Methotrexate: patient drug information

Methotrexate: Patient drug information
Obtained from Uptodate.

U.S. Brand Names: Rheumatrex®; Trexall™
Mexican Brand Names: Atrexel; Ledertrexate; Medsatrexate; Otaxem; Texate; Trixilem
Pharmacologic Category: Antineoplastic Agent, Antimetabolite (Antifolate); Antirheumatic,
Disease Modifying
What key warnings should I know about before taking this medicine?
• Your bone marrow, liver, lung, and kidney function will be followed closely. This medicine
may cause severe infections, severe skin reactions, lymphomas, diarrhea, and mouth sores.
Your healthcare provider will talk with you about the risks and benefits of methotrexate. There
is extensive monitoring that is required while taking this medicine.
• Talk with healthcare provider before taking any pain medicines (eg, ibuprofen, ketoprofen,
naproxen). Do not take this medicine if you are pregnant and being treated for rheumatoid
arthritis or psoriasis. The risks and benefits of other uses need to be compared in females of
childbearing age.
• Talk with healthcare provider if you are receiving radiation therapy. There may be an
increased risk of tissue and bone damage.
• This medicine does not mix well with many medicines. Serious reactions may occur. Check
all medicines with healthcare provider.
Reasons not to take this medicine:
•If you have an allergy to methotrexate or any other part of this medicine.
•Tell healthcare provider if you are allergic to any medicine. Make sure to tell about the allergy
and how it affected you. This includes telling about rash; hives; itching; shortness of breath;
wheezing; cough; swelling of face, lips, tongue, or throat; or any other symptoms involved.
•If you have any of the following conditions: Bone marrow disease, severe liver disease, low
blood cell count, or poor kidney function.
•If you are pregnant or may be pregnant; if you are breast-feeding.
What is this medicine used for?
•This medicine is used to treat arthritis.
•This medicine is used to treat a variety of cancers.
•This medicine is used to treat psoriasis.
•This medicine is used to treat inflammatory bowel disease.

How does it work?
•Methotrexate injures cancer cells causing their death.
•It reduces inflammation.
•It decreases the body's harmful response to diseases affecting the immune system.
How is it best taken?
•Follow directions given by healthcare provider or read the package insert.
•If taking orally, this medicine is usually only taken once a week. Talk with healthcare provider
to make sure dose is correct.
•Directions may change depending on blood work results, side effects, and response.
•Take this medicine on an empty stomach. Take 1 hour before or 2 hours after meals.
•This medicine may be given by mouth or as a shot into a muscle, vein, or the fatty part of
the skin. Rarely, a shot will be given into the spinal fluid.
•Drink plenty of noncaffeine-containing liquid unless told to drink less liquid by healthcare
provider.
What do I do if I miss a dose? (does not apply to patients in the hospital)
•Take a missed dose as soon as possible.
•If it is almost time for the next dose, skip the missed dose and return to your regular
schedule.
•Do not take a double dose or extra doses.
•Do not change dose or stop medicine. Talk with healthcare provider.

What are the precautions when taking this medicine?
•Talk with healthcare provider before receiving any vaccinations. Use with this medicine may
either increase the risk of serious infection or make the vaccination less effective.
•If you have had hepatitis B or C, talk with healthcare provider.
•If you have drug or alcohol addiction, talk with healthcare provider.
•If you have kidney disease, talk with healthcare provider.
•If you have liver disease, talk with healthcare provider.
•If you have a weakened immune system, develop infections easily, or are on antibiotics, talk
with healthcare provider.
•If you have mouth sores, stomach irritation or ulcers, talk with healthcare provider.
•Do not donate blood while using this medicine and for 1 month after stopping.
•Check medicines with healthcare provider. This medicine may not mix well with other
medicines.
•Talk with healthcare provider before using other: aspirin, aspirin-containing products, blood
thinners, garlic, ginseng, ginkgo, ibuprofen or like products, pain medicines, or vitamin E.
•Avoid alcohol (includes wine, beer, and liquor).
•You can get sunburned more easily. Avoid sun, sunlamps, and tanning beds. Use sunscreen;
wear protective clothing and eyewear. Continue to protect yourself against sunburn for at least
a month after methotrexate therapy.
•Use birth control that you can trust to prevent pregnancy while taking this medicine.
What are some possible side effects of this medicine?
•Anemia, low white blood cell count, and low platelet count.
•Risk of infection. Avoid people with infections, colds, or flu.
•Nausea or vomiting. Small frequent meals, frequent mouth care, sucking hard, sugar-free
candy, or chewing sugar-free gum may help.
•Not hungry, diarrhea.
•Mouth irritation. Frequent mouth care with a soft toothbrush or cotton swabs and rinsing
mouth may help.
•Sore throat.
•Headache.
•Hair loss. Hair usually grows back when medicine is stopped.
•Kidney failure can rarely occur.
•Liver damage can rarely occur.
•Lung damage can rarely occur.
•Other forms of cancer can rarely occur later in life.
What should I monitor?
•Change in condition being treated. Is it better, worse, or about the same?
•Check blood work regularly. Talk with healthcare provider.
•When taking methotrexate for a long time or at high doses, you may need closer monitoring
of liver and bone marrow function. Talk with healthcare provider.
•Take good care of your teeth. See a dentist regularly.
•Follow up with healthcare provider.

Reasons to call healthcare provider immediately
•If you suspect an overdose, call your local poison control center or emergency department
immediately.
•Signs of a life-threatening reaction. These include wheezing; chest tightness; fever; itching;
bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat.
•Signs or symptoms of infection. These include a fever of 100.5 degrees or higher, chills,
severe sore throat, ear or sinus pain, cough, increased sputum or change in color, painful
urination, mouth sores, wound that will not heal, or anal itching or pain.
•Chest pain or pressure, difficulty breathing, persistent cough.
•Pinpoint red spots on skin, severe belly pain, severe nausea or vomiting, severe diarrhea; not
able to eat.
•Unusual bruising or bleeding.
•Dark urine or yellow skin or eyes.
•Feeling extremely tired or weak.
•For females, if you become pregnant while taking this medicine.
•Any rash.
•No improvement in condition or feeling worse.
General statements
•If you have a life-threatening allergy, wear allergy identification at all times.
•Do not share your medicine with others and do not take anyone else's medicine.
•Keep all medicine out of the reach of children and pets.
•Most medicines can be thrown away in household trash after mixing with coffee grounds or
kitty litter and sealing in a plastic bag.
•Keep a list of all your medicines (prescription, natural products, supplements, vitamins, over-
the-counter) with you. Give this list to healthcare provider (doctor, nurse, nurse practitioner,
pharmacist, physician assistant).
•Call your doctor for medical advice about side effects. You may report side effects to FDA at
1-800-FDA-1088 or in Canada to Health Canada's Canada Vigilance Program at 1-866-234-
2345.
•Talk with healthcare provider before starting any new medicine, including over-the-counter,
natural products, or vitamins.

Source: http://www.aocst.com/uploads/Methotrexate.pdf