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Is It Safe To Take Methotrexate And Azoran For Psoriasis?
Question: Need a second opinion .
patient is a female 77 years old, diabetic (controlled) with BP (controlled)
Chronic psoriasis for 2-3 years.
was on methotrexate and atarax since then.
2 tablets of atarax 25 mg daily and 4 tablets of methotrexate once a week.
Now we have been prescribed AZORAN 50 mg 2 tablets daily + 4 tablets of methotrexate 2.5 once a week.
Course for 3 months.
Is azoran combined with methotrexate good for treatment of psoriasis?
.
what are the side effects if any of this drug is it safe to take for such a long period.?
And in your opinion is thsi line of treatment fine
patient is a female 77 years old, diabetic (controlled) with BP (controlled)
Chronic psoriasis for 2-3 years.
was on methotrexate and atarax since then.
2 tablets of atarax 25 mg daily and 4 tablets of methotrexate once a week.
Now we have been prescribed AZORAN 50 mg 2 tablets daily + 4 tablets of methotrexate 2.5 once a week.
Course for 3 months.
Is azoran combined with methotrexate good for treatment of psoriasis?
.
what are the side effects if any of this drug is it safe to take for such a long period.?
And in your opinion is thsi line of treatment fine
Brief Answer:
Combining methotrexate and azathioprine is not a good idea
Detailed Answer:
Hello. Thank you for writing to us.
I have taken note of your query and i have understood your concern.
Ideally they should not be combined because both are hepatotoxic.
Moreover giving these together for long durations would increase risk of developing Lymphoreticular malignancies as well as skin cancer because of profound immunosuppression.
Also considering that the patient is old it would be wise to not combine these in an old patient who would anyways have diminished organ functions due to age i.e decreased metabolism and renal clerance may also contribute to side effects.
Azathioprine is not a first line treatment option for psoriasis. Though azathioprine can be used in psoriasis patients in whom first line treatments like methotrexate, phototherapy, cyclosporin are not possible or contraindicated.
Ideally when 2 different immunosuppressives are used in psoriasis they are given as a rotational therapy e.g 3 months of each on rotation rather than in combination.
Goal of rotational therapy is to reduce side effects and cummulative toxicity of individual immunosuppressives while effective control of psoriasis is maintained.
Common side effects with these drugs include nausea, vomiting. Serious side effects like hepatotoxicity, bone marrow suppression, infections etc should be watched out for.
Regards
Combining methotrexate and azathioprine is not a good idea
Detailed Answer:
Hello. Thank you for writing to us.
I have taken note of your query and i have understood your concern.
Ideally they should not be combined because both are hepatotoxic.
Moreover giving these together for long durations would increase risk of developing Lymphoreticular malignancies as well as skin cancer because of profound immunosuppression.
Also considering that the patient is old it would be wise to not combine these in an old patient who would anyways have diminished organ functions due to age i.e decreased metabolism and renal clerance may also contribute to side effects.
Azathioprine is not a first line treatment option for psoriasis. Though azathioprine can be used in psoriasis patients in whom first line treatments like methotrexate, phototherapy, cyclosporin are not possible or contraindicated.
Ideally when 2 different immunosuppressives are used in psoriasis they are given as a rotational therapy e.g 3 months of each on rotation rather than in combination.
Goal of rotational therapy is to reduce side effects and cummulative toxicity of individual immunosuppressives while effective control of psoriasis is maintained.
Common side effects with these drugs include nausea, vomiting. Serious side effects like hepatotoxicity, bone marrow suppression, infections etc should be watched out for.
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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