During our last Rheumy visit we discussed MTX and folic acid. She prescribed (4) 2.5 mg tablets once a week with Folic acid tablets. She recommended crusihing and putting it in some chocolate syrup. I informed her that my daughter is allergic to chocolate. She gave no other ideas as far as administering this medication. I asked about the liquid which I have read that most children take, she said it's supposed to be for injections. So obviouisly she doesn't want to give the injectable ORALLY. OK Fine.I'm thinking that perhaps she'll only need a small amt of liquid and it will be easier to mask the taste.

When we got home i remembered about the folic acid. So we called her and dicussed it she said " take 1 tablet everyday except for the day of mtx" I confirmed that we buy it over the counter and she said yes.  OTC folic acid comes in 400 or 800 MCG.Which does she want? So I guess I'll be calling again.  Seems like most children take 1 MG of folic acid. Is this by prescription? How often is it taken? I'm concerned that our Rheumy isn't up on the lastest information. We go to a Children's hospital in NY. She has not spoken to us regarding and eye exam either, which I have read should be done to r/o an eye involvement. Hmmm I hope we don't have to go somewhere else.

Any ideas or opinions? Thanks  in advance.

Nancy

child- 6 yr old with Poly 4/09

My 4 yr old daughter was dx with poly JIA in Feb., so we are still somewhat new to this.  But I can tell you what our experience has been.  My daughter takes the injectible form of mtx orally.  Apparently it can be absorbed into the system at the low dose that she's on, but at higher doses cannot.  If she has to go to a higher dose at some point, then we will have to switch to giving injections.  I have read from other people that their rhuemys say the mtx is not absorbed as well when taken orally as opposed to when injected.  I'm just glad that our rheumy gave us a chance to do it this way first, to see how she responds.  So far, no problems.  We are taking 1 MG folic acid everyday, including the day she gets the mtx.  It is an rx, not OTC.  My daughter is also ANA+, so she has to have an ophthamologist examine her every 3 months.  If you are not ANA+, I'm not sure you need to have these eye exams.

HTH

I'll just share our story and hope it helps. 

My son was dx'ed with poly in April as well...however this was at his second appointment with the rheumy...he had seen him five weeks prior but before any bloodwork had been done.  We probably had one of the fasted dx's around...March 13th was when we noticed his knee swollen (for the second time) and went to the pedi the next day...it was a whirlwind of doctor visits and within two weeks we were at the rheumy's.  Anyway, the rheumy felt he was 'probable' so we started on the naproxen, were referred to the pedi ophthalmologist immediately and sent for bloodwork. 

Alex does have an underlying eye condition (nystagmus) so we got right into the ophthalmologist...it was found his eyes were clear of arthritis -YAY (but they found a serious vision loss...but that's another story.)  That was in early April...and we go back mid-July and will continue going every three months as he is ANA+ and he has the vision issues. 

At our second rheumy appointment, he found even more joint involvement and tried, unsuccessfully to get him into the Humira trial (he is very thin...38'ish pounds...but that was over the cutoff for the trial.)  So he was started on weekly mtx injections (Saturdays)...he stated he does not like to give the injectible orally as the rate of absorption is inconsistant.  Pills were never mentioned as an option.  Plus there appear to be fewer side effects when mtx is given by injection...something else to consider. He also got a prescription for 1mg of folic acid to be given Monday thru Friday...I crush it into applesauce (natural) every morning and we have no problem. 

If you are questioning your rheumy (and honestly you have vaild concerns) do you have any other options for a rheumy?  I know they are few and far between...we feel blessed that we have ours just twenty minutes away, another about a half hour away (but not as highly recommeded as the one we see) and then two more four and six hours away. 

All the best!

Karen and Alex, 5, poly 04/09

Thank-You for your responses. Upon reading them I remembered something the Rheumy mentioned at the visit with regard to the injectable being taken orally. She did say something about a compound pharmacy who can make the precise dosage, but pharmacists don't really like to do that anymore. Whatever that means. I hope the "1 tablet" of folic acid is really going to prevent the common side effects of this medication. I don't want to increase the folic acid after the fact. I want it to prevent it .I know the Rheumy is treating my child by protocol but i want it to be the easiest route available.

There are only 2 pediatric Rheumy's here on Long Island one of which I go to and her associate , a few about 1 hr away and I have had experience with that hospital and won't go there and all the rest in Manhattan about 2 hrs.

It will take alot to convince my husband to switch to injections, if we ever go down that road. My husband has juevenile diabetes (type 1) and gives himself insulin every time he eats. Just the thought of my daughter getting injections no matter how small the needle will be very hard to tolerate and he'll never inject her. He can't even watch when she recieves her immunizations.

Thanks for listening. I hope this doesn't sound to maniac. LOL

Nancy

Dgter 6 poly 4/09

My husband is from LI...he grew up in Merrick and we lived in Massapequa and Selden before we moved to sunny south Florida in 2001.  Just a little more we seem to have in common. 

I hope all works out with this rheumy...it's so hard because there are just so few out there.  As for the shots...they really aren't that bad...and Alex HATES needles...but I just started giving them to him in his sleep.  But I 'get' why your hubby would be against them. 

You should be able to find a compounding pharmacy/pharmacist...they are typically the smaller, non-chain ones.  When my son was a baby he had a parasite (of course) that required an antiobitic which had to be compounded (not certain that's the correct term.)  Anyway, that's when I learned about this.

All the best,

Karen

I am a mom of a 2 year old girl with polyJRA dx in 10/08 and I'm also a pharmacist. Methotrexate is not as well absorbed when taken orally so the doctors cannot tell whether the full dose given is actually the dose absorbed and working --especially when the child is not responding and you are giving the max dose for their size. That being said, who lkes to give shots to their baby? The injectable liquid can be given orally but it is more common to just crush the tablets and give them in a spoonful of your childs favorite food. It can be yogurt, applesauce, chocolate syrup, etc. It does make it even harder for them to absorb the med but this also helps their little tummies from getting upset. Ideally, this would get enough medication into your child once a week and you'll see results. Unfortunately, it doesn't always work and you end up having to give MTX by injection once a week. More med is getting into your little one this way because more is absorbed using the same amount of medicine- reducing the chance of giving too much and getting side effects.

Pharmacists (at least the ones I Know) like to get compounds because it breaks up the monotony of our day. Not everything can be compounded and not everything is reliable in a compound. I thought about compounding this for my daughter but decided against it because I was still going to give it to her with a little food because of the side effects.

The folic acid dose is usually 1mg. At 1mg it requires a prescription. Not every kid needs all 1mg so you can get 800mcg from the store. It is not a huge difference. If the child gets mouth sores, it would be better to get the rx for the 1mg. It is also cheaper to get the rx for 1mg sometimes.

I inject my daughter now once a week. It's not too bad. The problem I have is that the medicine is harder to get! It is always back ordered and unavailable. I am constantly asking other pharmacies if they have it stock.

Good luck and hope I've helped a little.

Thank-You for your reply and expertise.  I have read about the MTX tablets not being absorbed properly as you stated. Is this the same for the injectable given orally?  Is it truly lack of absorption or incorrect administering?  My plan is to give 4 tablets crushed in 1 TSP of pudding, carmel syrup or other thick snack.

So I guess I will give the 800 mcg of folic acid. I hope that will be sufficient.

All the Best

Nancy

Keep checking for side effects like sores in mouth. You will have to take her once a month for blood work to monitor for liver problems. This is the hardest part for us. The girl who draws the blood is known as the "bad doctor". She is very nice and very quick but it still is torture for us.

Good Luck!!