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Why Was I Switched from Methotrexate to Cyclosporine?
from Jim B.

I was getting great results from 20 mgs weekly of methotrexate for a couple of years. In the beginning it took awhile to show results; then the clearing happened fast and I've stayed clear.

For absolutely no reason I can think of, he's taken me off methotrexate and put me on cyclosporine. The number of cyclo pills is determined by body weight, so it depends.

If my P remains clear I suppose I won't fuss about the drug switch. I'm just curious: why did it have to happen? -Jim B.

*****

Ed's Response: Lots of possible reasons, Jim. Among them:

  • Your blood work may have indicated elevated enzymes from the MTX. If this has happened gradually it can mean your liver is not tolerating the MTX regimen.

  • Your derm may have a "working rule" that patients in your category (whatever that might mean) don't continue to use MTX for longer than "x" months, no matter what. You might want to find out if he's got a time limit on your use of cycloporine and, when he says that he does, does he intend to put you back on MTX when your "cyclo period" is over?

  • You may have mentioned a lifestyle change to your derm that suggests to him continuing MTX is not a good idea. (Resuming regular use of alcohol, for instance, may cause a derm to take you off MTX.)

Whatever the reason your derm changed your prescript, it is something you should find out and make note of. Treating your psoriasis will be a chronic problem — like the disease itself — and you owe it to yourself (and your pocketbook) to keep tabs of what's worked, what hasn't, exact prescription amounts, administration instructions, duration of use and outcomes. I've seen patient-created spreadsheets that record this data over years — and turn it into interesting, reflective graphics. Patients who go this far and bring this documentation to their first appointments with new derms are most likely to end up with the best, "no bullshit" Dr.-patient relationships (though it might take "working through" a few derms on the way to finding the "right one").

Let us know how you fare on the cyclosporine, Jim. As you probably know, I've used both drugs in a rotating regimen in the past, with excellent results. I hope you enjoy the same. -Ed

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