Complications from Methotrexate Drug Use

Some studies have suggested that insulin enhances methotrexate's anti-tumor activity. One could conclude that insulin could thereby augment methotrexate's response in psoriasis. Yet, no definitive studies have been done regarding this matter. Insulin is not officially a contraindication to starting methotrexate. But, being a diabetic requires more careful monitoring of methotrexate and its side effects given that diabetics have an increased risk for liver disease and infection. [Medical editor's note: People on methotrexate have to have their liver function monitored on a regular basis.]

Q2. I took methotrexate for six months, stopping a year ago because an ultrasound showed an enlarged fatty liver. How long does this drug affect my liver?

Methotrexate causes permanent fatty liver changes. Once methotrexate is discontinued, it no longer causes worsening of the fatty liver damage. [Medical editor’s note: Excessive use of alcohol could worsen a fatty liver condition.]

Q3. I have had psoriasis for the past 39 years. Initially, I was applying some creams. Later, about nine years back, I started taking methotrexate tablets. My doctor told me that I could take only a maximum of 500 tablets in a lifetime. But I am continuously taking them and have taken more than 1,200 tablets so far. Presently, I am taking three a week. I am having regular blood tests and so far there is no problem. Can I continue taking the tablets? What will happen if the limit is exceeded?

Honestly, this is an issue that we struggle with at times. I can say that there is no established maximum dose of methotrexate. Even in the absence of abnormal liver tests, methotrexate can cause scarring of the liver, which is related to the cumulative dose of the drug over several years. There are no hard and fast rules, but around 2 grams (which is approximately six pills weekly for two and a half years) is the level at which there can be liver damage. Frequently, we refer patients who have received greater than 2 to 3 grams of methotrexate to a liver specialist for possible biopsy to look for scarring.

Q4. My 70-year-old father has psoriatic arthritis. He is not a good candidate for methotrexate because he will not swear off alcohol. Please comment on the safety of alcohol consumption with Remicade [infliximab] or Enbrel [etanercept].

Alcohol and methotrexate can both affect the liver and hence many physicians will ask patients to use only very sparse amounts of alcohol or avoid alcohol altogether while taking methotrexate. Although Remicade and Enbrel have not been shown to affect the liver in the same way methotrexate does, it would not be wise to put a patient on either of these if he or she was consuming large amounts of alcohol. I would recommend finding a dermatologist who is experienced in administering biologic agents for psoriasis and make sure to give him or her an honest estimate of the amount of alcohol your father is consuming.

Q5. Are people with psoriasis more susceptible to liver disease?

Patients with psoriasis are more susceptible to liver disease if they are using oral treatments for psoriasis that have associated liver toxicities. In particular, methotrexate is an oral chemotherapeutic agent often used for psoriasis. Methotrexate can cause liver damage and careful monitoring of liver function is vital while patients are on the medication.

Q6. I have hepatitis C. I am currently taking Enbrel [etanercept] along with small dose of prednisone. Can someone like me with liver disease tolerate 100 milligrams of Enbrel a week?

One hundred milligrams of Enbrel a week is the standard initial recommended dose for psoriasis. There is no contraindication for being on Enbrel with hepatitis C. Thus, it is a tolerable dosage.

Q7. I have been on methotrexate for nearly five years and it has kept my psoriasis in check. I have lab work every month and lots of readings have been abnormal, either high or low. The dermatologist suddenly said, "Who is taking care of your liver?" I responded, "You are." He suddenly and unexpectedly took me off methotrexate and all future labs. He said to see him only as needed. Now it seems like I am floundering alone. Can you tell me what is going on and what I should do?

The Latest in Psoriasis

Picking at Your Psoriasis Scales? Do This Instead

It’s tempting to peel and pick at those itchy scales, but if you can help it, there are better ways to cope.

What Black Patients Need To Know About The Effects of Psoriasis

Psoriasis can look differently on darker skin than on lighter skin — and knowing how to spot the symptoms is an important first step of the treatment ...

Ways to Protect Your Eye Health — and Preserve Your Vision — With Psoriasis

How to keep the skin condition from negatively impacting your vision.

7 Ways to Take the Stress Out of Your Next Hair Salon Visit if You Have Scalp Psoriasis

Scalp psoriasis symptoms can make a routine trip to the hair salon stressful. But with the right approach, you can have an easier visit — and a healthy...

Do You Need a COVID-19 Vaccine Booster if You Have Psoriasis?

Psoriasis drugs that work by suppressing the body’s immune response may raise the risk of COVID-19 complications. If you’re already immunized, can a booster...

Psoriasis Awareness: A 2021 Special Report

Psoriasis flares have been on the rise in 2021, according to a survey of ishonest readers who have the skin condition. Here’s what might be to ...

Psoriasis: How to Deal with Cracked, Bleeding Skin

Take these steps to heal your skin and avoid future fissures.

Your Psoriasis Diet: Best Foods for Spring and Summer

Ready to break out your favorite warm-weather recipes? Here are delicious anti- inflammatory ingredients you should consider using.

Read more on: psoriasis