pain killer use with methotrexate

[Apollothalia]

I wonder if anyone can help? I had a flare last week and was told by the nhs to take ibruprofen and paracetamol to help every 4 hours. But I’ve just taken my weekly dose of methotrexate (7 tablets) and wondered if I can take these pain killers on the same day as the methotrexate? When I looked it up online it said not to take ibruprofen with methotrexate at all - so I’m a bit confused… does anyone know the answer to both or one of the above? The helpline I used at Nhs is sadly closed today… thanks so much!

Update - I have had a call from the GP, spoken to the pharmacist in the chemists and also spoken to the RA nurse at the hospital and all have said that I can take 2 tabs of ibuprofen and 2 tabs of paracetamol (as directed on the packets) with food while on methotrexate.

mum not sure what caused my flare - I had had a scan on my abdomen on 7 feb which involved a dye being injected and was ok before that… but maybe that’s a coincidence.

I was given a steroid injection a couple of days ago so symptoms are gradually decreasing .

Thanks so much for all your help during a time that was very difficult for me. I’m a yoga teacher and had to cancel classes during this flare 😞

[vonniesims]

You need to talk to your pharmacist I think. I take Paracetamol all the time, but was told not to take ibuprofen by my GP. I am on Methotrexate

[Apollothalia in reply to vonniesims]

thanks so much for your help.

[Amnesiac3637]

There is interaction between Ibuprofen and MtX and also Paracetamol so safest not to take either of them until you have a definitive answer. That answer is probably best supplied by a qualified pharmacist who knows medicines inside out and will be able to tell you when you’re safe to take your drugs - or not. If you’re able, head to your local pharmacy and talk to them before they close for the weekend. Best of luck.

[Apollothalia in reply to Amnesiac3637]

thanks so much for your help!

[Rachmaninov2]

I take methotrexate, my GP prescribed paracetamol and didn’t mention anything about not taking it on methotrexate day. I agree, it would be best to speak to your pharmacist just to be sure and to give you peace of mind.

[Apollothalia in reply to Rachmaninov2]

thanks so much for your advice! I really appreciate it.

[Gottarelax]

I was told by my consultant not to take aspirin, ibuprofen or codeine but he recommended taking the maximum dose of paracetamol. He said that the cumulative affect of taking paracetamol would help and not to be a martyr as it was totally safe. I also double checked with the nurse this week and she confirmed that paracetamol was OK. I’m on max dose methotrexate and now also taking sulfasalazine.

[Apollothalia in reply to Gottarelax]

thanks so much! Can I ask what is the max dose of methotrexate? I’m on 7 tablets but nothing else…

[Gottarelax in reply to Apollothalia]

I think I’m on the highest dose they give for RA. That’s 10 tablets (25mg).

[Apollothalia in reply to Gottarelax]

thanks for sharing that. I appreciate it.

[mld78]

hi. I have always been told not to take ibuprofen or aspirin for pain relief. The doctor also reconfirmed this when I started on Methotrexate. I stick with up to three doses of paracetamol in every 24 hours. It doesn’t get rid of the pain, but allows me to function within limits.

[Apollothalia in reply to mld78]

thanks so much for your help!

[KittyJ]

well you learn something new every day, I’ve never been told not to take either and have taken both, separately and together. More so recently as I’m waiting for my GP to sort out a new anti inflammatory. As has already been said I’d check with your pharmacist.

[Apollothalia in reply to KittyJ]

thanks so much - new to me too!

[helenlw7 in reply to KittyJ]

Well that’s news to me! I’ve been on mtx for over15 years and have never been told not to take ibruprofen or paracetamol. My prescribed painkiller is co codomol which is codeine and paracetamol. I take 2 ibruprofen every morning to be able to get moving.

[Apollothalia in reply to KittyJ]

thanks so much!

[LuzyCLL]

I have been told not to take naproxen or acetaminophen due to a previous bleeding ulcer ( shock of a cancer diagnosis)

[Apollothalia in reply to LuzyCLL]

thanks so much for your help!

[Apollothalia]

thanks so much for your help - it’s very much appreciated.

[Apollothalia]

thanks so much for your help!

[Boxerlady]

I was told by the rheumy nurse (more than one actually) to take both paracetamol and ibuprofen together and encouraged to take 2 of each 4 times a day when I was flaring. A rheumy consultant also said that was ok and I've been on Methotrexate since diagnosis in 2019. I think that it shows that you need to speak to your team if possible. My GP doesn't prescribe my Methotrexate and once told me that many GPs are scared of it (maybe because it's given in far higher doses for other conditions so they feel that it's out of their knowledge range) so I am happy to go with my rheumy team's advice but it should be personal advice.

[Apollothalia in reply to Boxerlady]

many thanks for your message. That was what I was told last week too - but when I looked online (and the messages below) it appears that ibruprofen may not be a good idea if you’re on methotrexate but as you say I’m not a doctor so I need to check with rheumatology again. So pleased I’m not the only one that has been told what you had been told though… thanks so much for your help.

[Downtime]

I’m on steroids now for PMR so only take paracetamol now but before, my rheumatologist prescribed 1600mg Brufen slow release to be taken daily. I did this for 8 years . It was fine. If my stomach started to object I took omeprazole but mostly no problems.

