Hi guys. I have been advised by several different people to take milk thistle supplement to offset the side effects of MTX. Have any of you heard of this???
Would appreciate your input
Were the people who advised this your rheumy, GP or your pharmacist?
Just askin’ …
I've never heard of this. I've only ever heard of folic acid supplements.
I was told that we cannot take milk thistle while on MTX. You need to always check with your doctor.
Thanks guys - I have some very forceful friends (one a oncology nurse) who insisted that I should be taking it. I am very reluctant to try "alternative" drugs without sound foundation. I am firmly of the opinion that these herbalists who do a 6 month course if they are lucky, should not be trusted over docs who have trained for years. If there had been some sound argument and case history, then I would have raised the possibility with my rheumy first. Nice to know that you guys are all of the same mind. :) Cheers
And tntlamb hasn’t even weighed in yet!
NO! NO! NO! NO! NO! not ever.
Milk thistle slows down the absorption of medicines, which of course WILL cut back on side effects of the MTX including making it (MTX) work..... So pretty much if you are going to take MTX and Milk Thistle, don't bother taking either. Its sorta like taking MTX pills with milk. They aren't absorbed so you don't get any side effects (or therapeutic effect.
I would imagine given the massive amounts of MTX given for cancer (about 100X more than we take) it wouldn't make much difference on way or another (but who would want to slow the effect of chemo???) but with the little bit we take it would make a difference
Lamb... Since I'm fairly new to this whole MTX thing, is there anything else I should not take with it? I take mine at night and get less nausea that way but am always afraid to take anything else that night such as omeprazole or a sleeping aid.... I am forever asking the pharmacist about all these new meds together and when best to take them... Now I have a cold and am hesitant to take Nyquil or anything else... Thanks.
tntlamb said:
NO! NO! NO! NO! NO! not ever.
Milk thistle slows down the absorption of medicines, which of course WILL cut back on side effects of the MTX including making it (MTX) work..... So pretty much if you are going to take MTX and Milk Thistle, don't bother taking either. Its sorta like taking MTX pills with milk. They aren't absorbed so you don't get any side effects (or therapeutic effect.
I would imagine given the massive amounts of MTX given for cancer (about 100X more than we take) it wouldn't make much difference on way or another (but who would want to slow the effect of chemo???) but with the little bit we take it would make a difference
When it comes to "real medicine" there isn't a lot that bothers MTX other than some antibiotics You should always ask about these as they are often drugs we commonly take for PsA and it its dirty little friend
leucovorin (yeah I know its designed to be taken to offset MTX side effects BUT it can go too far..... If you have to take i, you may need to to move on (IMO)
Dialntin and other anti convulsants (used to treat neuralgia for us)
probenecid and colchicine used to treat gout for some of us;
sulfa drugs; (Liver toxicity may be an issue
- tetracyclines: destroy bowel flora which are needed to break down the methotrexate. This may result in increased free methotrexate concentrations. and toxicity
- Amoxycillin kidney problems
isotretinoin, retinol, tretinoin; (used in a lot of creams we use for psoriasis
NSAIDs (non-steroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or
salicylates such as aspirin, Nuprin Backache Caplet, Kaopectate, KneeRelief, Pamprin Cramp Formula, Pepto-Bismol, Tricosal, Trilisate, and others.
The problem with supplements is you NEVER know what you really are getting. They are TOTALLY unregulated. Its hard to say what they will do and with what. I ALWAYS ask. Heres two good resources:
As mentioned I have heard of the Folic Acid supplements which help your body but not side effects necessarily. I had I think 14 side effects from Mtx, nothing was going to help me lol
I know a lot of natural remedies should not be taken with certain meds so I would always do your research first. Be sure to check a few different sources too.
I was also told by the health food store owner that you can't have Echinacea when taking MTX. I can't remember why...
Lamb, Sulfa drugs? Why am I on MTX and Sulfasalazine then? Seems like a bad combination...I also take celebrex sometimes. I wonder if I should just get off the MTX....I don't really like it and I have no idea why I have to stay on it with the Sulfa.....
tntlamb said:
When it comes to "real medicine" there isn't a lot that bothers MTX other than some antibiotics You should always ask about these as they are often drugs we commonly take for PsA and it its dirty little friend
leucovorin (yeah I know its designed to be taken to offset MTX side effects BUT it can go too far..... If you have to take i, you may need to to move on (IMO)
Dialntin and other anti convulsants (used to treat neuralgia for us)
probenecid and colchicine used to treat gout for some of us;
sulfa drugs; (Liver toxicity may be an issue
- tetracyclines: destroy bowel flora which are needed to break down the methotrexate. This may result in increased free methotrexate concentrations. and toxicity
- Amoxycillin kidney problems
isotretinoin, retinol, tretinoin; (used in a lot of creams we use for psoriasis
NSAIDs (non-steroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or
salicylates such as aspirin, Nuprin Backache Caplet, Kaopectate, KneeRelief, Pamprin Cramp Formula, Pepto-Bismol, Tricosal, Trilisate, and others.
