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Combining Medications

Q: I have rheumatoid arthritis (RA), for which I take a prednisone-methotrexate combination. Now my doctor wants to prescribe hydroxychloroquine (Plaquenil) for me. Have you ever heard of someone taking Plaquenil, prednisone and methotrexate at once? Is this safe?

A: It is common for physicians to prescribe a combination of low doses of prednisone and drugs like methotrexate for patients with rheumatoid arthritis. In selected cases, as in your case, physicians are adding on additional drugs. These combinations of drugs are used for patients with RA whose disease has not responded well to a single drug or to two drugs.

A number of clinical studies have shown that patients treated with certain drug combinations do better with no greater incidence of side effects than those taking individual drugs. In these situations, it's important to have your disease managed by a physician experienced in the arthritic diseases.

Doyt Conn, MD, Rheumatologist

Jill Murphy

21 Jul 2010, 12:56

I have recently be given methrotresate. I an in the treatment where you take 5 pills one day for 2 weeks and the 6 pill for 2 weeks and then 7 pills for two weeks. I ame on my fouth week which means that tomorrow I take my final 6 pills. I am also taking folic acid. I have not noticed any difference in the swelling of my elbow and it is not helping with the pain. Now my entire arm and hand hurt. Anys suggestions as what to do for the pain. I remember reading the Advil, Alleve, etc is not good for my liver.
I really don NOT want to take prescription pain pills but I need something. Any suggestions?? HELP

Lee Brown

12 Jul 2010, 14:04

I tried methotrexate, got major nose bleeds and had to get off. Tried placquenil, couldn't breathe on 3rd day, had to get off. Been on prednisone for several years, on and off by rheumys, and even though docs have weaned me off, I came down with addisons disease last Aug. Now, the same med that caused the addisons, is now the med that I have to be on forever, in order to live. So, I say to you, the biologics may be a better way to go. I haven't tried the enbrel yet, even though it's in my fridge, because I now have 3 auto immune issues, the addisons being the third one. So, I am really scared about it. With my immune system so weakened now, and the biologics weaken it even further, I'm not sure which way to go. So choose carefully.

Christine

16 Jun 2010, 12:32

I have been taking Plaquenil for 6 months, and I think I am getting the maximum benefit I am going to get with it. I have not taken prednisone in five months. The doctor just prescribed methotrexate in addition to the Plaquenil, but I had to wait because of wrist surgery also. I am having some reservations about starting it because right now, I feel ok. I still have swollen joints and some tenosynovitis in one hand, so I guess the idea is to keep it from progressing further. My real problem is that I have not been officially diagnosed with RA or Lupus, but as "possible" sarcoidosis. The surgeon I had for my hands is recommending I try another Rheumatologist. I can tell he thinks RA is more likely, but doesn't want to say so. Is diagnosis always this hard?

Annette Little

02 Jun 2010, 14:21

I have had lupus for five years and have been on hydroxychloriquine and azathioprine for all of that and doing pretty good with the pain levels. Lately I have been having more and more pain that I just am not getting over and my Dr. is talking to me about starting on methotrexate. I was wondering what anyone else thought about it I know that in the end it is my decision but I still like to have more information. I do also take meloxicam,and cymbalta. Let me know your thoughts on the matter. Thanks

Ellie

20 May 2010, 09:40

Alma, you sound like me a year ago. I am doing better now on Methotrexate. Was able to stop the pred (and am loosing weight yeah!) and just stopped plaquinel a few days ago.
I also made major dietary changes. Cut out sugar, artificial sugars, red meat and for now grains though I intend to start bringing them in again slowly over the next few weeks to see how they affect me. I hope to get off the Meth some day too.
Good luck to you - I hope you get some relief soon.

xx Ellie

Sue A.

10 May 2010, 22:23

I was diagnosed with RH Arthritis in July of 1978. March 17th I had surgery on the right wrist. Some bone removed, 3 bones fused and a plate put in. The pain was horrible until I had the surgery. I have been on Remicade for probably 8 years. Prednisone has probably helped me more than anything. I take methotrexate and folic acid. I guess if you do not take the folic acid you will experience hair loss. I have not had Remicade since Feb 8th. The doctor was waiting for the wrist to heal. It is healed and now I have no idea what she is waiting for. Easy exercise is very important. Elec blanket in winter helps. Hot tub helps. Water walking helps. I have had glaucoma since July 2009 and had emergency laser surgery. Keeping busy helps. I get up at 6:00 AM and have pain until about 12:30. I only have the use of the thumb and first finger of each hand. I am thankful that I am not bed ridden and I can play Mah Jongg. That is a chinese card game played with tiles. No cards to hold.I feel that there are a lot of people in the medical field and pharmacy field that get rich from our pain since there really is no cure. I remember the sales talk I got on Gold shots. All I got was mouth ulcers and lost 20 pounds in one month. Exercise and keeping busy is very im[portant. God Bless all of you.
Sue

Pat

22 Apr 2010, 14:38

Hi,

I have been diagnosed with RA mostly in my hands. The dr. put me on Methotrexate 2.5mg plus Folic acid 1mg. and prednisone 5mg. I'm not to happy being on the predisone tried getting off it but had to go back on it because of the swelling. Has anyone been on these.meds. So far its been 6 months for me.

Thanks.

