I think lawyers get paid to have extreme cases of CYA and put down every possible symptom/outcome possible in the literature just so the company is covered in case someone decides that they would like to sue.
The not drinking thing isn't a big deal for me as I don't drink anyway because of my pain meds...tend to fall asleep when you drink on those!
thanks for the recipe lamb, I enjoy the tea very much. Maybe why my livet counts are good?
I will put on a batch of wine next week . Maybe only one gallon though.
Back in the UK in 1994 the advice was no alcohol, although I didn't actually care - the MTX made me feel so sick I didn't want any. Glad when I got off that DMARD ! Loving my glass of red a few times a week now though .
As Seenie mentioned, here in Aus (and in the UK), the docs can be somewhat more lenient. I’ve added a few simple links below that show a varying range of findings - the most appropriate way I’ve found to summarise the information is that because there is not enough data, no safe limit can be advised, therefore it is safe to advise patients to consume nothing.
http://www.ncbi.nlm.nih.gov/m/pubmed/17163236/
http://www.ncbi.nlm.nih.gov/m/pubmed/18609744/
http://www.rheumatology.org.au/community/documents/MTX210208.pdf
And to suggest that the safety profile of MTX in PsA is not the same as in RA;
http://m.rheumatology.oxfordjournals.org/content/47/7/939.full
I’m going to have to fess up that this weekend I can’t find that study that implied no correlation up to 15 drinks (the top one above shows none up to 6, but it’s not a robust study) - if I find it I’ll post it (again though, as I said to Robd0gg, nobody is suggesting that’s a good idea to drink every week!)
Can you take Lemon Balm pills? I know this is about drinking & PSA but just wondering about the pills.
tntlamb said:
I think I have this solved........ I have been reading about the advantages of Lemon Balm for arthrits
Soooooo:
- 4-6 cups lightly packed lemon balm
- 1-3/4 to 2 pounds finely granulated sugar
- 7 pints water
- 1-1/2 cup white grape juice frozen concentrate
- 1 tsp yeast nutrient
- 1/4 tsp pectic enzyme
- 1/8 tsp grape tannin
- 3 tsp acid blend or juice of 2 large lemons
- 1 packet Champagne wine yeast
Rinse and clean lemon balm and then chop leaves and stems coarsely. Put into 2-qt saucepan with lid. Add 1 quart water, bring to a boil, put lid on pan, and turn off heat. Let steep for 2 hours. Meanwhile, boil remaining water and dissolve sugar, tannin and acid blend (or lemon juice) in it. Pour into primary and allow to cool to room temperature. Strain lemon balm and add water to primary. Stir in pectic enzyme, grape concentrate and yeast nutrient. Cover and set aside for 8-10 hours. Add activated yeast, recover, and stir daily for 6 days. Transfer to secondary and fit with airlock. Rack, top up and refit airlock after 30 days and again after wine clears. Stabilize and sweeten to taste if desired. Bulk age under airlock for 3 months and taste. If wine has not smoothed out, age another 3 months. Rack into bottles and serve chilled.
I have five gallons almost ready to bottle. Now no doc is going to deny a "natural remedy" are they??? BTW it fabulous stuff
I think you have it pretty much right, Lamb. The links that JenAus sent are very interesting, and as she says there is no definitive conclusion that can be drawn, with the possible exception of the concurrent use of mtx and leflunomide.
Here’s the bit I found most interesting, from the Arthritis Australia mtx information:
.Alcohol:
Alcohol increases the risk of liver damage while taking methotrexate. Methotrexate usage in heavy drinkers has been associated with cirrhosis of the liver. It is not known precisely what level of drinking is safe when on methotrexate, however there is general agreement that 1-2 standard drinks taken once or twice a week is unlikely to cause a problem.
Drinking a lot (more than 6-8 standard drinks) on one occasion, even if infrequently, is strongly discouraged.
That all sounds very sensible to me, and makes me think that, yes indeed, North American doctors are covering theirs. I wonder if they sue doctors much in Oz.
Thanks, JenAus, for sending those.
Not arguing with the literature but somehow SOMEONE is either giving us a snowjob or doing an extreme case of CYA
If you take the reported incidence of liver damage from chronic long term use of several popular NSAIDS along the reported incidence of liver damage from MTX do a two tailed regression. Anyone taking NSAIDS should be equally concerned with using alcohol with them. I can't help but wonder if the combination of NSAIDS and MTX is the problem?? I dont' have enough data to make a for sure analysis, but it sure makes one wonder.......
I went to an all boys catholic school at one time. We were told a certain "impure act" would cause blindness. The common response (sure to get a few "hacks") was we would quit when we needed glasses.
