METHOTREXATE
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Over the past couple of years I've started to encourage patients to adjust
their weekly dose of MTX depending on how their psoriasis is doing - eg. I
prescribe "MTX 2.5 mg #60 - up to 6 tablets once a week." rather than "MTX
2.5 mg #60 - 6 tablets once a week." 

This has considerably reduced the rate at which  MTX is consumed by many of
my patients -- staving off the dreaded day when they hit 1.5 grams and have
to go off to talk to the liver doctor about a liver biopsy. I think the
patients are happier and feel more "in control" too. Of course I warn them
sternly about not taking MORE than the prescribed maximum, and I encourage
them to take less if they can get away with it. 

I tell them you son't have to get 100% resolution of the psoriasis - just
enough to please yourself; and I explain that "sometimes you can get 90% of
your side effects trying to get rid of the last 10% of your disease". They
are strongly and repeadedly encouraged to use all the other treatments
(topicals, UV-light) in order to reduce the long-term need for MTX.

Anyone else have experience doing it this way?

KC Smith MD FRCPC
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