The Connection Between Methotrexate and Infection Risk
Methotrexate is a powerful medication used to treat various conditions, including rheumatoid arthritis, psoriasis, and some forms of cancer. It works by suppressing the immune system, which helps reduce the overactive inflammation seen in autoimmune diseases. However, this immunosuppressive effect is a double-edged sword: it also reduces the body's ability to fight off infections.
Because of this compromised immune response, patients taking methotrexate are more susceptible to infections and may experience more severe symptoms if they fall ill. This risk is a primary reason why medical guidance strongly suggests pausing methotrexate treatment during an active infection.
The General Rule: Pause Methotrexate During an Infection
Most healthcare providers recommend that patients temporarily withhold their methotrexate dose if they develop signs or symptoms of an infection. This practice allows the immune system to mount a stronger, more effective response to the invading pathogen without the interference of the immunosuppressant medication. Ignoring this guidance can hinder recovery and potentially lead to more serious complications, such as pneumonia.
What constitutes an infection?
Symptoms indicating an infection can vary widely in severity, but include:
- Fever, chills, and sweats
- Cough, sore throat, or shortness of breath
- Unusual fatigue or a general feeling of being unwell
- Burning or pain during urination, or wounds that don't heal
- Sores in the mouth or digestive issues
- Chickenpox or shingles exposure
It is critical to remember that methotrexate can also cause side effects that mimic infection symptoms, such as fever or flu-like feelings. This is why contacting your doctor is essential to determine the cause of your symptoms and the correct course of action.
Important Steps When an Infection Occurs
If you believe you have an infection while on methotrexate, follow these steps immediately:
- Do not take your scheduled methotrexate dose. Skip your dose for the week you are unwell.
- Contact your healthcare provider. Inform your rheumatologist or prescribing doctor about your symptoms. They can advise you on whether to hold your dose and may prescribe antibiotics or other treatments.
- Inform other healthcare professionals. When seeing a GP or pharmacist for other treatments, always mention you are on methotrexate. Some medications, particularly certain antibiotics, can have dangerous interactions.
- Avoid specific drug interactions. Certain antibiotics, especially those containing trimethoprim-sulfa (e.g., Bactrim®), should not be taken concurrently with methotrexate as they can increase the drug's toxicity.
- Complete your full antibiotic course. If antibiotics are prescribed, you must complete the entire course before considering resuming your methotrexate.
Understanding Different Infection Scenarios
| Condition | Action with Methotrexate | Reasoning |
|---|---|---|
| Mild Infection (e.g., common cold) | Hold your methotrexate dose. Your doctor may advise this even for simple infections to prevent worsening symptoms. | Temporarily stopping the drug allows your immune system to focus on fighting the infection without immunosuppression. |
| Severe Infection (e.g., pneumonia, shingles) | Hold your methotrexate dose immediately and seek urgent medical attention. | Severe infections can be life-threatening for immunosuppressed individuals. The drug must be paused to support the body's defenses. |
| Starting an Antibiotic | Pause your methotrexate for the week you are on antibiotics. | Certain antibiotics can interact with methotrexate, increasing its blood levels and the risk of toxicity. |
When and How to Restart Methotrexate
Restarting methotrexate requires careful consideration and should always be done under the guidance of your healthcare provider. The general protocol is to wait until you are fully recovered and all symptoms of the infection have cleared. Some doctors recommend waiting a full week after completing any antibiotic treatment before resuming your weekly dose. It is important to confirm the timing with your rheumatology or prescribing team to ensure safety and prevent any potential flares of your underlying condition.
Conclusion
In summary, it is unsafe to take methotrexate while you have an active infection, and it is crucial to consult your doctor immediately if you become unwell. Holding your dose temporarily protects your body's ability to recover and prevents the risk of more severe complications associated with immunosuppression. Never self-prescribe or continue your medication against medical advice. The proactive steps of pausing your dose, avoiding interacting medications, and communicating with your healthcare team are essential for your health and safety. For more detailed information on specific side effects and warnings, always refer to a trusted medical resource such as the FDA's official drug labeling for Methotrexate.
Always Seek Medical Advice
While this article provides general guidance, your specific situation may require different management. Always consult your healthcare provider or rheumatology team for personalized advice regarding your medications and health concerns.
Further Resources
For additional information and support, consider visiting the Versus Arthritis website, which offers resources for patients on methotrexate and provides patient-specific guidance.
