Fighting a 3 Front Battle

I've had a 2+ year flare. It was brutal from the Fall of 2016 to Summer of 2017 when I started Entyvio. Entyvio has been great. It really got things 70% better with little side effects. Two scopes this year confirmed what I was thinking: mild inflammation centralized in the rectum and first inches of the colon. My doctor added a number of drugs that gave me nasty side effects like vomiting. My doctor put me on 25mg of methotrexate weekly. It sucks for this because they only make 2.5mg tablets so I have to take 10 pills which I dont enjoy. After being on that for several months, my second scope of the year saw my mild inflammation go from 30cm to around 20cm, so pretty much all in the rectum now. My doctor and I finally added canasa suppositories. I was nervous about the suppositories at first, but almost a week in, I've been pleasantly surprised how easy they have been to use. Obviously it is still too early to know if they will make a difference, but I'm hoping that this can finally be the end of this fight and get me back into some much needed remission.

My problem is that I feel like I'm feeling some bad side affects to the Methotrexate and just general constipation. I'm getting a lot of nausea and headaches, especially at night. I've read that symptoms late at night like that can be a sign of constipation. I know the Methotrexate is making me ill. I take pills on Friday night, feel horrible Saturday, feel okay Sunday, better Monday, & perfect on Tuesday. At the same time, I hate to come off a medication that has cut my inflammation from 30cm to 20cm.

So I'm wondering how people here have weighed coming off a medication that is working but is making you sick? I feel like my doctor will want me to stick with the medication, maybe add an anti-nausea medication. My other question is how best to deal with constipation? I guess if the inflammation is getting more under control, constipation will happen. I have fiber bars that I try to eat daily. Is that enough or is there something better out there?

Hi iPoop,

I didnt know that Methortrexate was in the same class as 6mp & Azathioprine and that makes sense now that I think about it. I've gotten sick while on both of those, similar symptoms to the Azathioprine and not as bad as the 6mp. I was up all night vomiting while taking the 6mp. I guess that class of drug just isn't for me.

UCer23 said...
Hi iPoop,

I didnt know that Methortrexate was in the same class as 6mp & Azathioprine and that makes sense now that I think about it. I've gotten sick while on both of those, similar symptoms to the Azathioprine and not as bad as the 6mp. I was up all night vomiting while taking the 6mp. I guess that class of drug just isn't for me.

Methotrexate is similar to 6mp and azathioprine in that it's considered an immunomodulator at the doses used in IBD. But it's chemically different from 6mp and aza and has a different mode of action.

Unfortunately methotrexate does often have side effects, with nausea being a common one. Often GIs prescribe it in shots instead of pills, as that often reduces the nausea for patients. You could ask about that as Curious Crapper suggested. Also, as mentioned, folic acid supplements are usually prescribed as well when one is taking methotrexate.

There isn't a whole lot of data on its use in UC, as said above. And even for Crohn's, there's only limited data. That's not to say that it doesn't work, just that it's not so well known how effective it is.

It's often used when one needs more help from a biologic but the patient can't tolerate 6mp or aza, so that's your case.