It was also 8 pills a week. Maybe can go back to 6.

I do think that is quite an increase. And the problem with many things, including alcohol is that mthx dramatically impacts its effects on the body!

I think if you are serious about staying on mthx, you do need to stop totally drinking. Like I said, I know so many people on mthx, who had even one drink for Christmas or a special occasion and the liver enzymes went up.

The increase is the issue. You won't be really bad with the liver, till it hits over 1000 for the key markers. BUT, that being said, once the enzymes start to go up, they will continue to go up, if you don't address what is causing the problem, which is obviously the mthx, but perhaps the drinking, in combination.

That is just my opinion. I also have a strong opinion that people who will not stop drinking, even socially, for obvious medical problems may have a problem with drinking. I personally think you need to totally stop drinking if you are going to stay on mthx. You can always add it back later, and if you get the same results, you will know.

All I can do is wait to see where I am I a month. So far, I'm not in pain with no drugs, but my joints are letting me know of their existence. I think of RA as the troll monster in movie "Cat's Eye" and he's just figuring out the drugs are gone and he's coming for me with his tiny little sword and a hammer too!

How many months ago did you start MTX?

Including the bloodwork you had prior to startingTX, how many blood draw appointments did you have?

Started mtx in sept after initial /diagnostic draw. Normal draw in oct. Now 3 months later.

From what my doctor explained Methotrexate will stay around for 5 weeks. I wish you luck on finding a replacement

Trish-I know, there isn't one,right? Do biologics also affect liver enzymes? How about mtx injectible:does that bypass liver?

Injectable MTX is also metabolized through the liver.

Susie - have you ever had a liver disease or condition in the past?

Half-Life - The terminal half-life reported for injectable methotrexate is approximately three to ten hours for patients receiving treatment for psoriasis, or rheumatoid arthritis or low dose antineoplastic therapy (less than 30 mg/m2).

Excretion - Renal excretion is the primary route of elimination and is dependent upon dosage and route of administration. With IV administration, 80% to 90% of the administered dose is excreted unchanged in the urine within 24 hours. There is limited biliary excretion amounting to 10% or less of the administered dose. Enterohepatic recirculation of methotrexate has been proposed.

[A lot of the literature about injectable MTX is for the IV version of MTX used for cancer patients, which is in much higher doses.]

Nope. Never a problem. Everything else you just wrote was Greek to me.

I totally agree with Marlene. You have to totally cut out the alcohol.

Also, were you on antibiotics prior to starting MTX? Which one? How long before starting MTX?

No antibiotics in years and years. Nothing really.

Bummer. I'm trying to find reasons.....So far all I can come up with is the alcohol.

Liver enzymes increasing early in treatment happens, and from what I have read, studies report it doesn't always mean there is going to be damage. A lot of people are able to go back on MTX, or sometimes they stay on it, and the liver enzymes decrease or even return to normal. Your rheum is probably being extra cautious by having you stop, retest, and maybe try it again. Other than alcohol, other things are underlying liver disease, other meds that affect the liver, obesity, high cholesterol levels, and lack of folate.