Which Cold Remedies Can I Use While on Methotrexate?


I am new to RA. In the past I have used Echinacea when I felt like I had a cold coming on. I read on the information pamphlet that I received with my prescription for methotrexate that says I should not use it. Now I have a cold and wonder what over-the-counter remedies I could maybe use. I used to also use Alka-Seltzer Plus and wonder if I could use that. I’m pretty frustrated as I haven’t had a cold in a very long time. I am also on prednisone, hopefully for the short term only.



Dear Kathi,

Dealing with a cold or the flu when you have rheumatoid arthritis (RA) can be a challenge. The condition itself makes you more susceptible to infection and catching contagious illnesses, as well as often making it harder to recover from one. Add an immunosuppressant, such as prednisone, methotrexate or biologics — which would make the immune system weaker — and things could get more complicated.

RA is an autoimmune disease. This means that the immune system attacks the body’s tissues as if they were foreign invaders or bacteria. In RA, this attack causes inflammation that can damage joints and other systems, such as internal organs. The best way to control that inflammation is with medication, such as disease modifying antirheumatic drugs (DMARDs) like methotrexate, biologics, and biosimilars.

Some of these medications — methotrexate, biologics, and to a lesser extent, steroids — are immunosuppressants. They have been designed to suppress the immune system’s activity and therefore its attack on the tissues in your body. When the immune system is suppressed, so is the RA, hopefully bringing you into remission. The downside is that the way these medications work also leaves you more vulnerable to infection, such as catching a cold or the flu.

Immune system boosters and RA

[Colds] are caused by the rhinovirus, which is especially present in the winter months. When this virus is present, your immune system will send out white blood cells to defend against it, but if you haven’t been exposed to this exact virus before, the result is a cold.

The idea behind immune system boosters, such as echinacea and golden seal, is that they will stimulate the cells that fight infection, such as white blood cells. Therefore, the immune system will be better able to fight back against the impending cold and prevent you getting sick.

Research into the effectiveness of echinacea is inconsistent. Some studies indicate that echinacea is no better than a placebo, but a large study showed that it may reduce both how many colds you have and how bad they are by as much as 25 percent. However, you need to be careful taking herbal supplements as they are less standardized and can be mixed with compounds that interact dangerously with your RA medications. Consult your physician before taking these supplements.

It’s important that you not use echinacea if you have RA or another autoimmune disease. Regardless of the inconsistency of studies into the efficacy of echinacea, there is wide agreement that immune system boosters can cause a flare in people who have autoimmune diseases.

In such conditions, the immune system attacks itself. If you increase the immune response to combat the cold, you can also expect the attack on your body to become more severe. Also, as methotrexate and biologics suppress the immune system and therefore suppress your RA, taking echinacea [could counteract the effects of the medication].

Cold remedies and RA

There is generally not an interaction between over-the-counter cold medication and immunosuppressant medications, such as methotrexate. However, it’s important to be aware that cold medication usually contains acetaminophen — the generic name for Tylenol. If you are using acetaminophen as a painkiller, also using cold medication can put more of this medication into your body than it can handle. Too much acetaminophen can become an overdose and be toxic to your liver.

In additiona, some of the remedies contain nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, Motrin, and Advil, which can cause kidney and liver damage and will result in toxicity due to Methotrexate.

Speak to your pharmacist or your doctor regarding what other cold remedies you can take. In the meantime, drink lots of fluids, make sure you get plenty of vitamin C and rest as much as you can.

You may also want to speak to your rheumatologist about whether they recommend skipping methotrexate while you are having a cold. Rheumatologists seem to differ on this — some want you to stop your medication only if you have a fever or are taking antibiotics, whereas others recommend skipping a dose if you are sick.

You should know: The answer above provides general health information that is not intended to replace medical advice or treatment recommendations from a qualified healthcare professional.

You should know: The answer above provides general health information that is not intended to replace medical advice or treatment recommendations from a qualified healthcare professional.

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