# Racing / Training while on Methotrexate?



## WaitUp (Aug 31, 2007)

I’ve recently started taking methotrexate in a low dose format (6 x 2.5 mg once per week) to treat granulomas in my thigh muscles (due to sarcoidosis). No unpleasant side effects so far. However, reading the literature indicates that even in this low dose, the point of the med is that it inhibits cell growth, which is what it’s supposed to do to treat the various inflammatory diseases that it’s used for in this low dose format. I assume that it can and will interfere with recovery after training. (I’m cat 3. My 2007 season is done, but I’d like to be competitive in 2008.)

How bad can the side effects of methotrexate be in the context of endurance sports training? Am I interpreting this correctly that even if it works exactly as it’s supposed to, it will inhibit training / recovery? Does anyone have experience with this stuff?


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## f1oored (Jan 16, 2005)

I work at a cancer hospital and I see a lot of people on methotrexate. The only precaution they tend to be on is for UV light (as methotrexate can make your skin sensitive). You should know that I'm not a doctor and my patients are usually not athletes. I work next on saturday night and I can ask around to get a few solid opinions on vigorous exercise while on methotrexate. I would ask your doc and see what his opinion is. I'll get back with you after I work next.


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## vanjr (Sep 15, 2005)

Ask your doctor this specific question!!


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## OldEndicottHiway (Jul 16, 2007)

Oh dear. Sorry to hear about the trouble with sarcoidosis. What a pain!

As for the Methotrexate, its a pretty potent drug (as I'm sure you've read the list of potential side effects). I'm no expert on it, but, I do know it suppresses the immune system, so hard training might put you in greater risk for some nasty bugs. I don't really know know how Metho will effect recovery, but there surely could be some ramifications regarding training in general, and your concerns overall are definitely not unfounded. I am glad you are on "low dose." 


Also, it causes bone marrow suppression so anemia including, I think, the possibility of low platelets (cells that help in clotting) is a real concern. It is also can be hard on the liver and kidneys. 

I don't want to talk out my hiney too much here, because as I said I don't work with this drug too often, and don't want to raise your anxiety level unnecessarily..._all_ drugs have side effects/potential risks, even plain old aspirin.

I am convinced you and your MD can come up with a plan specific to your athletic needs. Haven't you already discussed this with him/her? I would ask if a referral to a sports med doc, is in order just to put your mind at ease with a good plan. Hey, knowledge is power Bud.


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## f1oored (Jan 16, 2005)

Alright, I've asked a few of my co-workers and the general consensus is that you should be able to train while on the low dose of methotrexate. Again, ask your doctor and let him or her have the final say on the issue.


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## Oldteen (Sep 7, 2005)

f1oored said:


> Alright, I've asked a few of my co-workers and the general consensus is that you should be able to train while on the low dose of methotrexate. Again, ask your doctor and let him or her have the final say on the issue.


The demands of Cat 3 racing/training on your body will likely be unfamiliar to your doc. Try to find a good Sports Medicine specialist to discuss your situation. A search of the medicine & physiology literature may shed some light on intense physical training (inc. recovery) with methotrexate. 

BTW- I do (did) some MTB racing at the club-level & was diagnosed with a health issue early this year. In discussing exercise issues with my generally well-read doc it became clear he had no idea what my recreational training regimen entailed. He said exercise was fine and no limitation of activities- until I described cycling 4000+miles/yr with intervals and LT sessions and races. THEN he told me to limit my intensity, cancel long club rides, and no racing for at least a year (when I will be re-evaluated). Docs must be conservative in their advice, but it pays to know the specific pitfalls of your condition & treatments (inc. medications). For example- others have mentioned the hypertensive athlete who starts on a new blood pressure med then passes out after resuming their usual vigorous work-out. Don't take a genius to guess that a new water pill plus lots of sweating= MAJOR dehydration!!!

Hang in there, and remember that appropriate exercise can be beneficial for many conditions. Hope all works out well for you!!!!!


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## supercrank (Feb 20, 2004)

I don't think there are any studies investigating the effect of methotrexate on athletic performance or recovery. I'm a pulmonologist, and I see a lot of patients with sarcoidosis, and I have a fair amount of experience with methotrexate.

I think that the sarcoidosis is more likely to affect your performance and recovery than the medication, but obviously this depends on which organs are being affected by the disease and how severe it is. In general, methotrexate can cause bone marrow suppression and anemia, and I'm sure you're getting routine bloodwork to rule this out. Methotrexate can also cause a hypersensitivity reaction in the lungs which could result in symptoms of cough and shortness of breath. If you get these symptoms, be sure to talk to your doctor immediately since further testing is sometimes needed to distinguish between infection and methotrexate toxicity.

Otherwise, make sure you're well hydrated, and enjoy riding. Oh, and you should have also had a routine electrocardiogram to make sure that the sarcoidosis isn't affecting your cardiac conduction system. OK, I'll stop now before I get too into this.



WaitUp said:


> I’ve recently started taking methotrexate in a low dose format (6 x 2.5 mg once per week) to treat granulomas in my thigh muscles (due to sarcoidosis). No unpleasant side effects so far. However, reading the literature indicates that even in this low dose, the point of the med is that it inhibits cell growth, which is what it’s supposed to do to treat the various inflammatory diseases that it’s used for in this low dose format. I assume that it can and will interfere with recovery after training. (I’m cat 3. My 2007 season is done, but I’d like to be competitive in 2008.)
> 
> How bad can the side effects of methotrexate be in the context of endurance sports training? Am I interpreting this correctly that even if it works exactly as it’s supposed to, it will inhibit training / recovery? Does anyone have experience with this stuff?


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## Lookbiker (Sep 2, 2006)

Ask your doctor.


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## WaitUp (Aug 31, 2007)

*Thanks for the reponses*



supercrank said:


> ... but obviously this depends on which organs are being affected by the disease and how severe it is.


The granulomas are in the thigh muscles. I didn't see a picture, but based on where the pain is, it feels like lots of granulomas in amongst the muscle fibers. Also, FYI, I had three very large granulomas on the lungs in '98, but they were mostly removed, and there's been no recurrence in the lungs.



supercrank said:


> ... In general, methotrexate can cause bone marrow suppression and anemia, and I'm sure you're getting routine bloodwork to rule this out.


Blood work yes, but the doc didn't mention anemia. He's mostly monitoring for liver damage as I understand it. I'll ask him about the other stuff. Any reason I wouldn't supplement with some iron (SloFE or the like)?



supercrank said:


> ... Oh, and you should have also had a routine electrocardiogram to make sure that the sarcoidosis isn't affecting your cardiac conduction system.


Thanks for the heads up, I'll ask about that too.

Very helpful responses, thanks. FWIW, the doctor (in this case a rheumatologist) is aware of my biking, and is monitoring the meds, dosages, outcomes, etc. with an eye towards making sure I can continue at this level. That said, I don't think he's a sports doc or has many (if any) other patients in a similar situation as me.

Thanks!!


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