Relapsing need some advice

[kristie]

Hi there! I’ve been on mino since 2011 and in remission until last summer when aches and pains came back. Mid October last year I changed to doxy and was doing well on it but for the last few weeks it’s been a downward spiral. I am not sure if 5 months is a long enough tolerance break from the mino and whether I should go back on it. Or should I ask my dr for another antibiotic to go with my doxy but I’m not sure my dr will agree as they aren’t really on board with this treatment. I’m already at 100mgs bid on doxy for my RA. Hoping someone will chime in with what worked for them. Thank you, Kristie

[whaleharbor]

Kristie, Like you I am a patient and I don’t know. I can only tell you what happened to me recently. My pharmacy switched generics (minocycline) and I went downhill fast. I wonder, did they switch generics or generic/brand or whatever on you? If so…fixing this flare may be a matter of going back on the brand that was working previously. Just a thought.

Minocycline 100mg every other day with food...lots of food: Zydus brand. Celecoxib 200mg twice per day: Greenstone brand.

[kristie]

Hi whaleharbor! I have been sure to always get Teva with both the mino and doxy since it has always worked well…maybe another generic brand would be worth a try…Thanks for your thoughts

[PhilC]

Hi Kristie,

So you’ve been on antibiotics continuously since 2011? Why did you switch to doxy?

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[Maz]

Hi Kristie,

See FAQ #30: https://www.roadback.org/faqs/?faq-category=35

If, after a 5 month mino to doxy rotation to prevent tolerance issues, symptoms are creeping back or flaring starts up, I think I’d switch back to mino. The way Dr. Brown treated flares was to do a round of IV clindamycin (see Carol Lange’s story in the book), but as you’re not with a doc who provides this service, perhaps you could ask to switch back to mino?

The following is from an article on the old website, called, “Treating Plateaus and Non-responders”:

“10. Does the drug need to be rotated? Antibiotic therapy is a long-term therapy, months and years in most, – even for a lifetime in some. After 5-6 years, a patient can become tolerant of an antibiotic. Rotating to another antibiotic even within the same drug class can keep response optimal and avoid plateaus.“

[kristie]

Hi Phil, Yes I’ve been on antibiotics continuously since 2011 and switched because symptoms were coming back.

Hi Maz, Reading that material helped me make the decision to change to doxy last summer. I was going to keep with the doxy but since I’ve been flaring awhile now…I’m getting nervous. I just hope 5 months is long enough. I would love to have the IVs but I know that won’t happen where I live. However I might try talking to the dr about a combo. I think I will start the mino. Thank you Maz

[PhilC]

Hi Kristie,

I doubt that switching back to mino will help. It may have lost effectiveness due to the development of resistance by the bacteria, or you may have developed a hypersensitivity to the mino. It’s also possible that you developed a sensitivity to one of the “inactive” ingredients in the generic mino you were taking; in that case, switching to a more hypoallergenic generic may help.

I’m a little confused because your first message makes it sound like you were initially doing well on the doxy. Did your condition improve after you switched from mino to doxy last year? If so, how long did that last?

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[kristie]

Hi Phil, I was doing well on the doxy. I noticed as soon as I switched that my wrists felt better and the rest of the pains went away shortly after. But the last month the aches and pains are creeping back. October 13 2016 I switched to doxy.
When I was first diagnosed with RA (but I feel it may be PSA as I have psoriasis as well as tendon involvement) I had a constant sore throat and my strep titre was high. My dr didn’t want to treat the strep separately but agreed to the mino. I feel as though that should have been dealt with.
I’m nervous you may be right about the mino, but not sure what to do. I could ask my pharmacist for Par tablets(I noticed you and others do well on) Maybe try asking my dr. for something to compliment the doxy or mino and target the strep….maybe clindamycin or clarithromycin? Thank you for your thoughts Phil!

[PhilC]

Hi Kristie,

What does the doxy you are taking look like, and what codes (letters and/or numbers) are on them?

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[kristie]

Hi Phil,
Baby blue with Novo 100 written on them. Kristie

[PhilC]

Hi Kristie,

I couldn’t find any match for those. Where did you get them?

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[kristie]

Hi Phil,
I order through Loblaws Pharmacy since it’s the only place I could find a pharmacist who was willing to bring in teva for me. Both my mino and doxy say novo 100 on them. But my mino is in an orange and blue/purple capsule. I’m in Canada-not sure if that makes a difference. Interested in what you find…thank you!!!! Kristie

[PhilC]

Hi Kristie,

I believe that, in your case, doxy is not strong enough. Initially you felt good on it, but I suspect that the main reason is because you were no longer taking mino. It appears that either minocycline or one of the inactive ingredients in Teva-Minocycline no longer “agrees” with your body, and if that is the case it makes sense that you would improve after you stopped taking it.

Talk to your doctor about the possibility of adding azithromycin or clarithromycin to your treatment. If that’s not an option, then I would ask about dropping the doxy and switching to azithromycin or clarithromycin. As for which one to choose, that would depend on which generics are available to you, and the inactive ingredients they contain.

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[kristie]

Hi Phil,
Thank you very much for your perspective as I hadn’t considered an intolerance. Definitely something to discuss with my pharmacist as well as the other antibiotics you mentioned. I have a month to wait to see the dr…I will keep on the mino and find some material to give to her regarding why combo antibiotics is good for RA or a different antibiotic altogether if the mino and doxy aren’t working.
Thank you!!! Kristie

[richie]

Just curious –isnt mycoplasma cell wall deficient therefore resistance not an issue –I recollect extensive talk about this quite awhile back –

[Author]

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