This week we bring you the last in our “Looking Back” series on methotrexate. We continue to look at managing methotrexate adverse effects.

Here is the original post from 2017…

In our last two blogs we discussed the importance of folic acid supplementation while on methotrexate,  and the use of dextromethorphan (DM) to reduce the potential “sick day” phenomenon which some people experience the day after taking methotrexate.  In this blog,  I am addressing strategies to avoid nausea that is associated with methotrexate use in some patients.  Of great importance is the use of folic acid as was mentioned earlier.

In addition, methotrexate can be given as a weekly injectable dose instead of swallowed tablets.  This avoids contact with the stomach and reduces nausea.  The injectable is available in three ways.  1. A vial where patients draw up their dose in a syringe,  2. a pre-filled syringe,  3. an auto-injector device (newly available in Canada).  Currently only the first option is a benefit under government based insurance where the other options may be a benefit under private insurance.  The injectable also provides excellent absorption and may be a more effective treatment than the tablets which aren’t as efficiently absorbed.

For patients using tablets, splitting the dose over the day the methotrexate is taken will reduce stomach upset and allow for better absorption.  The maximum number of tablets that can be absorbed at any time is 6.  Doses higher than this need to be split over the day, even if there is no nausea (ie. if you take 8 tablets weekly; swallow 4 after breakfast and 4 tablets after your evening meal on the same day).

It is important to note that many patients using methotrexate experience no adverse effects.

A couple of weeks ago, we looked back on folic acid and methotrexate. At the end of that blog, we referenced today’s “Looking Back” blog, “Managing the Adverse Effects of Methotrexate.” In keeping with our series on some of our most popular blogs and those that we receive questions about regularly, we’re looking back on this one today!

Here is the original post…

Managing the Adverse Effects of Methotrexate

In our last blog, we looked at the role of folic acid and its importance when taking methotrexate. Even though folic acid reduces the adverse effects of methotrexate and is needed, it may fall short in managing the fatigue (or what some call their ‘sick day’) the day following their dose. Methotrexate is known to inadvertently stimulate a part of the brain referred to as the NMDA receptor. Dextromethorphan blocks this receptor and therefore can reduce the tiredness and foggy thinking that some people complain of after taking methotrexate.

An easy way to get the benefits of dextromethorphan, and combat this foggy thinking and fatigue is through taking DM Cough Syrup, which is readily available and can be purchased over the counter at any pharmacy. The suggested dose is two teaspoons twice daily the day before, day of, and day after taking methotrexate. While this tip is not commonly known, it was shared at past Ontario Rheumatology Association Conference by Dr. Jack Cush, a well respected American rheumatologist who uses this approach regularly.

Stay tuned to next week’s blog on options for methotrexate dosing…

Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

Many people in Canada live with chronic pain every day. National Pain Awareness Week is being acknowledged next week and we are involved with a public education forum on Sunday afternoon in Burlington, Ontario. There will also be an educational day on Wednesday, November 6 for health professionals to attend. Our pharmacist, Carolyn Whiskin, has been a speaker at many public pain forum events in the past. She will again be sharing her expertise this Sunday alongside many other knowledgeable health professionals. We encourage anyone living with chronic pain to attend this complementary educational afternoon.

Chronic Pain Public Forum
Sunday November 3, 2019
2-6PM
Burlington Seniors Centre, 2285 New Street, Burlington
FREE

Bonefit is a program that was designed by health professionals in cooperation with the Osteoporosis Society to “reduce fractures, morbidity, mortality and costs from osteoporosis through an integrated and comprehensive approach aimed at health promotion and disease management.”¹ The program has three self directed modules and a workshop component. Specialists in rehabilitation medicine must complete a certification course to be instructors. The Bonefit website lists where instructors can be found anywhere in Canada. There are several in southern Ontario in a range of settings, from private clinics to the YMCA.

Learn more about this program by contacting:
Phone: 416-696-2663 ext. 2290
Email: bonefit@osteoporosis.ca

Maintaining the goal of 150 minutes of exercise per week is important for all Canadians. However, doing it in a way that is safe and offers your the most benefit is important. Using this resource can help you make sure any exercise you’re doing is done safely.

This week on our blog, we are continuing our theme of looking back at some of our more popular posts from the last few years. Today, we bring you a very popular one, “Raynauds Phenomenon is more than cold hands and feet.”

Here is the original text:

In our cold winter weather, many people complain of cold hands and feet with reduced circulation to these areas.  Often the skin will be whiter than normal and quickly normalizes once warmed.  Raynaud’s Phenomenon is a level beyond this whereby blood vessels constrict to a greater extent than normal as a result of cold temperatures or stress. There are three phases to the colour change of the skin. Initially, the restricted blood flood causes the skin surface to feel cold and the skin has a white colour, then the skin turns to a purple-blue colour, followed by a pink or red colour as the blood flow eventually returns.

There are prescription medications which can swallowed to promote blood flow that often cause a lowering of blood pressure.  A variety of prescription ingredients can also be prepared in a prescription cream and applied to the affected areas.  Feel free to ask our pharmacists about these options.  Raynaud’s can exist on its own or happen as a result of a pre-existing autoimmune condition.  Be sure to speak to your physician if you are experiencing the symptoms outlined above.  If severe and not treated, lack of blood flow can result and ulceration and the skin and serious consequences.

Keep tuning in to our blog for more of our favourite blogs. If you have a burning question, get in touch with us!

We often get questions as to why medications have such long complicated names and people wonder if the names have meaning.

In actual fact, the naming of prescription medications is based on international nomenclature regulations. When a new category of medications is introduced, certain groups of letters will be assigned to represent an aspect of how the medication works. Any other medication that is introduced in that category will have to incorporate that same group of letters within their name. For example, medications ending in “olol,” such as atenolol, bisoprolol and propranolol are all referred to as beta blockers and slow the heart rate. Medications ending in ‘zole” such as omeprazole and pantoprazole are acid lowering medications.

In the family of biologic medications which mimic proteins in the human body, several letter combinations have been assigned to indicate how the biologic works and what type of biologic it is. For example…

• “Mab” at the end of the name means it mimics a monoclonal antibody, such as adalimumab (Humira)
• If there is an “xi” included in the name, it means the cell used to produce the biologic is chimeric or mouse based such as; Infliximab or Rituximab
• When the antibody being mimicked by the biological treatment is humanized in origin then “zu” is included, such as tocilizumab.
• When a biologic is treating a tumour, “tu” is in the name. Such as tratuzamab.
• Biologics used to treat bones have “os” such as denosumab (Prolia).

There are many more examples of this. The next time you look at a medication’s name, you’ll realize there is a lot of meaning behind those letters.

This blog post was written by Charlton Health specialist pharmacists Vishnu Dyal and Carolyn Whiskin.

For many of us September feels like the start of a new year, even though we are still in 2019. As we reflect back over the last 2 1/2 years we have been writing our Wise Words Wednesdays blog, there are posts that generated great interest that are still quite applicable today. In our next few weeks we will highlight some of the top viewed posts and encourage you to use the search bar on the charltonhealthcare.com website to find answers to many of the common questions we receive from our patients.
As an example, I was recently asked about magnesium supplementation from a patient who is on an acid lowering medication. I knew I had written on the topic. We searched “magnesium” in the search bar on our website’s homepage and voila, here is the post that was displayed. It is still great information and I have added a little more…

#WiseWordsWednesday: Do medications affect nutrition?

See the original blog here.