The problem with supplements is you NEVER know what you really are getting. They are TOTALLY unregulated. Its hard to say what they will do and with what. I ALWAYS ask. Heres two good resources:
The MTX/SSZ combo is somethin fairly new. The SSZ increases the efficacey of the MTX. Most of the studies involve RA like this one:
http://www.ncbi.nlm.nih.gov/m/pubmed/16926184/
Its aversion of triple therapy which also usually includes hydroxychloroquine studies have foind its as effective as Biologics for thousands less per year IF it works. Of course most of the studies are for RA. The good news is if it doesn't work. You start biologics much quicker. The bad news is the side effects are killer........ Like I said earlier, this is touchy CALL your rheumy and make sure he understands the headaches and nausea. This isn't the normal MTX side effects.
Thanks for the info Lamb! I have a feeling the next combo will be the Avara and MTX as she talked about this with me on the phone, to be honest I was fine with 3 sulfa a day, going to 4 has been tough. The conversation before that was to use Enbrel. I'm getting a little frustrated, will check out the study. Thanks again, you're a wealth of knowledge and your feedback is greatly appreciated!
tntlamb said:
The MTX/SSZ combo is somethin fairly new. The SSZ increases the efficacey of the MTX. Most of the studies involve RA like this one:
http://www.ncbi.nlm.nih.gov/m/pubmed/16926184/
Its aversion of triple therapy which also usually includes hydroxychloroquine studies have foind its as effective as Biologics for thousands less per year IF it works. Of course most of the studies are for RA. The good news is if it doesn't work. You start biologics much quicker. The bad news is the side effects are killer........ Like I said earlier, this is touchy CALL your rheumy and make sure he understands the headaches and nausea. This isn't the normal MTX side effects.
Lets face it....so many of these meds are a problem for the liver. That's part of the reason they talk about limiting alcohol consumption, drinking lots of water and regular blood tests. Almost every med I've tried so far for PsA is a liver concern.
Tara,
Arava and MTX together is a pretty big hammer on your liver - I had it sitting my cupboard but decided I wasn’t willing to try them together. Can you open up that conversation about Enbrel again with your Rheumy? I had to be very persistent with my Rheumy, culminating in basically begging for it, before he’d write me a script.
I’m not saying that’s a good thing, just that remember its reasonable for you to have a partnership with your Rheumy in making decisions about your meds.
TaraLynn said:
Thanks for the info Lamb! I have a feeling the next combo will be the Avara and MTX as she talked about this with me on the phone, to be honest I was fine with 3 sulfa a day, going to 4 has been tough. The conversation before that was to use Enbrel. I’m getting a little frustrated, will check out the study. Thanks again, you’re a wealth of knowledge and your feedback is greatly appreciated!
tntlamb said:The MTX/SSZ combo is somethin fairly new. The SSZ increases the efficacey of the MTX. Most of the studies involve RA like this one:
http://www.ncbi.nlm.nih.gov/m/pubmed/16926184/
Its aversion of triple therapy which also usually includes hydroxychloroquine studies have foind its as effective as Biologics for thousands less per year IF it works. Of course most of the studies are for RA. The good news is if it doesn’t work. You start biologics much quicker. The bad news is the side effects are killer… Like I said earlier, this is touchy CALL your rheumy and make sure he understands the headaches and nausea. This isn’t the normal MTX side effects.
Tara, Arava and MTX together, I think, is a real last-ditch attempt at avoiding biologics. It’s a combination that some docs don’t like to use, because it is extremely toxic. My rheumie’s advice was “On Methotrexate you shouldn’t drink. With Arava you MUSTN’T drink.” I got a small amount of improvement on the combination, but when I went on a cruise, I allowed myself a measured 70 mL (half a small glass) of wine a day. Bloodwork when I got back indicated that my liver couldn’t take even that small amount. I was really walking on the edge with that combination.
I was on triple therapy (MTX/sulfasalazine/hydroxychloroquine) for several months, and it did nothing for me. Arava helped a tiny bit: if the improvement on Arava/MTX was a 1, the improvement on Enbrel was a 10. For me, anyway – your mileage may vary! And during the year of experimentation with this drug and that, my hips sustained terrible damage, while the rest of me felt like a bag o’ dirt.
I agree with Jen: I think you need to open the conversation about biologics with your rheumatologist. What does your husband think? Will he be going with you to your next appointment?
I'm trying milk thistle, vitamin D, multivitamin no iron or paba, and folate. My liver enzymes have been elevated for a couple of years. It may be coming from my bone though. Will find out Tuesday. Not on MTX yet but probably soon. My mother took milk thistle during her chemo with Dr. blessing.