04 Apr 2010, 16:33

Alma, I empathize with you about the weight issue. I am 53 and just got a full-time job that is all desk work, so I've gained 3 lbs and didn't need that. I try to eat celery sticks now and only soup at night. The problem is that the joint, tendon, & muscle pains are so bad that walking seems to hurt me more later than just doing small exercises as tolerated in bed, or at the bedside holding onto furniture. I take frequent mineral baths which are great. am on Plaqu, short-term pred, 1/2 vic five times per day, alleve 3 times/day & Lyrica 2xday for the fibromyalgia. I lean on JC every minute of the day for encouragement. Thank God I'm doing great at my job & staying off disability. I'll be praying for you.

patty

12 Mar 2010, 07:29

My doctor just starting me on Cimzia, has anyone had experience with this injection?

ALMA

09 Mar 2010, 21:34

I was diagnosed with Rh.and fybro.and i am taking the prednisone 5 mg 2Xday also i take plaquenil,and i don't think its helping me that much.i am getting bigger gaining weight so fast. i have sugar now.. i don't know what else to do i hurt most of the time once in a great while i may feel good . i hurt in my fingers, elbows, hips. my hips hurts so bad sometimes when i go for a walk it seems like i can't hardly get back cause of my hips and around my legs hurt.. does anyone else ever feel this way... one thing i have never in my life weighed as much as i do now ..and never felt like this ...anyone that knows anything that might help PLEASE LET ME KNOW THANKYOU

Darlene

25 Feb 2010, 11:22

I started out with Placqenil years ago. An annual eye examination is required. I never had any problems. I've since been on methotrexate, Vioxx (best remission I ever had), Lodine, Enbrel, Voltaren, Sulfasalazine, Celebrex, and I'm now coming off Orencia after 1 1/2 years. The problem with me and RA is that my immune system can't take it for very long. It's a constant balancing act between the pain, the immune system and the medication.

gil

07 Dec 2009, 15:47

Please consider the following tips to reduce your NSAID use, and maybe reduce your prednisone: Reduce or eliminate your sleep meds or tranquilizers. I have found that shoulder and leg pain from RA is reduced markedly, probably due to not sleeping in one position for hours. If you are a couch potato, get up every 15 minutes and do a chore or stretches. Most surprisingly, in my agressive case of RA, very long walks 3 to 8 miles)and something like paddling or rowing for 1-3 miles actually diminish my pain! For me, inactivity is putting fuel on the fire.

Bernadette

02 Nov 2009, 07:23

I have recently be diagnosed with RA. I am taking one 200 mg Celebrex twice a day. It is active in almost every joint. I want to stay away from taking DMAD's (Embril, Remicade etc), prednisone, methotrexate. My doctor has said for me to start taking Plaquenil. I am worried about taking plaquenil as there may be eye issue that occur. Does anyone know the percentage of this happening? I am aware that there is (was) a drug free option out there called Prosorba Column. It may have been stopped due to cost of treatment. Does anyone know about the Prosorba Column? Is it better for the patient to be managed by medications or does this better benefit the drug companies?

Kathy Geiger

24 Sep 2009, 13:52

I suffer from RA. Am currently on arava, plaquenil, sulfasalazine, and prednisone,5 mg. My only side effect is occasional diarrhea and heartburn. My main worry is my blood sugar; I hear pred and plaq combined will raise the blood suger.

mom of 3

05 Aug 2009, 07:44

I have currently been taking the 3 drugs you mentioned plus several others. I find these more cost effective & less long term side effects when I compared them to biologic drugs. The purpose was to get the RA under control & to gradually whean down off medications. The major side effect for me with plaquenil is diahrea, but I have found that if I eat an hour before taking plaquenil this side effect does not occur.I also get heart burn from some meds, so after taking them I do not lay down for at least 20 minutes. There are all kinds of little tricks of the trade to help with side effects it's all a learning process.Don't fear multiple drug therepy there are alot of us out here on them & are fairing very well.

Brenda

24 Jul 2009, 00:40

Sue' I just read your comment, I too am on all of the same drugs, but I went off fosamax. I worried about the side affects. I guess you have to weigh the good against the bad .I also started to have pain in my jaw , my dentist gave me a night guard but also sid it could be from the fosamax. Good luck. Brenda

Sue

23 Jul 2009, 10:49

I had similiar concerns about adding yet another med, I also have RA, but have been able to eliminate, for the most part, the prednisone, which was the Dr's goal in adding Plaquenil. Have had no negative effects, be sure to have enough food in your belly, I stagger my doses around meals, I also take multi vitiamns, Folic acid, 81mg asprin, calcium and Fosamx. Good luck!

Ramona

20 May 2009, 23:05

I was recently taken of my medications due pausytopenia .My counts have gone up to border line norma.I have ankolosis spondonitis and resently dx with bachets how safe is Imuran,colchacine and methrotrexate?

janice weiner

07 Apr 2009, 13:46

i am taking alprazolam propranolol 20 mg cymbalta 60 mg clonidine 0.1mg levothyroxine 0.05mg prevacid 30mg in the morning in an half hour i am shacking. and i have to take a alprazolam to get me over it.

jargon08

01 Apr 2009, 18:37

I am on all 3 of those meds, plus I just started on Arava/Leflunomide too. I haven't seen any negative side effects so far. I also take a Multivitamin, Calcium pill and Folic Acid ... and of course, a birth control pill too. It's A LOT of pills to stomach but if it helps ... !

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Combining Medications

Combining Medications

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