WARNING

Methotrexate is a medication commonly used to treat conditions like rheumatoid arthritis, psoriasis, and some types of cancer. While it can be very effective, it also carries several risks and potential side effects:

• Gastrointestinal Issues: Nausea, vomiting, and diarrhea are common. Some people may also experience mouth sores.
• Hematologic Effects: Methotrexate can affect blood cell production, leading to anemia, leukopenia (low white blood cell count), or thrombocytopenia (low platelet count). Regular blood tests are necessary to monitor these levels.
• Liver Toxicity: Methotrexate can cause liver damage, which may be seen as elevated liver enzymes in blood tests. Long-term use increases this risk, and liver function should be monitored regularly.
• Kidney Toxicity: It can also affect kidney function, potentially leading to kidney damage, especially in higher doses or when used in combination with other drugs that impact the kidneys.
• Pulmonary Toxicity: There’s a risk of lung problems, including inflammation and fibrosis, which can lead to breathing difficulties.
• Skin Reactions: Rash and photosensitivity (increased sensitivity to sunlight) can occur.
• Increased Risk of Infections: Methotrexate can suppress the immune system, making it easier for infections to develop.
• Pregnancy and Breastfeeding: Methotrexate is contraindicated during pregnancy due to its high risk of causing birth defects and miscarriage. It is also not recommended while breastfeeding.
• Drug Interactions: Methotrexate can interact with other medications, which may either increase its toxicity or reduce its effectiveness. It’s important to inform your healthcare provider about all the medications and supplements you’re taking.
• Bone Marrow Suppression: This can lead to decreased production of blood cells, increasing the risk of bleeding, bruising, or infections.

Regular monitoring by a healthcare professional is essential to manage these risks and adjust the treatment as needed. Always follow your doctor’s advice and report any unusual symptoms promptly.

Why is this medication prescribed?

Methotrexate is prescribed for several conditions due to its ability to modify the immune system and alter cellular processes. Here are some common reasons for its use:

• Rheumatoid Arthritis: Methotrexate is a first-line treatment for rheumatoid arthritis, helping to reduce inflammation and slow disease progression.
• Psoriasis: Methotrexate is used to treat severe psoriasis by reducing the rapid growth of skin cells and alleviating symptoms.
• Cancer: Methotrexate is employed in chemotherapy regimens for various cancers, including leukemia, lymphoma, and certain solid tumors. It works by inhibiting DNA synthesis and cell division in cancer cells.
• Inflammatory Bowel Disease: It can be used for Crohn’s disease and ulcerative colitis when other treatments are insufficient or not tolerated.
• Autoimmune Conditions: Besides rheumatoid arthritis and psoriasis, methotrexate is sometimes prescribed for other autoimmune diseases like systemic lupus erythematosus (SLE) and vasculitis.
• Ectopic Pregnancy: In certain cases, methotrexate is used to treat ectopic pregnancies by stopping the growth of the pregnancy tissue.

In these conditions, methotrexate helps control symptoms, reduce inflammation, and improve overall quality of life. However, its use needs to be carefully monitored due to potential side effects and the need for dosage adjustments based on individual response and tolerability.

How should this medicine be used?

When taking methotrexate as a tablet, it’s important to follow your healthcare provider’s instructions carefully to ensure effective treatment and minimize side effects. Here’s a general guide on how to use methotrexate tablets:

• Dosage and Schedule: Take methotrexate exactly as prescribed by your doctor. The dosage can vary depending on the condition being treated and your response to the medication. It’s often taken once a week for conditions like rheumatoid arthritis or psoriasis, rather than daily.
• Administration: Take the tablets by mouth with a full glass of water. You can take them with or without food, but if the medication upsets your stomach, taking it with food may help.
• Consistency: Try to take the medication at the same time each week to help remember it and maintain consistent blood levels.
• Avoid Missing Doses: If you miss a dose, contact your healthcare provider for guidance on what to do next. Do not double up on doses to make up for a missed one.
• Hydration: Drink plenty of fluids while taking methotrexate to help prevent dehydration and support kidney function.
• Monitoring: Regular blood tests are essential to monitor for side effects, such as liver damage or changes in blood cell counts. Adhere to your scheduled appointments for these tests.
• Interactions: Inform your doctor about all other medications, supplements, or over-the-counter drugs you are taking, as methotrexate can interact with many substances.
• Avoid Alcohol: Alcohol can increase the risk of liver damage, so it’s generally advised to avoid it while on methotrexate.
• Pregnancy: Methotrexate is contraindicated during pregnancy. Use effective contraception and discuss family planning with your doctor if you’re taking this medication.
• Side Effects: Be aware of potential side effects and report any unusual symptoms to your healthcare provider promptly.

Always follow the specific instructions provided by your healthcare provider, as they will tailor advice to your individual needs and medical condition.

Other uses for this medicine

In addition to the conditions already mentioned, methotrexate can be used for:

• Systemic Lupus Erythematosus (SLE): To manage symptoms and control inflammation.
• Vasculitis: To reduce inflammation in blood vessels.
• Dermatomyositis: An inflammatory condition affecting the skin and muscles.
• Certain types of Cancer: As part of chemotherapy regimens for cancers like osteosarcoma or choriocarcinoma.
• Recurrent Pregnancy Loss: Occasionally used to treat certain cases of recurrent miscarriage, though this is less common.

What special precautions should I follow?

