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% Complications from Methotrexate Drug Use Everyday Health MenuNewslettersSearch Psoriasis
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14 likes
N
I am diabetic and take insulin injections daily. Is it safe to take methotrexate while taking insulin?
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11 likes
J
Some studies have suggested that insulin enhances methotrexate's anti-tumor activity. One could conclude that insulin could thereby augment methotrexate's response in psoriasis.
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18 likes
L
Yet, no definitive studies have been done regarding this matter. Insulin is not officially a contraindication to starting methotrexate. But, being a diabetic requires more careful monitoring of methotrexate and its side effects given that diabetics have an increased risk for liver disease and infection.
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48 likes
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[Medical editor's note: People on methotrexate have to have their liver function monitored on a regular basis.]
Q2. I took methotrexate for six months, stopping a year ago because an ultrasound showed an enlarged fatty liver.
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28 likes
H
How long does this drug affect my liver? Methotrexate causes permanent fatty liver changes. Once methotrexate is discontinued, it no longer causes worsening of the fatty liver damage.
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C
[Medical editor’s note: Excessive use of alcohol could worsen a fatty liver condition.]
Q3. I have had psoriasis for the past 39 years.
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5 likes
L
Initially, I was applying some creams. Later, about nine years back, I started taking methotrexate tablets.
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24 likes
J
My doctor told me that I could take only a maximum of 500 tablets in a lifetime. But I am continuously taking them and have taken more than 1,200 tablets so far.
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42 likes
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Presently, I am taking three a week. I am having regular blood tests and so far there is no problem. Can I continue taking the tablets?
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17 likes
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What will happen if the limit is exceeded? Honestly, this is an issue that we struggle with at times.
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6 likes
N
I can say that there is no established maximum dose of methotrexate. Even in the absence of abnormal liver tests, methotrexate can cause scarring of the liver, which is related to the cumulative dose of the drug over several years.
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11 likes
A
There are no hard and fast rules, but around 2 grams (which is approximately six pills weekly for two and a half years) is the level at which there can be liver damage. Frequently, we refer patients who have received greater than 2 to 3 grams of methotrexate to a liver specialist for possible biopsy to look for scarring.
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16 likes
N
He is not a good candidate for methotrexate because he will not swear off alcohol. Please comment on the safety of alcohol consumption with Remicade [infliximab] or Enbrel [etanercept]. Alcohol and methotrexate can both affect the liver and hence many physicians will ask patients to use only very sparse amounts of alcohol or avoid alcohol altogether while taking methotrexate.
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20 likes
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Although Remicade and Enbrel have not been shown to affect the liver in the same way methotrexate does, it would not be wise to put a patient on either of these if he or she was consuming large amounts of alcohol. I would recommend finding a dermatologist who is experienced in administering biologic agents for psoriasis and make sure to give him or her an honest estimate of the amount of alcohol your father is consuming. Q5.
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30 likes
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Are people with psoriasis more susceptible to liver disease? Patients with psoriasis are more susceptible to liver disease if they are using oral treatments for psoriasis that have associated liver toxicities.
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23 likes
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In particular, methotrexate is an oral chemotherapeutic agent often used for psoriasis. Methotrexate can cause liver damage and careful monitoring of liver function is vital while patients are on the medication.
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Q6. I have hepatitis C. I am currently taking Enbrel [etanercept] along with small dose of prednisone.
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16 likes
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Can someone like me with liver disease tolerate 100 milligrams of Enbrel a week? One hundred milligrams of Enbrel a week is the standard initial recommended dose for psoriasis.
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29 likes
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There is no contraindication for being on Enbrel with hepatitis C. Thus, it is a tolerable dosage. Q7.
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35 likes
A
I have been on methotrexate for nearly five years and it has kept my psoriasis in check. I have lab work every month and lots of readings have been abnormal, either high or low. The dermatologist suddenly said, "Who is taking care of your liver?" I responded, "You are." He suddenly and unexpectedly took me off methotrexate and all future labs.
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48 likes
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He said to see him only as needed. Now it seems like I am floundering alone.
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37 likes
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Can you tell me what is going on and what I should do? This sounds like a frustrating situation as you describe it.
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41 likes
M
Psoriasis patients need doctors who are interested in helping treat this chronic condition and managing potential complications. Methotrexate, as you point out, is an effective therapy for psoriasis and it can be used safely with appropriate monitoring and follow-up.
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40 likes
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There are plenty of side effects from methotrexate and one of the main concerns for patients on this drug is liver toxicity. Methotrexate can cause inflammation of the liver that can be seen in routine lab monitoring. There are many things that can cause a temporary elevation in liver tests and an isolated elevation in liver enzymes is not a major concern if it quickly returns to and stays normal.
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47 likes
J
A more sinister effect of methotrexate is its ability to cause permanent scarring of the liver (cirrhosis) even in the absence of abnormal lab tests. It is reasonable to see a liver specialist or gastrointestinal doctor after a cumulative dose of 3 or 4 grams (approximately 3.5 years at an average dose of 15 mg per week) or so to be evaluated for a potential liver biopsy.
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14 likes
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Learn more in the Everyday Health Psoriasis Center.
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