[Apollothalia in reply to Downtime]

thanks so much for your reply!

[Runrig01]

I take 25mg of MTX weekly. My rheumatologist is happy for me to use both. Brufen can cause toxicity of MTX, but he explained that was at the higher chemotherapy doses used for cancer patients, rather than the doses we take. Paracetamol the issue is the increased pressure it puts on the liver, but as long as liver function tests are ok, I can take this too. Many AS patients are prescribed regular nsaids alongside MTX, on a longterm basis. Obviously check with your rheumatologist and see if they are happy

[Apollothalia in reply to Runrig01]

thanks so much for your reply I really apppreciate it!

[Sheila_G]

I can't take ibuprofen in tablet form but can use the gel effectively (don't use both.) I get most of my information from my Pharmacist. They know more about medication than GP does. Twice now they have rung me to say I can't take a medication with mxt that my GP has prescribed.

[Apollothalia in reply to Sheila_G]

how interesting that they know more than Gp! Thanks so much for your reply.

[Sheila_G in reply to Apollothalia]

I must stress that that is only my experience. Someone else may say differently.

[Apollothalia in reply to Sheila_G]

yes of course.

[Rachmaninov2 in reply to Sheila_G]

I agree, if I need to find out anything about my medication my first port of call is my pharmacist.

[Apollothalia in reply to Rachmaninov2]

thank you.

[wilbertjellyfish]

I get co codamol on prescription with mtx so think paracetamol would be fine. Never been told to avoid ibuprofen.Let us know if you get a definite answer.

[Apollothalia in reply to wilbertjellyfish]

thanks so much! And yes of course!

[GinnyE]

My Rheumatologist put me on methotrexate and told me I could take ibuprofen, which I do very occasionally.

[Apollothalia in reply to GinnyE]

thanks so much Ginny!

[Fergie432]

I’m on Methotrexate too and was told by GP and Rheumatologist the only painkillers I can ever take is Paracetamol. Hope this helps, if flare up really really bad I’d discuss with GP, you might need a wee steroid injection or course of Oral steroids. Hope you feel better soon.

[Apollothalia in reply to Fergie432]

thanks so much for your reply. I really appreciate it!

[Hightower62]

I am on 20mg of Methotrexate & have always taken paracetamol which I understand is fine to take with MTX. I believe that you should not take ibuprofen with MTX. This is from nhs.co.uk.

From nhs.co.uk

[Seatgeorge]

Paracetamol is ok i take a 600mg tablet when required I would stay clear of ibuprofen, hope this helps.

[Apollothalia in reply to Seatgeorge]

thanks sir much for your reply. That’s useful to know.

[BeachsideVia]

Im having the same issue. On 17.5 mg methotrexate and left knee flared. Rheumy office says Celebrex is ok but I read that it’s not. Celebrex would be like Ibuprofen. It looks like paracetamol is a better one for me to try (tylenol).

[Apollothalia in reply to BeachsideVia]

thanks so much for this reply, really useful.

[Mich1701]

I take ibuprofen and the rheumatologist and her nurse know. They put it in my notes and never told not to take it or paracetamol and I also use co codamol if flaring badly. There's a lot if conflicting information. The only thing I've been told not to take is aspirin. I don't take anything on methotrexate day. Paracetamol doesn't seem to do much for me if I've got swollen joints. Best to talk it over with a Dr or Pharmacist.

[Apollothalia in reply to Mich1701]

thanks so much for your reply.

[nomoreheels]

Hiya Apollothalia, welcome. You've had lots of useful info so thought I’d just add the pain & inflammation relief I'm prescribed on MTX. I regularly take co-codamol (paracetamol & codeine) etoricoxib ( NSAID or anti inflammatory), buprenorphine (transdermal pain relief).

I may be repeating info as I’ve not read through the replies but the 2 suggested to you by the NHS helpline will be because they are both over the counter meds & easily available. With taking them as recommended you may have to trawl round shops to gather enough to take regularly as you're only allowed to buy 2 packs of each in the one purchase, until your team can take over & advise or prescribe for you. Alternatively you could ask for advice or alternatives from the Pharmacist where you have your repeat scripts filled.

Whilst you will read certain meds aren't recommended to take with MTX we unfortunately live in RD land which determines we need to control inflammation. As such our primary & secondary carers prescribe anti inflammatories & pain relief as required, including MTX day. We are monitored so if anything abnormal shows up it can be attended to. So, if it was me I’d do as the helpline said & take 4 hourly doses of paracetamol & ibuprofen, even on MTX day. Both can work well together if taken regularly & should help towards easing inflammation & pain & bringing your flare under control.

[Apollothalia in reply to nomoreheels]

many thanks for your help - much appreciated.

[Ritaritis]

Good morning, paracetamol from my local shop works for me when I have a flare up of pain. I also add ginger and turmeric to my food and drinks. My doctor says these to items are a waste of time but they work for me and my pain has lessened so much. My last flare up was due to me manually cutting my hedge. Being 4' 11" and having arthritis in my hands and knees didn't help.🐈🐈🐈

[Apollothalia in reply to Ritaritis]

thanks so much! I use garlic ginger and turmeric too 😊