WARNING

Trexall, also known by its generic name methotrexate, is a medication primarily used to treat certain types of cancer, autoimmune diseases like rheumatoid arthritis, psoriasis, and inflammatory bowel disease. While effective for these conditions, there are several risks associated with taking Trexall:

• Suppression of Bone Marrow: Trexall can suppress the bone marrow’s ability to produce blood cells, leading to anemia, decreased white blood cell count (increasing the risk of infections), and decreased platelet count (increasing the risk of bleeding).
• Liver Damage: Trexall can cause liver toxicity, leading to abnormal liver function tests. Long-term use or high doses can potentially lead to liver damage or even liver failure.
• Lung Problems: Rarely, Trexall can cause lung problems such as interstitial pneumonitis or pulmonary fibrosis, which can lead to difficulty breathing.
• Gastrointestinal Effects: Some people may experience nausea, vomiting, diarrhea, or mouth sores while taking Trexall.
• Increased Risk of Infections: Due to its effects on the immune system, Trexall can increase the risk of infections. Patients are advised to avoid contact with people who have contagious illnesses while taking this medication.
• Skin Reactions: Trexall can cause skin reactions such as rash, itching, or sun sensitivity.
• Teratogenicity: Trexall is known to cause birth defects and should not be used during pregnancy or by women who are planning to become pregnant.
• Increased Risk of Lymphoma: There is a small increased risk of developing lymphoma, particularly in patients with autoimmune diseases who are taking Trexall.

It’s essential for individuals taking Trexall to be closely monitored by their healthcare provider to manage these risks and ensure the medication’s benefits outweigh the potential harms. Additionally, patients should be aware of the signs and symptoms of adverse effects and report them promptly to their healthcare provider.

Why is this medication prescribed?

Trexall, or methotrexate, is prescribed for several medical conditions due to its ability to suppress the immune system and inhibit cell growth. Here are some common reasons why Trexall may be prescribed:

• Cancer: Trexall is used to treat various types of cancer, including leukemia, lymphoma, breast cancer, lung cancer, and certain types of tumors.
• Autoimmune Diseases: It is commonly used to treat autoimmune diseases such as rheumatoid arthritis, psoriasis, psoriatic arthritis, juvenile idiopathic arthritis, and inflammatory bowel disease (Crohn’s disease and ulcerative colitis).
• Ectopic Pregnancy: In some cases, Trexall may be used to treat ectopic pregnancies, a condition where a fertilized egg implants outside the uterus.
• Severe Psoriasis: Trexall can be effective in treating severe psoriasis that has not responded to other treatments.

How should this medicine be used?

As for how Trexall should be used, the specific dosage and administration instructions may vary depending on the condition being treated and individual patient factors. However, here are some general guidelines:

• Dosage: Trexall is typically taken once a week. The dosage can vary widely depending on the condition being treated and individual patient factors. It’s essential to follow the dosage instructions provided by the healthcare provider carefully.
• Administration: Trexall is usually taken orally in tablet form. It can also be given by injection, either subcutaneously (under the skin) or intramuscularly (into the muscle), in certain situations.
• Monitoring: Patients taking Trexall require regular monitoring by their healthcare provider to check for side effects and ensure the medication is working effectively. This may include blood tests to monitor liver function, blood cell counts, and other parameters.
• Folate Supplementation: Because Trexall can interfere with the body’s ability to use folic acid, patients are often prescribed folic acid supplements to reduce the risk of certain side effects, such as mouth sores and gastrointestinal symptoms.
• Patient Education: Patients should be educated about the potential side effects of Trexall and instructed to report any unusual symptoms to their healthcare provider promptly.

It’s crucial for patients to follow their healthcare provider’s instructions carefully when taking Trexall and to communicate any concerns or questions they may have about the medication.

Other uses for this medicine

Trexall (methotrexate) may have several other off-label uses. These can include:

• Ectopic Pregnancy: Methotrexate is sometimes used to terminate ectopic pregnancies (pregnancies outside the uterus) when surgery is not necessary or feasible.
• Treatment of Vasculitis: Some forms of vasculitis, such as giant cell arteritis or Wegener’s granulomatosis, may be treated with methotrexate, often in conjunction with other medications.
• Management of Asthma: In certain cases of severe, persistent asthma that is not responsive to other treatments, methotrexate may be considered to help control inflammation and symptoms.
• Management of Lupus (Systemic Lupus Erythematosus): Methotrexate is sometimes used off-label to treat lupus, particularly when other treatments have not been effective or have caused significant side effects.

What special precautions should I follow?

As for special precautions to follow when taking Trexall (methotrexate), here are some key considerations:

• Pregnancy and Conception: Methotrexate is known to cause birth defects and should not be used during pregnancy or by women who are planning to become pregnant. Reliable contraception should be used during treatment and for a period after discontinuing methotrexate.
• Liver Function: Methotrexate can cause liver toxicity. Liver function tests should be monitored regularly, and methotrexate may need to be adjusted or discontinued if there are signs of liver damage.
• Blood Counts: Methotrexate can suppress bone marrow function, leading to decreased red blood cells, white blood cells, and platelets. Regular blood tests should be done to monitor blood counts.
• Folate Supplementation: Folic acid supplements are often prescribed alongside methotrexate to reduce the risk of certain side effects, such as mouth sores and gastrointestinal symptoms.
• Infections: Methotrexate can increase the risk of infections due to its effects on the immune system. Patients should avoid close contact with individuals who have contagious illnesses, and any signs of infection should be reported to a healthcare provider promptly.
• Sun Exposure: Methotrexate can make the skin more sensitive to sunlight, increasing the risk of sunburn. Patients should use sunscreen and take other precautions to protect their skin from sun exposure.
• Drug Interactions: Methotrexate can interact with other medications, including over-the-counter drugs and supplements. Patients should inform their healthcare provider about all medications and supplements they are taking to avoid potential interactions.