Liver Damage is a huge concern, but remember when the anatgonist goes away the liver frequently will fix itself. I'm NOT suggesting the "need glasses response...." just not to freak.....
I was told by my rheumatologist not to drink any alcohol when starting MTX, not a problem as I rarely drink. The medication label added by the pharmasist also states ‘do not drink alcohol’ …I might have the odd glass of wine or half of beer about once a month but other than that I steer clear just for my livers sake. I think its all about informed choice as long as you know and understand the dangers it up to the individual to make a choice that they can live with. I’m in the UK
I am in the United States. I was told NO alcohol. That was not a problem for me at the time as I rarely drank. However a couple of years ago my sister died under sad circumstances and I began to have a few drinks at times. Specifically, right after her death, I would have 2-5 beers if we went out to dinner. For a about a year, that was once a week. I was self-medicating my grief, without a doubt. The second year, I would have 2-3 beers at a time, maybe once a month. I also discovered a very tasty wine that I would drink a few glasses of once every few months when I would bother to drive the distance to where it could be bought. I did that for 2.5 years without a problem, then I had a blood test that showed a change in my liver numbers. The night before my blood-test we happened to go out for dinner and I had 2 beers. I am not sure how much that affected the liver numbers.
My rheum. immediately cut my Methotrexate does in half. I immediately stopped drinking alcohol. I also researched vitamin/herbal supplements that would help with liver function. For the next 3 months I drank an herbal tea with licorice, etc and also took milk thistle supplements 2x a day. On the half does of Metho. my right knee filled with fluid and I had to have it drained and got a cortisone shot.
After 3 months a new blood test showed the liver back to normal. Dr. said I could go back to old dose of Metho. I however, instead of taking the old dose of 8 pills weekly, am taking 6. I have more pain than I would like to have on this dose but the liver scare....scared me! I also continue to take the milk thistle and drink the tea, but not as consistently. As for alcohol, sometimes I will have one or two drinks a week, sometimes no alcohol for several weeks. I def. am more careful.
Hope that helps with your research :)
Hi Seenie,
You and Lamb have probably hit the nail on the head regards CYA and litigation. The litigation environment here is worlds apart from North America - this is not an area I’ve researched, but in popular media it would seem that in Australia you’d almost have to prove deliberate harm from a doc / pharma (ie not just negligence) before you’d get anything, and it still wouldn’t be much.
I believe that the professional indemnity insurance is run through the medical association, which I also think would have a big impact.
For example I’m a qualified first aider - if I break someone’s ribs trying to resuscitate them at a car wreck and they try to sue me, the big (not for profit) first aid association that I (and most Ambos) did training through steps in and defends the case with their lawyers. (as long as I was acting consistent with my training).
I think the MTX guidelines put out by the Australian Rhuematology Association seem pretty sensible, though my concerns with long-term MTX use (I said no to Arava because of the compound effect) remain.
Advice from my Rheumy here in India:
Absolutely "No alcohol" 48 hours prior to and after taking Mtx. So, basically that rules out 4 days every week. Apart from this, 60-90ml of whisky/scotch Or 2 Beers once a week should be fine.
This all depends on blood tests every couple of months, of course.
UK calling. My rheumatologist said to stick to the uk women’s weekly guidelines for alcohol which equates to 2-3 units a day with at least 2 days alcohol free. I don’t actually drink this much but it’s nice to know I can have a glass of wine after a tough day at work.
Well done on getting over the binging…that’s not easy!
Had the results of my most recent blood test yesterday. My liver is absolutely fine. Woohoo. Will celebrate with a nice glass of wine (only joking, it is mtx night so don’t touch alcohol on a Wednesday)
Very interesting responses, everyone! And it’s more or less as I thought. The further you get from the US, the less stringent the caution is.
Meanwhile back at my ranch … I added leflunomide (arava) to the mtx, beginning in May. I read about its liver toxicity, especially when taken with mtx, which made the “you really mustn’t drink” warning redundant for me. Abstinence all summer. And last week, it happened. Rheumy’s office calls and says to reduce my dose of mtx. I’m guessing my liver is beginning to twitch. If I’d consumed any alcohol, I would have felt guilty. So I don’t. But I am very interested to see what the rheumy has to say later this month.
Summer’s almost over and I’m dyyyying for a beer. The one I won’t be having. Have one for me if you can! That’s what I love about this board: we get it and we help eachother out. LOL
Sennie, I'll have 2 for you....
Things are relative though..... When I went in several years ago with a rhythm problem the doc asked me me how much coffee I drank. I told him one or two. He said that wasn't the prboblem until my tattle tale wife informed him that it was one or two - POTS