WARNING

Methotrexate is a medication used to treat various conditions, including certain types of cancer, autoimmune diseases like rheumatoid arthritis, and psoriasis. However, it comes with several potential risks and side effects. Here are some detailed risks associated with Methotrexate injection:

• Bone Marrow Suppression: Methotrexate can inhibit the production of blood cells in the bone marrow, leading to anemia, leukopenia (low white blood cell count), and thrombocytopenia (low platelet count). This can increase the risk of infections, bleeding, and fatigue.
• Gastrointestinal Issues: Nausea, vomiting, diarrhea, and abdominal pain are common side effects. In severe cases, methotrexate can cause mucositis (inflammation of the mucous membranes in the mouth and throat).
• Liver Toxicity: Methotrexate can be toxic to the liver, leading to elevated liver enzymes, hepatitis, or liver fibrosis. Regular liver function tests are usually required to monitor liver health during treatment.
• Kidney Damage: Methotrexate can impact kidney function, potentially causing kidney damage or exacerbating pre-existing kidney conditions. Hydration is important to help reduce the risk of kidney issues.
• Pulmonary Toxicity: In rare cases, methotrexate can cause lung problems, such as pneumonitis or pulmonary fibrosis, leading to cough, shortness of breath, and other respiratory symptoms.
• Skin Reactions: Skin rashes, itching, and photosensitivity (increased sensitivity to sunlight) can occur. Rarely, severe skin reactions like Stevens-Johnson syndrome may develop.
• Neurological Effects: Methotrexate may cause neurological side effects such as headaches, dizziness, or, in rare cases, seizures or confusion.
• Reproductive Risks: Methotrexate is contraindicated during pregnancy as it can cause birth defects and harm the fetus. Effective contraception is recommended for both men and women during treatment and for a period after discontinuation.
• Interactions with Other Medications: Methotrexate can interact with other drugs, such as NSAIDs (non-steroidal anti-inflammatory drugs) and certain antibiotics, potentially increasing toxicity or decreasing effectiveness.
• Increased Risk of Infections: Due to its immunosuppressive effects, methotrexate can increase susceptibility to infections.

Regular monitoring and follow-up with your healthcare provider are essential to manage these risks effectively. If you experience any concerning symptoms or side effects while on methotrexate, it’s important to contact your healthcare provider promptly.

Why is this medication prescribed?

Methotrexate injection is prescribed for several conditions due to its ability to suppress the immune system and inhibit cell growth. Here’s a detailed look at its uses:

• Cancer Treatment:
  • Leukemia: Methotrexate is used in various types of leukemia, such as acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). It helps to kill cancer cells and prevent them from multiplying.
  • Lymphoma: It’s also used for certain types of lymphoma, including non-Hodgkin lymphoma.
  • Breast Cancer: Methotrexate can be part of a chemotherapy regimen for breast cancer, particularly when it is used in combination with other drugs.
• Autoimmune Diseases:
  • Rheumatoid Arthritis: Methotrexate helps reduce inflammation and slow disease progression. It is often used when other treatments are not effective.
  • Psoriasis: For severe cases of psoriasis, methotrexate helps reduce the rapid growth of skin cells and inflammation.
  • Juvenile Idiopathic Arthritis: It’s used to control symptoms and prevent joint damage in children with this condition.
• Ectopic Pregnancy:
  • Early Ectopic Pregnancy: Methotrexate is used to treat early ectopic pregnancies, where a fertilized egg implants outside the uterus. It helps dissolve the tissue and prevent surgery.
• Other Uses:
  • Crohn’s Disease and Ulcerative Colitis: Methotrexate can be used in certain cases of inflammatory bowel disease (IBD) when other treatments haven’t worked.
  • Sarcoidosis: In some cases, it’s used to manage sarcoidosis, a disease involving abnormal collections of inflammatory cells.

How should this medicine be used?

Methotrexate injection is used for various conditions, including certain types of cancer, autoimmune diseases, and sometimes for severe psoriasis. Here’s a general guideline on its use, but make sure to follow your healthcare provider’s specific instructions:

• Administration: Methotrexate can be injected intramuscularly (into the muscle), subcutaneously (under the skin), or intrathecally (into the spinal canal) depending on the condition being treated.
• Dosage: The dosage varies based on the condition. For cancer treatment, it might be higher and more frequent compared to doses for autoimmune conditions.
• Frequency: The frequency of injections also varies. For some conditions, it might be weekly, while for others, it could be less frequent.
• Preparation: The medication should be prepared and administered using aseptic techniques to prevent infection. It’s usually done by a healthcare professional, but if you’re administering it yourself, ensure you follow proper guidelines.
• Monitoring: Regular monitoring by your healthcare provider is necessary to check for side effects and ensure the medication is working as intended. This includes blood tests and assessments of liver function.
• Storage: Store the medication as directed, typically in a cool, dry place away from light. Follow any specific storage instructions provided.
• Side Effects: Be aware of potential side effects, which can include nausea, fatigue, and liver issues. Report any severe or unexpected symptoms to your healthcare provider immediately.

Always consult your healthcare provider for specific instructions tailored to your condition and treatment plan.

Other uses for this medicine

Methotrexate injection has several uses beyond cancer treatment:

• Autoimmune Diseases: It’s used to manage conditions like rheumatoid arthritis, juvenile idiopathic arthritis, and lupus.
• Psoriasis: It’s effective for severe cases of psoriasis that haven’t responded to other treatments.
• Ectopic Pregnancy: In certain cases, methotrexate is used to treat ectopic pregnancy by stopping the growth of the embryo.

What special precautions should I follow?

