribed at much higher doses for cancer treatment. 

Teresa, this truly is very kind of you to offer. Thanks so much! I will PM you with my address in a mo. 😀

I think you're right on that mtx in high doses would be contraindicated with mino. She should be all right, because her mtx is very low now. Mino would be a very good alternative, if her doc will agree, than upping the mtx.

MIL has been sick for so long now, I'd hate for her to try this and then wind up herxing madly while living alone, so I'm putting it out there she'll just go visit Dr H and get proper supervision from an experienced AP doc.

Thanks, again!

Peace, Maz

[kat]

Maz, oh I understand too well about the doctor problems and having to travel if you can't find one locally. It's a crying shame that people can't get the help they need when and where they need it!

Clindy certainly can be hard on the gut, especially the oral. Interestingly enough, my gut problems have gotten better since I started clindy, both oral and IV. But then, I don't take MTX so I can't factor that into the equation.

I really don't know what psoriatic arthritis looks like but I was surprised when my rheum doc looked at a rash I have on my back and asked me if it was psoriasis. I'd always been under the impression that it was part of the discoid lupus I have. Anyway, I just finished day 3 of the IV clindy and that rash on my back is almost gone. My point being, I guess, that if it really is part of a psoriatic arthritis, the IV clindy is fixing that too! Whatever it is, it sure seems to be part of my disease.

I do hope your MIL finds some type of relief. I'll be thinking of her. 🙂

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