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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

libyana

02 Feb 2012, 13:09

I was just started on a med program yesterday for R A.I have it very bad in my hip,knee & ball of foot along with other areas& I am not able to walk longer than 15 mins so not very active.I am on Prednisone & Plaquenil & I was wondering if anyone could tell me if Tylenol#1 is ok to take for pain,also I like a glass of wine with dinner ..can I still have that????
Thanks for all the info it is encouraging to talk with people who have the same trouble

Gideon

29 Jan 2012, 07:02

I have had mixed connective tissue disease for nearly a year now. I was on methatrexate for a few months a first but was noticing some abdominal issues and having a hard time remember to take it, since it has an odd schedule. I then got off of it and started the Arava...It was horrible though it did work. Lost forty percent of my hair and it just died... also started to form a rast behind my ears and on my scalp...not sure if this is because of the med or if I'm forming psorisis...doctor as just put me back on methatrexate again... alittle scared after reading everyones stories. I also am going to be taking folic acid and tramadol works for the pain.

Dejan

17 Nov 2011, 14:45

Hi there
Let me just first say to ya all. Dont give up and keep the faith. Things must and will get better.
I am 33 years old and have been very active allways. I've had 4 surgeries on my left knee. Lately everyday pain became ubeareble and i am thinking of taking some medicine ( wasnt using it till now )
I ve heard that human growth hormon is the only thing that can rePlace/ rebuild dammaged cartillage. Because i just dont want to take everything, i was hoping someone will know something about it and its benefits. Or is it just a hype

Thanks for answer,
Dejan

Jimmy

11 Nov 2011, 11:14

I am 48. Just started getting trigger thumb and hands get numb. What gives?

Denise

10 Nov 2011, 18:39

Hi

I have never responded on one of these sites but after reading everyone's posts, I feel I should. I have had RA for 15 years I am now 49 years old,....I have been on every type of medication regimen there is intermittantly with no favorable results only severe side effects.
I am just now going back to Methotrexate/folic acid in hopes for some effect on the disease.

To all of you out there, I would like to say, please consider doing what you have to to get the disease under control. I have extreme damage and deformity in my hands/feet and I only wish something would have worked.

i did have a physician treat me with antibiotics and supplements, not voodoo or herbs, but amino acids, etc. and that treatment seemed to put me into remission for 5 yrs,.....but I developed kidney issues with the antibiotic and moved to another state and there are no physicians here who believe in that type of therapy.

I am scared to death to be back on metho, the first time I took it when I first was diagnosed, I puked my head off and lost quite a bit of hair....and with the reactions to the other meds...Arava, Plaquenil, Enbrel.....I feel lost and that somehow my disease is sooooo different than others.

My point is Don't be afraid to research and let your physicians know how you are reacting to the meds,esp if they are causing severe side effects but don't seem to be helping the disease ....something different may work better.

I hope that all of you are blessed with some kind of relief.

jean

04 Nov 2011, 15:06

I have RA and fibromyalgia..Been on 13mg of Methotrexate a week and 3mg prednisone a day.Just diagnosed with periferal neuropathy in feet and legs and sent for physical therapy..Session of therapy was to long(went to 4 session 2 hrs each)flare up of Ra. Hands, Hips and legs.Taking Tramadol for pain.
This is helping. Rheumatoligist wants me to start enbrel. Is anyone on enbrel. Does it help or should I wait to see results of blood tests? Really dont want to get on anymore drugs as I take others meds for medical problems. Try to keep a positive attitude.I know this is important. Has anyone tried medical marijuana for pain. I hear it works. Everyone else seems to have more problems than I so hang in there.

Lou

31 Oct 2011, 11:48

Just about to start Methotrexate and folic acid. Dreading it for so many reasons but Salazopyrin just kept bringing me right down with one infection after another. I feel for sure that my hands and hip which are diagnosed as RA are nowhere near as bad as you guys are describing and I am still able to work as a chef (with a bit of help with the heavy stuff and quite a lot of pain meds) My lovely docs seem to think its important to start on one of these meds before my hands become distorted. I just cant face changing my whole life and filling my boxy full of pills and potions, particularly as I am told this will not help my winter depression. Hey ho, more meds I suppose.

