Methotrexate

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Generic Name: Methotrexate Brand Name(s): Generics only. No brands available.

Uses

What is methotrexate used for?

Methotrexate interferes with the growth of certain cells of the body, especially cells that reproduce quickly, such as cancer cells, bone marrow cells, and skin cells.

Methotrexate is used to treat certain types of cancer of the breast, skin, head and neck, or lung. It is also used to treat severe psoriasis and rheumatoid arthritis.

Methotrexate is usually given after other medications have been tried without successful treatment of symptoms.

Methotrexate may also be used for purposes not listed in this medication guide.

How should I take methotrexate?

Take methotrexate exactly as it was prescribed for you. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You must use the correct dose of methotrexate for your condition. Methotrexate is sometimes taken once or twice per week and not every day. Follow the directions on your prescription label. Some people have died after taking methotrexate every day by accident. Ask your doctor or pharmacist if you have questions about your dosage or how often to take this medicine.

Use methotrexate regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Methotrexate can lower blood cells that help your body fight infections and help your blood to clot. Your blood will need to be tested often, and you may need an occasional liver biopsy. Your cancer treatments may be delayed based on the results of these tests.

How do I store methotrexate?

Methotrexate is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store methotrexate in the bathroom or the freezer. There may be different brands of methotrexate that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush methotrexate down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using methotrexate?

Before using this drug, tell your doctor if:

  • You are pregnant or breastfeeding. This is because, while you are expecting or feeding a baby, you should only take medicines on the recommendation of a doctor.
  • You are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • You have allergy with any of active or inactive ingredients of methotrexate or other medications.
  • You have any other illnesses, disorders, or medical conditions.
  • You have or have ever had a low level of folate in your blood.

If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking methotrexate.

Plan to avoid unnecessary or prolonged exposure to sunlight or ultraviolet light (tanning beds and sunlamps) and to wear protective clothing, sunglasses, and sunscreen. Methotrexate may make your skin sensitive to sunlight or ultraviolet light. If you have psoriasis, your sores may get worse if you expose your skin to sunlight while you are taking methotrexate.

Do not have any vaccinations during your treatment with methotrexate without talking to your doctor.

Is it safe during pregnancy or breastfeeding?

There are no adequate studies in women for determining risk when using methotrexate during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking methotrexate. Methotrexate is pregnancy risk category X, according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk
  • B=No risk in some studies
  • C=There may be some risk
  • D=Positive evidence of risk
  • X=Contraindicated
  • N=Unknown

Side effects

What side effects can occur from methotrexate?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using methotrexate and call your doctor at once if you have any of these serious side effects:

  • Dry cough, shortness of breath
  • Diarrhea, vomiting, white patches or sores inside your mouth or on your lips
  • Blood in your urine or stools
  • Urinating less than usual or not at all
  • Fever, chills, body aches, flu symptoms
  • Sore throat and headache with a severe blistering, peeling, and red skin rash
  • Pale skin, easy bruising or bleeding, weakness
  • Nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)

Less serious side effects may include:

  • Nausea, vomiting, upset stomach
  • Dizziness, tired feeling
  • Headache
  • Bleeding of your gums
  • Blurred vision

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with methotrexate?

Methotrexate may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Products that may interact with this drug are:

  • Azathioprine
  • Leucovorin
  • Phenytoin
  • Probenecid
  • Theophylline
  • An antibiotic or sulfa drugs
  • Isotretinoin, retinol, tretinoin
  • NSAIDs (non-steroidal anti-inflammatory drugs) – ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others
  • Salicylates – aspirin, Nuprin Backache Caplet, Kaopectate, KneeRelief, Pamprin Cramp Formula, Pepto-Bismol, Tricosal, Trilisate, and others

Does food or alcohol interact with methotrexate?

Methotrexate may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with methotrexate?

Methotrexate may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Health conditions that may interact with this drug are:

  • Alcohol abuse
  • Anemia
  • Leukopenia (low white blood cells)
  • Liver disease
  • Thrombocytopenia (low platelet blood level)
  • Weak immune system
  • Ascites (extra fluid in the stomach area)
  • Kidney disease
  • Pleural effusion (extra fluid in the lung)
  • Diabetes
  • Liver disease
  • Obesity
  • Peptic ulcers
  • Ulcerative colitis (inflammation of the colon)
  • Infection (bacteria, fungus, virus)

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using methotrexate.

What is the dose of methotrexate for an adult?

Usual Adult Dose for Acute Lymphoblastic Leukemia

Induction: 3.3 mg/m2/day orally or IM (in combination with prednisone 60 mg/m2).