Special Precautions for Methotrexate:

• Regular Monitoring: Frequent blood tests are necessary to monitor liver function, kidney function, and blood cell counts. This helps to catch any adverse effects early.
• Dosage Adherence: Follow your doctor’s prescribed dosage and schedule precisely. Overdosing or taking the medication too frequently can increase the risk of severe side effects.
• Avoid Alcohol: Alcohol can exacerbate liver toxicity, so it’s advisable to avoid drinking alcohol while on methotrexate.
• Infection Risk: Methotrexate suppresses the immune system, increasing your susceptibility to infections. Practice good hygiene and avoid contact with sick individuals. Report any signs of infection, such as fever or sore throat, to your healthcare provider immediately.
• Vaccinations: Consult your doctor before receiving any vaccines, especially live vaccines, as methotrexate can affect vaccine efficacy and increase the risk of adverse reactions.
• Pregnancy and Breastfeeding: Methotrexate is contraindicated during pregnancy due to its high risk of birth defects and miscarriage. It should also be avoided while breastfeeding. Use effective contraception and discuss any pregnancy plans with your doctor.
• Hydration: Drink plenty of fluids to help prevent dehydration and support kidney function, especially if you experience gastrointestinal side effects.
• Sun Protection: If you develop photosensitivity (increased sensitivity to sunlight), use sunscreen and protective clothing to avoid sunburn and skin damage.
• Drug Interactions: Inform your healthcare provider about all medications and supplements you are taking. Methotrexate can interact with many drugs, potentially altering its effectiveness or increasing side effects.
• Avoid Certain Supplements: Some supplements, like folic acid, can interact with methotrexate. Your doctor may recommend a specific dose of folic acid or other supplements to mitigate side effects without interfering with methotrexate’s effectiveness.

Always keep your healthcare provider informed about any changes in your health or medication regimen to manage treatment effectively and safely.

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 remember the missed dose on the same day, take it as soon as you recall. If it’s almost time for your next dose, skip the missed dose. Do not double up to make up for the missed dose.
• Do Not Double Dose: If you’re unsure what to do or if you miss multiple doses, contact your healthcare provider for advice on how to proceed.
• Keep a Schedule: Maintain a record of your medication schedule and missed doses to discuss with your healthcare provider if needed.

What side effects can this medication cause?

Methotrexate can cause a variety of side effects. Common ones include:

• Gastrointestinal issues: Nausea, vomiting, diarrhea, and stomach pain.
• Fatigue: Feeling unusually tired or weak.
• Hair loss: Thinning or loss of hair.
• Mouth sores: Ulcers or sores in the mouth or on the tongue.
• Skin reactions: Rash, itching, or sensitivity to sunlight.

Less common but more serious side effects can include:

• Liver problems: Elevated liver enzymes or liver damage.
• Lung issues: Cough, shortness of breath, or lung inflammation.
• Bone marrow suppression: Decreased blood cell counts, which can lead to anemia, increased risk of infections, or bleeding problems.
• Kidney problems: Reduced kidney function or kidney damage.

It’s important to have regular follow-ups with your healthcare provider while on methotrexate to monitor for these side effects and adjust the treatment as needed.

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

Storage and Disposal of Methotrexate:

Storage:

• Store methotrexate tablets at room temperature, away from heat, moisture, and direct light. Typically, this means keeping them in a cool, dry place.
• Keep the medication in its original container, tightly closed, and out of reach of children.
• Do not store medications in the bathroom where humidity can affect their efficacy.

Disposal:

• Do not flush methotrexate down the toilet or sink, as this can harm the environment.
• Use drug take-back programs or disposal sites for safe disposal. Many pharmacies or community programs offer this service.
• If no take-back program is available, mix methotrexate with an undesirable substance (like used coffee grounds or cat litter), place it in a sealed plastic bag, and dispose of it in your household trash.
• Check with your local waste disposal regulations for any additional disposal instructions specific to your area.

In case of emergency/overdose

• Seek Immediate Help: Contact emergency medical services or go to the nearest emergency room right away. Overdose symptoms can be severe and require prompt treatment.
• Symptoms of Overdose: Symptoms may include severe nausea or vomiting, dizziness, unusual tiredness, bleeding, or severe diarrhea.
• Inform Medical Personnel: Provide details of the overdose, including the amount taken, the time of ingestion, and any symptoms experienced.
• Do Not Self-Treat: Avoid trying to treat an overdose on your own or waiting to see if symptoms resolve. Immediate medical attention is crucial.

What other information should I know?

• Regular Monitoring: Regular check-ups and blood tests are essential to monitor the effects of methotrexate on your liver, kidneys, and blood cells.
• Drug Interactions: Be aware of potential interactions with other medications, including over-the-counter drugs and supplements. Inform your healthcare provider of all substances you are taking.
• Emergency Contacts: Keep contact information for your healthcare provider or a local poison control center handy in case of emergencies.
• Medication List: Maintain an updated list of all medications and dosages to share with your healthcare provider in case of any health changes or emergencies.
• Patient Education: Educate yourself about methotrexate, including how it works, potential side effects, and what to do if you experience any issues. Understanding your treatment can help you manage it more effectively.
• Pregnancy and Contraception: If you are of childbearing age, discuss contraception with your healthcare provider, as methotrexate is contraindicated in pregnancy.
• Health Changes: Report any new or unusual symptoms to your healthcare provider, as these could be related to your medication or condition.

By following these guidelines and staying informed, you can help manage the risks associated with methotrexate and ensure its effective use in your treatment.