Patricia

05 Oct 2011, 03:10

i am taking salazopyrin en 500mg 3 times a day. what side effects have you heard about this tablet i went from 1 a day for first week then 2 a day for this week and next week onwards on 3 tablets a day. i work full time some days i dont know how i get out of bed with the pain. i feel sick now on these tablest does this last for long will my hair fall out will i put on weeight. i look forward to a reply so i can sort this all out in my head. i also take a lot of pain killers and also have Fibromyalgia.

patricia

03 Oct 2011, 13:33

hello i am on cimzia 200mg injection every second week and have started salazopyrin en 500mg 3 times a day.

have any body been on both. i did put on weight but now afraid that the new tabs will make it happen again. please reply i am a young at heart 47 with bad ra. from ireland

Ana

10 Sep 2011, 07:23

Back in 1995 I was diagnosed with RA. My RA would bother me usually when the weather went from one extreme to the next. I have no disfiguration whatsoever in any of my hands or feet and I do not have any pain in any of my joints at this time. I used to be on Celebrex in 2004, but cannot take it anymore as I had experienced pain down my left side of my arm and it made me feel awful. I was put on Plaquenil and Methotrexate in 2005 and I found that the Methotrexate made be feel sick to my stomach and I had nausea and I was very depressed after taking this pill. Fast forward -- I am 53 years of age now and in November 2009 was misdiagnosed with Fibromyalgia because no one at this hospital knew what I was suffering from and they sent me home after 2 weeks and put me on Lyrica. Lyrica did nothing for me because it was my own RA specialist who knew exactly what I was going through although she could not see me at this particular hospital as she had no specialist privileges there and she worked out of another hospital in Toronto. She took a look at me immediately the next day I was released in her office and said OMG I think you have Vasculitis. I had never heard of this, but she said I don't know what type of Vasculitis you are suffering from. I was sent to the hospital the next day to have a biopsy and that's when I was told that I had a rare autoimmune disease known as Polyartritis Nodosa. I was put on high doses of Prednisone, am back on Methotrexate by injection (which by the way I have noticed an increase of hair loss) and I have to take an anti-nausea pill when taking Methotrexate as I am still having problems tolerating this medication and I am still to this day since 2004 have been on 400 mg of Plaquinel a day and I get my eyes tested twice a year and so far my eyes are ok. You have to realize that being on Prednisone and Plaquenil can have adverse affects on your eyes. The Prednisone tends to make my vision go blurry and the Plaquenil can give you other issues. So testing is necessary to watch for any changes in your vision. I am also on 1 mg of Folic Acid, 1300 IU of Calcium, 5000 IU of Vitamin D (which by the way blood work shows my Vitamin D is still extremely low), and I take Zopiclone 7.5 mg for sleeping (never been on sleeping pills but that's what the hospital gave me to sleep because I wasn't able to sleep in the hospital and now I cannot get off them because otherwise I could never fall asleep. I have found myself forgetting alot and have trouble focusing. I am wondering if anyone else here has the same issues? And, a few other things I forgot to mention I have had Epicleritis in both eyes which has cleared now but had to be on Prednisone eye drops for weeks for that to clear up. I've been on insulin because of the Prednisone spiking my glucose but am now off insulin. My Prednisone has been reduced now to 5 mg a day. I also take Synthroid for a hypoactive thyroid condition (0.15 mg). Also forgot to mention that I have Srogrens (most dry eyes and mouth). It has taken me almost 2 years to recover from all of this but my fatigue is still extremely an issue with me. I am grateful that I can walk again without the burning in my legs, but have suffered with both my feet as a result of this disease. My feet are both numb as the progression of the disease destroyed my nerves and circulation. I am grateful to a wonderful RA specialist who saved my life. If you would like to discuss please leave your comments here and I'll check in later. God bless you all and let's pray that one day we'll find a cure for these terrible diseases.