Overall, patients taking Trexall (methotrexate) should be closely monitored by their healthcare provider and should follow all instructions and precautions provided to ensure safe and effective use of the medication.

What special dietary instructions should I follow?

Special Dietary Instructions:

• Folic Acid Supplementation: Your healthcare provider may recommend taking folic acid supplements to reduce the risk of certain side effects, such as mouth sores and gastrointestinal symptoms. Follow their instructions regarding dosage and timing.
• Alcohol: Avoid or limit alcohol consumption while taking methotrexate, as it can increase the risk of liver toxicity.
• Hydration: Drink plenty of fluids unless instructed otherwise by your healthcare provider. Staying hydrated can help reduce the risk of certain side effects.

What should I do if I forget a dose?

If you forget to take a dose of methotrexate:

• Oral Tablets: Take the missed dose as soon as you remember, unless it is almost time for your next scheduled dose. Do not double the dose to catch up.
• Injections: If you miss a dose of methotrexate injections, contact your healthcare provider for guidance on when to administer the missed dose.
• Follow-up: If you are unsure about what to do, contact your healthcare provider or pharmacist for advice. They can provide specific instructions based on your individual situation.

What side effects can this medication cause?

Trexall (methotrexate) can cause a range of side effects, which may vary in severity and frequency depending on the dose, duration of treatment, and individual factors. Common side effects of Trexall include:

• Nausea and vomiting: These are among the most common side effects of methotrexate and may occur shortly after taking the medication. Taking it with food or dividing the dose throughout the day may help alleviate these symptoms.
• Mouth sores: Methotrexate can cause inflammation and sores in the mouth and throat, which may be painful. Maintaining good oral hygiene and using mouthwash as recommended by your healthcare provider may help manage this side effect.
• Fatigue: Feeling tired or fatigued is a common side effect of methotrexate therapy. It’s important to get adequate rest and avoid strenuous activities if you experience fatigue.
• Decreased blood cell counts: Methotrexate can suppress the bone marrow’s ability to produce blood cells, leading to a decrease in red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia). This may increase the risk of infections, bruising, and bleeding. Regular blood tests are typically performed to monitor blood cell counts during treatment.
• Hair loss: Methotrexate may cause temporary hair thinning or hair loss, although this side effect is usually reversible once treatment is stopped.
• Liver toxicity: Methotrexate can affect liver function, leading to elevated liver enzymes. Regular monitoring of liver function tests is essential during methotrexate therapy to detect any liver abnormalities early.
• Gastrointestinal disturbances: In addition to nausea and vomiting, methotrexate may cause other gastrointestinal symptoms such as diarrhea, abdominal pain, and loss of appetite.
• Skin reactions: Some individuals may experience skin rash, itching, or sun sensitivity (photosensitivity) while taking methotrexate. Avoiding prolonged sun exposure and using sunscreen can help reduce the risk of sunburn.
• Headaches: Headaches are a relatively common side effect of methotrexate treatment.
• Respiratory symptoms: Methotrexate may rarely cause lung problems such as cough, shortness of breath, or interstitial lung disease. Notify your healthcare provider if you experience any respiratory symptoms while taking methotrexate.

It’s important to discuss any side effects you experience with your healthcare provider, as they can provide guidance on managing symptoms and may adjust your treatment regimen if necessary. Additionally, seek medical attention promptly if you experience severe or concerning side effects while taking Trexall.

What should I know about storage and disposal of this medication?

Storage and disposal of Trexall:

• Storage:
  • Store Trexall/methotrexate at room temperature away from light and moisture.
  • Keep it out of reach of children and pets.
  • Do not store in the bathroom, where moisture and humidity can affect the medication.
• Disposal:
  • Follow any specific disposal instructions provided with your medication or given by your pharmacist.
  • Do not flush medications down the toilet unless instructed to do so. Proper disposal helps prevent harm to the environment and reduces the risk of accidental ingestion by children or pets.
  • You can check with your local pharmacy or government for medication take-back programs or other disposal options.

In case of emergency/overdose

In case of emergency or overdose of Trexall:

• In case of overdose or emergency, call your local emergency services immediately or go to the nearest emergency room.
• Symptoms of overdose may include nausea, vomiting, diarrhea, mouth sores, hair loss, drowsiness, confusion, weakness, seizures, or difficulty breathing.
• It’s crucial to seek medical attention promptly in the case of overdose, as methotrexate toxicity can be severe and potentially life-threatening.

What other information should I know?

• Inform your healthcare provider about all medications, supplements, and herbal products you are taking, as they may interact with methotrexate.
• Regular monitoring of blood counts, liver function, and kidney function may be necessary during methotrexate therapy.
• Methotrexate can cause side effects such as nausea, vomiting, mouth sores, diarrhea, hair loss, rash, and decreased blood cell counts. Contact your healthcare provider if you experience any concerning side effects.
• Avoid prolonged exposure to sunlight or tanning beds while taking methotrexate, as it may increase the risk of sunburn.
• Methotrexate can harm an unborn baby, so it’s essential to use effective contraception during treatment and for some time afterward if you are of childbearing age and sexually active.
• Inform your healthcare provider if you become pregnant while taking methotrexate.
• Methotrexate can also affect sperm production in men, so discuss fertility concerns with your healthcare provider if applicable.

Always follow your healthcare provider’s instructions regarding the use, storage, and disposal of Trexall/methotrexate, and do not hesitate to contact them if you have any questions or concerns.