Special Precautions for Methotrexate Injection:

• Dosage and Administration: Follow your healthcare provider’s instructions closely regarding dosage and frequency. Do not self-adjust your dose.
• Monitoring: Regular blood tests are essential to monitor liver function, kidney function, and blood cell counts. Methotrexate can affect these organs and systems.
• Avoid Infections: Methotrexate can weaken your immune system, making you more susceptible to infections. Practice good hygiene and avoid close contact with sick individuals.
• Pregnancy and Breastfeeding: Methotrexate is contraindicated during pregnancy due to the risk of harm to the fetus. It’s also generally advised against during breastfeeding.
• Interactions: Inform your healthcare provider about all other medications and supplements you’re taking, as methotrexate can interact with many drugs.
• Liver Health: Methotrexate can impact liver function. Avoid alcohol and check with your healthcare provider before taking any new medications.
• Hydration: Maintain adequate hydration, as dehydration can increase the risk of side effects.
• Sun Exposure: Methotrexate can increase sensitivity to sunlight. Use sunscreen and protective clothing when outdoors.
• Vaccinations: Live vaccines should be avoided while on methotrexate. Consult your healthcare provider before receiving any vaccines.

Always consult with your healthcare provider for personalized advice and to address any specific concerns you might have.

What special dietary instructions should I follow?

• Balanced Diet: Maintain a well-balanced diet rich in fruits, vegetables, lean proteins, and whole grains. A healthy diet supports overall well-being and can help mitigate some side effects.
• Avoid Alcohol: Minimize or avoid alcohol to protect your liver, which can be affected by methotrexate.
• Hydration: Drink plenty of fluids to stay hydrated and support kidney function.

What should I do if I forget a dose?

• Timing: If you miss a dose, contact your healthcare provider as soon as possible for guidance. They will advise you whether to take the missed dose or skip it and continue with your next scheduled dose.
• Do Not Double Dose: Do not double the dose to make up for a missed one. This can increase the risk of side effects.
• Keep a Schedule: Use reminders or a medication schedule to help keep track of doses and reduce the likelihood of missing one.

What side effects can this medication cause?

Methotrexate injection can cause a range of side effects. Not everyone will experience these side effects, but it’s important to be aware of them and report any concerning symptoms to your healthcare provider. Common and serious side effects include:

Common Side Effects:

• Nausea and Vomiting: Some people may experience gastrointestinal issues.
• Fatigue: Feeling tired or weak is a common side effect.
• Hair Loss: Temporary hair thinning or loss can occur.
• Mouth Sores: Painful sores or ulcers in the mouth.
• Dizziness: Feeling lightheaded or dizzy.
• Skin Rash: Mild rashes or skin irritation.

Serious Side Effects:

• Liver Damage: Symptoms of liver damage include jaundice (yellowing of the skin or eyes), dark urine, and abdominal pain.
• Kidney Problems: Issues can lead to changes in urination, such as decreased urine output or blood in urine.
• Bone Marrow Suppression: This can result in a decrease in red blood cells, white blood cells, and platelets, leading to anemia, increased risk of infections, or bleeding.
• Pulmonary Toxicity: Symptoms may include a dry cough, shortness of breath, or chest pain, indicating possible lung problems.
• Severe Allergic Reactions: Signs include rash, itching, swelling, severe dizziness, or trouble breathing.
• Infections: Methotrexate can weaken the immune system, increasing susceptibility to infections.
• Stomatitis: Severe inflammation of the mouth and throat.
• Gastrointestinal Issues: Severe nausea, vomiting, or diarrhea can occur in some cases.
• Neurological Symptoms: Rarely, methotrexate can cause symptoms like confusion or seizures, particularly if used in high doses.

If you experience severe or unusual symptoms, contact your healthcare provider immediately. They may adjust your treatment or provide supportive care to manage side effects. Regular monitoring and communication with your healthcare team are crucial for managing potential side effects effectively.

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

Storage and Disposal of Methotrexate Injection:

Storage:

• Store methotrexate injection as directed, typically in the refrigerator (between 2°C and 8°C or 36°F and 46°F). Do not freeze.
• Keep the medication in its original container, protected from light.
• Store it out of reach of children and pets.
• Check the expiration date on the medication and do not use it past this date.

Disposal:

• Follow local regulations or guidelines for the disposal of unused or expired medications. Many areas have take-back programs or designated disposal sites.
• Avoid flushing methotrexate down the toilet or pouring it down the drain unless instructed to do so by local regulations.
• Dispose of any used syringes or vials as directed by your healthcare provider or local waste disposal guidelines.

In case of emergency/overdose

• Seek Immediate Help: If you suspect an overdose or experience severe symptoms, seek immediate medical attention. Call emergency services or go to the nearest emergency room.
• Symptoms of Overdose: Symptoms can include severe nausea and vomiting, mouth sores, dizziness, and significant changes in blood counts or liver function.
• Contact Poison Control: You can also call your local poison control center for guidance on what to do in case of an overdose.

What other information should I know?

• Drug Interactions: Inform your healthcare provider about all other medications you are taking, including over-the-counter drugs and supplements, to avoid potential interactions.
• Pregnancy and Fertility: Methotrexate can affect fertility and is harmful to a developing fetus. Discuss contraception and pregnancy plans with your healthcare provider.
• Regular Check-ups: Schedule and attend all regular check-ups and blood tests to monitor the effects of the medication and manage any side effects.
• Medical Records: Keep a record of your medication, including the dosage and frequency, and share it with any new healthcare providers.
• Emergency Contacts: Have a list of emergency contacts, including your healthcare provider’s phone number, readily available.

Always follow the specific instructions provided by your healthcare provider and pharmacist regarding the use, storage, and disposal of methotrexate injection.