Methotrexate and psoriasis: have you problems with this drug?
One problem that I had to face was the patient took the medicine on daily basis, for ten days and as she was illiterate and inspite of repeated education the patient took daily medication. probably they require much more understanding and nurses and pharmacists must be thought to communicate the necessity of pulse medication.
burning micturition was seen in a middle aged woman who responded with alkalinization.
rebound psoriasis was seen in one client who used medication irregularly.
break through psoriasis was seen in one client who was put on methotrexate.
these I would lie to know if they were due to inadequate dosing or improper medication consumption
It is the most commonly used drug for treatment of psoriasis in our region. I have never come across long running adverse events if used judiciously as per guidelines. I monitor blood counts, X ray- Chest, Liver function test, RFT as per guidelines. It takes some time for counseling at first visit. But its worth spending time initially rather than regretting later.
What doses do you use ? or better - what is the lower and the higher you use ?
I use 10-25 mg/week MTX and additional Folic acid 5 mg/week. I never have seen serious AE events in my patients, even some of them takes MTX for more than ten years. Follow up blood test are mandatory to do once in 3 months, while on established doses. On the beginning of the treatment it is worth to follow up blood tests once in month.
Dose of methotrexate is 7.5 to 10 mg per week as a single dose or weekly divide dose.
The most common problem that arises is of lack of doctor patient interactions after a duration, either because of change in patients change of city, or patient changing the treating doctor, or a voluntary stoppage of medication due to recovery of symptoms and signs.
Recurrence of psoriasis, often responds either to the same medication or an increased dosage.
One question which we find difficult to answer is whether Methotrexate should be used lifetime to prevent complications such as psoriatic arthritis, or pustular psoriasis.
what dosage should be used for localized psoriasis.
Role of other anti metabolites like cylosporin and biologicals influencing treating doctor to change methotrexate.
prescribed formats to decide failure of methotrexate in psoriasis.
Who have experiene of association of MTX and cyclosporin both in low doses ?
Combination of cyclosporin and methotrexate can be used safely and effectively for recalcitrant psoriasis, but combined treatment period should be short. This combination can provide lower cumulative doses for methotrexate. I have only one patient with recalcitrant psoriasis and psoriatic arthritis treated with a combination of methotrexate (15 mg per week) and cyclosporine (3 mg/kg/day) for three months. I have not seen serious adverse effect.
I have the same experience - very good - with both in low doses.
Should there be a complete renal assay before starting cyclosporine.
Satyaprasad: it. is not necessary a complete renal study before the treatment. As we use 2.5 to 3 mg/ kg, this dose is generally very well supported by the kidney.
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