Chris Kennell

29 Jul 2011, 07:05

To reply to my comments on RA please email me at specimenstorage@aol.com
Christopher

Chris Kennell

29 Jul 2011, 07:04

I have had RA for 52 years. I have been through it all. I mean ALL. My majic bullet was exactly this, 20mg ARAVA, two 40 mg folic acid and Vicoprophin every 6 hours. To be clear, 1 Arava, 2 folic acid and 4 Vicoprophin daily.
The Arava turned my RA off in two weeks. I was taking baby steps holding onto my wife to walk. Within two weeks I was feeling SO MUCH BETTER that I knew that I had found something significant. I have been on Arava for over 5 years with no side effects. After about a year I reduced my dosage to 10mg daily.
If you have been on Methotrexate for a while with no real benefits, try Arava. Perhaps those of us that are no responding to all of the old standard attempts to control the RA have a body chemistry that responds to Arava.
You need the Vicoprophin to manage the pain so that you can stay active. Staying active is a vital ingredient to being able to stay active if you know what I mean.
I started this regiment of treatment by my request to my doctor. Thank God he was willing to allow me to try it. BINGO! It works great for me. I am fulltime employed and taking care of my one acre yard. I am obviously crippled up from so many years of failed attempts to stop the RA but I am no longer in sever pain. I just have natural pain from the damage done in the past. This type of pain is much more tolerable than full blown RA.
Please let me know how it works for you. Try to get on it tomorrow if possible. That is provided you are not being treated successfully at this time.
Christopher

Deanna

07 May 2011, 00:08

I'm reading some of the above comments.

I've never had headaches till the last 6 months or so. I've been on methotrexate and Plaquenil for nearly 2 years, but am getting worse. My legs have gone bonkers and I started eating sleeping pills like candy, and now back on morphine, which brings it's own set of troubles. I wonder if this is just the progression of the disease (lupus, Sjogren's) or is it the medication?

I'm trying a long term course of antibiotics. I get terrible flare ups during the antibiotic week (followed by 3 weeks of probiotics). I'm hoping the flare ups are just a die off reaction (Herx reaction).

Any suggestions or comments?

Mary

21 Feb 2011, 11:38

Just started 15 mg weekly of methotrexate 4 months ago; was taking 200 mg of Plaquenil daily prior to this. I have had eye exams 2 times in 1 year, both times my opthamologist said that my eyes have shown no side effects to the plaquenil. I feel great now that I am taking both!! I have 4 children under the age of 9, am pretty active, walking and light weight lifting. I don't want the disease to hamper my life anymore because it did prior to starting the meds. I also take lots of nutritional supplements, such as resveratrol, alpha lipoic acid, fish oil, glucosamine/chondroitin, and others. I take milk thistle to deter the effects of the methotrexate on my liver, and so far my liver panels have been normal. Hope this helps!!

mons

16 Feb 2011, 02:16

i have R,A and it very hard to do lots of stuff i used too,i used to be on methrotrexate for 8months it helped but the side effect was i lost so much of my hair and got hair extensions my hair so so weak that so a year ago
i got off very slowly,and was taking pedniose only than slowly came off that and i was free from pain for a good few months ,i was on fish iol only.
but now i suffur my hand finger are so tender and im alway tied.
my docter say to go back on methotrexte what do you think befor it made me almost bold and fat
please help me ive even changed my diet helped a little,
i pray that we all get cured naturally and dont need this med with all it side effects
thanks for reading

Lena

15 Oct 2010, 21:40

Plaquenil is excellent for RA or Lupus, antibiotics have always worked great for my symptoms. I have been bitten by ticks several times but they couldn't find Lyme's. 20 years later I now have NK LGL Leukemia. I was ANA negative all the years they thought I had either RA or Lupus. I suffer from Neutropenia as well.

dotsdaughter

04 Oct 2010, 08:00

has anyone heard of the road back foundation or the use of antibiotic protocol for ra. Do you experience less pain when your on some antibiotics.some doctors think ra and other diseases may be from bacteria, worth a look.

Deb Danton

30 Sep 2010, 06:49

I am also taking Methotrexate and Plaquenil which was working quite well up until recently but im starting to notice signs of flaring. My specialist wants me to take 14 fish oil capsules a day but i cant do it! i start gagging and it just makes me feel ill st the thought of it. Has anyone else tried the fish oil and did it work?

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

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