Mr. X was presented with a very unique problem. He was a patient of psoriasis and we prescribed usual medicines that most of the skin specialist start with.
Once he came to know that he has to take a tablet in weekly pattern he started feeling nausea.
Methotrexate is the drug that elicits nausea and vomiting in many patients because of its minor side effect of gastritis in normal or above normal doses.
Then we enquired about his past history of treatments and why he never responded to any of them.
Everytime he went to a skin specialist they give him this medicine which is in weekly doses and Everytime it causes vomiting. He was unable to take this important medicine so there was no improvement in his skin lesions.
This was an example of conditioning response of vomiting to the stimulus of dosing pattern .
Patient was unaware of the medicine name. Just the weekly dose was conditioned with nausea and vomiting. His spouse told us that even a sight of this tablet makes him vomiting. So we made this unique attempt of systematic desensitization of stimulus.
We adviced same thing initially as half tablet and daily doses just to stop conditioned reflex.
Later on we suggested him to reduce days one by one until it comes to two days a week.
The dose was reduced so there was no gastritis and dosing pattern was different than usual methotrexate so conditioned response of vomiting was not elicited.
Mr. X was happy after 4 weeks of treatment and he tolerated well this medicine and almost forgot how he felt initially with weekly doses.
