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Flu shot and methotrexate

my little penguin

Staff member
Flu shot time
Methotrexate normally is Saturday
All the studies state hold for 1-2 weeks after the flu shot
So if he gets mtx Sat
And flu shot on Sunday or Monday
Then no mtx for 7-14 days after
Or does it matter how close mtx is taken before the shot ??
Trying to space out one week from Stelara given and three weeks until next shot of Stelara given
Plus other biologic in there as well


Well-known member
San Diego
This is an interesting puzzle. I can't quite piece all the interlocking schedules together from here, but taking the drugs one at a time I suggest this:

Methotrexate: get the flu shot 2 or 3 days after the MTX to allow the MTX to clear his system, then hold the next MTX at least one week to allow allow the response to the flu shot to kick in. Hold it two weeks if you can get away with it, but don't take undue risks of a flare.

Stelara: On a 4 week schedule I would split it right down the middle. Get the flu shot two weeks after the prior dose and two weeks before the next dose. The rule of thumb for all vaccines is that the minimum time for a full immune response to vaccination is two weeks. So you want the Stelara concentration in his blood to have dropped as much as possible before getting the shot yet still allowing approximately two weeks for the immune response to develop before the next Stelara injection.

Can you overlay these two schedules and find a sweet spot - a day for the flu shot on which both of these things will work at the same time?
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my little penguin

Staff member
Not sure there is much to do about timing his second biologic (it’s every two weeks )
But I can leave at least two weeks for Stelara and space out mtx
2-3 days makes sense since his liver enzymes go up within 24 hours of the pills but then drop to normal after 2 days .


Staff member
We were told to hold MTX for two weeks after the flu shot, BUT only if disease activity allowed. Since my daughter is flaring, we're only going to hold it 7 days. We were not told to hold any biologics per M's rheumatologist. We are planning on doing the flu shot 4-5 days after MTX and we'll hold it for 7.

Based on what we have been told, Stelara is really one of the least immunosuppressive biologics - but since it's relatively easy for you to do it 2 weeks after his dose, I'd do that. But if that doesn't work, I honestly would not worry about Stelara. MTX is the bigger issue - I'd try for 2 weeks off that as long as his arthritis is calm and so is his IBD.