Update on how we're doing/ Questions about Methotrexate and side effects

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Jan 13, 2013
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Hey all,
I thought I would update now that we are back from our second opinion in Cincinnatti. My 12 yr old son was confirmed to have the moderate to severe range of Crohn's disease, and the doctors up there were very helpful with answering questions and discussing a treatment plan. They recommended methotrexate injections, whereas our local doc wanted to do 6MP. After Once we returned home, we conferred with our Ped GI doc here, discussed the options, and decided to begin Methotrexate injections two weeks ago, while simultaneously weaning my son slowly off the budesonide and Asacol. Since we started the Methotrexate injection, my son has felt worse than he did before we started it. He has barely moved off the couch, with waves of pain that come and go, and we realized tonight his BMs have become less frequent, down to maybe once a week. I was wondering what other parents have kids doing these injections, and how long does it take to feel better on them? Do the side effects get better? How long does it take for the symptoms to improve? Do most kids on this lay around in pain the first few weeks? We want to give this med a fair trial before trying something else, but currently he is actually feeling worse on this med than he was before he started it. I was also a little nervous that his BM had slowed down so much. I know I should be on top of all this stuff, but with monitoring everything else, I hadn't thought to ask him in the last two weeks about his bm's. Diarrhea has never been one of his symptoms; in fact, before he was diagnosed with Crohn's apparently he was constipated and we hadn't realized it since we had not been questioning him about his bowel habits. Don't all 12 year old sons love it when their moms quiz them about poop? lol Anyway, All of his bloodwork from the past couple months have shown lowered inflammation levels, which is good news. Although he has still had a lot of pain. We also have him taking D3, Calcium, and folate in addition to his regular vitamins, per his docs recommendations.
Thanks for all your input, and I just want to say what a blessing these boards are. My husband and I have really wrestled so much with getting the right care for our son, and making these decisions regarding meds and diet. Sometimes it feels like this is the only place where others seem to understand what we are going through. What a breath of fresh air all of you are. God bless each of you, and thanks for feedback. :ghug:
 
Sorry I don't know the answer to your question about how long. I wonder if maybe you started the wean from the budesonide too soon... The symptoms could be the withdrawal of the steroids and not side effect of the methotrexate. Have you tried to call the Cincy docs?
 
Thanks, Carol. To clarify, We have just stepped down his other meds,not taken him off of them completely. The doc here said that was what we should do, and that methotrexate pretty much took effect immediately, which was one advantage to it vs. the 6MP. So hopefully, this is not a byproduct of lowering the dose of his other med. We went up to Cincy to go over treatment plans and confirm his diagnosis, but for day to day treatment we are still dealing with a doc here, who seems to do a good job. Planning to call him in the morning to make sure the decreased BMs are not an issue. They also prescribed Zofran, tylenol no 3, and nuleve, last week when I called them about my son's pain and nausea, but we have been trying to limit the amount of pain meds and nausea meds. It's hard to know sometimes which pain is caused by what---heartburn, Crohn's pain, or nausea from the methotrexate.
 
Sorry..rushing kids to get on the bus but I have always heard it can take up to 3 months for Methotrexate to work. As a matter of fact, my daughter just started Mtx pills (maybe injections work faster?) and the doc told us to make our next appointment three months out and we will decide then if we think it is working.

I will try to get you a link to something that supports that when I get back this afternoon.

So sorry he isn't feeling better. Poor pumpkin.
 
I agree with CIC, it does take time for MTX to work, I think with injections it is supposed to be up to six weeks. If his symptoms are indicative of his normal CD flares I would let the GI know he may want to increase the budesonide. I hope you find answers and get him feeling better soon.
 
Sorry he's not feeling any better :(

I don't have any experience with the drugs recommended, but I hadn't heard of one of the meds you posted "Nulev" so I looked it up - here's the link I found: http://www.webmd.com/drugs/drug-20600-NuLev+Oral.aspx?drugid=20600&drugname=NuLev+Oral

What caught my attention was it says, "slowing down the natural movements of the gut, and relaxing muscles in many organs (e.g., stomach, intestines, bladder, kidney, gallbladder)." Could that be causing him MORE constipation? Is the drug actually helping him?

Praying for you all!!
 
We were told 12 week before it was therapeutic even with injections when we started. That's why we did 12 weeks of Enteral Nutrition while waiting for it to work. My son has even changed dosages a couple of times and the GI's have said that they wouldn't know if it was working for about 3 mos.
Sorry you are having such a rough time - I hope it works for you in the end!
 
We were told 6 weeks for Mtx injections .
DS aslo has constipation issues .
Our Gi gave it 8 weeks to work.
I agree with weaning too fast.
DS was on pred with Mtx and every time we tried to wean symptoms came back.
He did have fatigue , joint pain, stomach pain, vomiting , nausea , mouth ulcers and vasculitis . For him these EIM's were signs it was not working but we waited the full eight weeks .
Hope it kicks in soon
 
12 yr olds like to be asked about as much as 15 yr olds...I am sure!! Some days I just say "Oh my life...the conversations that go on in this house!"

It took a while for us to get settled into the methotrexate shots. We had to move them to Saturday afternoons so that he could sleep and relax on sundays. The shot makes him nauseated (zofan helps this tons) and tired. He still has those symptoms, but not as bad and we have timed it so it doesn't affect his life as much. We've been doing them for about a year. Give it some time yet. Oh, also, use some miralax once a day to loosen up the stool and don't forget the 1000 mg of folic acid!

Hugs from T-town!!
 

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