Maintenance (during remission): 15 mg/m2 IM or orally twice a week.
Alternate remission dosing: 2.5 mg/kg IV every 14 days.

Usual Adult Dose for Choriocarcinoma

15 to 30 mg IM or orally daily for 5 days. Repeat courses 3 to 5 times with a rest period of greater than or equal to 1 week between courses, until any manifesting toxic symptoms subside.

Usual Adult Dose for Trophoblastic Disease

15 to 30 mg IM or orally daily for 5 days. Repeat courses 3 to 5 times with a rest period of greater than or equal to 1 week between courses, until any manifesting toxic symptoms subside.

Usual Adult Dose for Lymphoma

For Burkitt’s tumor in Stages I-II: 10 to 25 mg orally once a day for 4 to 8 days.

Malignant lymphoma in Stage III: 0.625 to 2.5 mg/kg orally daily as a part of combination chemotherapy.

Treatment in all stages usually consists of several courses of the drug interposed with 7 to 10 days rest periods.

Usual Adult Dose for Meningeal Leukemia

12 mg/m2 intrathecally every 2 to 5 days until the cell count of the CSF returns to normal. At this point, one additional dose is advisable. Administration at intervals of less than 1 week may result in increased subacute toxicity.

Usual Adult Dose for Mycosis Fungoides

2.5 to 10 mg PO daily or 50 mg IM once a week or 25 mg IM twice a week.

Usual Adult Dose for Osteosarcoma

Initial Dose: 12 g/m2 intravenously as a 4-hour infusion (in combination with other chemotherapeutic agents). If this dose is not adequate to achieve a peak serum concentration of 1000 micromolar at the end of the infusion, the dose may be increased to 15 g/m2.

Treatments may occur at 4, 5, 6, 7, 11, 12, 15, 16, 29, 30, 44, and 45 weeks after surgery.

Usual Adult Dose for Psoriasis

Single Dose: 10 to 25 mg/week orally, subcutaneously, IM, or IV until adequate response is achieved.

Divided Dose: 2.5 mg orally, IM, or IV every 12 hours for 3 doses once a week.

Maximum weekly dose: 30 mg.

Usual Adult Dose for Rheumatoid Arthritis

Single dose: 7.5 mg orally weekly.

Divided dose: 2.5 mg orally every 12 hours for 3 doses once a week.

Maximum weekly dose: 20 mg.

Usual Adult Dose for Neoplastic Diseases

I.V.: Range is wide from 30-40 mg/m2/week to 100-12,000 mg/m2 with leucovorin rescue.

What is the dose of methotrexate for a child?

Usual Pediatric Dose for Acute Lymphocytic Leukemia

100 mg/m2 over 1 hour followed by a 35-hour infusion delivering 900 mg/m2/day.

Usual Pediatric Dose for Dermatomyositis

15 to 20 mg/m2 orally once weekly.

Usual Pediatric Dose for Meningeal Leukemia

Less than 4 months: 3 mg/dose intrathecally.

Greater than or equal to 4 months less than 1 year: 6 mg/dose intrathecally.

Greater than or equal to 1 year less than 2 years: 8 mg/dose intrathecally.

Greater than or equal to 2 years less than 3 years: 10 mg/dose intrathecally.

Greater than or equal to 3 years: 12 mg/dose intrathecally.

The dose may be administered every 2 to 5 days until CSF counts return to normal followed by a dose administered once weekly for 2 weeks and monthly thereafter.

Administration at intervals of less than 1 week may result in increased subacute toxicity.

Usual Pediatric Dose for Neoplastic Diseases

7.5 to 30 mg/m2 IM or orally every 2 weeks.

Alternate dosing: 10 to 18,000 mg/m2 IV bolus or continuous infusion over 6 to 42 hours.

Usual Pediatric Dose for Rheumatoid Arthritis

5 to 15 mg/m2 IM or orally once weekly.

Subcutaneous injection for Polyarticular Juvenile Idiopathic Arthritis: 10 mg/m2 subcutaneously once weekly.

Usual Pediatric Dose for Solid Tumors

Less than 12 years: 12000 mg/m2 IV.

Greater than or equal to 12 years: 8000 mg/m2 IV.

Maximum dose: 18 grams.

How is methotrexate available?

Methotrexate is available in the following dosage forms and strengths:

  • Solution, Injection: 25 mg/mL

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of methotrexate, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

msBahasa Malaysia

Review Date: July 18, 2017 | Last Modified: July 25, 2017

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