Methotrexate

Methotrexate is an immunosuppressive drug which helps to control over-activity of the immune system by interfering with some actively growing cells within the body.

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What is this medication used for

  • Methotrexate is an immunosuppressive drug which helps to control over-activity of the immune system by interfering with some actively growing cells within the body.

  • It is used for the treatment of various autoimmune diseases e.g. rheumatoid arthritis, Systemic Lupus Erythematosus (SLE), juvenile arthritis, psoriatic arthritis, and inflammatory myositis (muscle inflammation).

  • In arthritis, Methotrexate acts as a disease modifying agent to help to reduce pain, swelling and long-term joint damage.

Dosage and How to Use

  • A typical weekly dose of Methotrexate ranges from 7.5mg to 25mg, given in the form of tablets or injection. Dosage may vary depending on your disease activity and response to the medicine.

  • It should be swallowed whole with a glass of water. Do not chew or crush the tablets. Wash hands thoroughly after administration.

  • Folic or folinic acid (also called folate) is often given with Methotrexate to reduce the risk of some side effects. It is usually taken a day before or after Methotrexate unless advised otherwise by your doctor.

  • The beneficial effects of Methotrexate will begin after 6 weeks and the full benefits may not be seen until after 12 weeks of treatment. Thus it is important that you take your medication regularly, otherwise you may not benefit at all.

  • If you miss a dose, take it as soon as you remember if it is within 2 days from your scheduled dose. For example, your scheduled dose is on Sunday, if you remember on Tuesday, take the dose on Tuesday and resume back to the Sunday schedule the next week. Skip the dose if 3 or more days have lapsed since the missed dose. Do not double the dosage to make up for the missed dose.

Side Effects, Precautions, Contraindication

Can Methotrexate be taken with other medications?

  • Methotrexate can be taken with other medications such as corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) and other disease modifying agents.

  • Please inform your doctor, pharmacist or rheumatology nurse clinician if you are taking other medications including over-the-counter medicines, supplements or traditional/herbal remedies as they may interact with Methotrexate.

  • Do not drink alcohol while on this medicine as it may increase the risk of liver toxicity associated with Methotrexate.

  • Pneumococcal and influenza (flu) vaccinations are safe and may be given if required. Avoid live vaccines such as MMR (measles, mumps and rubella), OPV (oral polio vaccine), yellow fever or BCG (tuberculosis). Discuss with your doctor before receiving any vaccines.

What are the important side effects of Methotrexate?

  • Many of the side effects occur at higher doses. Due to the way Methotrexate works, some side effects may be present only after years of taking this medication. Always discuss with your doctor if you experience any side effects.

Side Effect

Management

Mouth ulcers

Folic/folinic acid can be prescribed to reduce this side effect.

Nausea, vomiting, diarrhoea or loss of appetite

Take medication after food to minimise the side effects. Folic/folinic acid can be prescribed to reduce this side effect. Alternatively, Methotrexate can be converted to an injection form. Consult your doctor immediately if you see bloody vomit or stools.

Slow loss of hair

It is generally reversible when the medicine is discontinued.

Skin rashes

These usually resolve readily upon decreasing the dose or stopping the medicine.

Lung inflammation

(Warning signs: Persistent coughing, breathlessness or chest pain)

Consult your doctor immediately. It is advisable to stop smoking.

Liver disorder

(Warning signs: Yellowing of eye whites or skin, dark or tea-coloured urine, or constant abdominal pain)

Consult your doctor immediately. Avoid alcohol. Inform your doctor if you have any liver disease (e.g. jaundice, hepatitis) or if any of your family members has hepatitis.

Blood disorders

(Warning signs: May be asymptomatic; unusual bleeding or bruising, lip or mouth ulcers with ‘flu-like’ symptoms may occur)

Consult your doctor immediately. Monitoring the effects of your new treatment is important for early detection of side effects. For your safety, you need to do regular blood tests for monitoring.

Infections e.g. shingles, chickenpox

(Warning signs: Fever, chills, persistent severe sore throat or mouth ulcers)

Consult your doctor immediately.

If you develop rashes, facial swelling or shortness of breath after taking the medication, you could be allergic to the medication. Please seek medical attention immediately.

Are there any special precautions that I need to take?

  • Avoid crowded places and consumption of raw or undercooked food while on Methotrexate.

  • Inform your doctor if you intend to conceive or breastfeed while taking this medication. Methotrexate can cause miscarriage or serious birth defects. Hence, it is advisable to avoid pregnancy if any one partner, regardless of male or female, is on Methotrexate. Reliable contraceptive measures must be used to avoid unplanned pregnancy. Patients are required to wait at least three months after stopping Methotrexate before trying for a child.

  • Women are advised not to breastfeed as Methotrexate is excreted into the breast milk.

  • If you develop high fever, sore throat or other infections, see a doctor early because Methotrexate may reduce your immune response and cause some infections to become more severe. The doctor whom you consult should be told that you are on Methotrexate.

What monitoring do I require while I am taking Methotrexate?

  • Regular blood tests are essential for early detection of side effects such as liver inflammation or blood disorders. A chest X-ray is often done before starting Methotrexate, as well as tests for hepatitis B and C.

Handling and Storage

  • Store your medication in a cool, dry place away from heat, moisture and direct sunlight.

If you have any problem with your treatment, please contact your doctor, pharmacist or rheumatology nurse clinician.

Please keep all medications out of reach of children.


© Tan Tock Seng Hospital, Singapore 2017. All rights reserved. All information correct as of August 2017. No part of this document may be reproduced, copied, reverse compiled, adapted, distributed, commercially exploited, displayed or stored in a database, retrieval system or transmitted in any form without prior permission of Tan Tock Seng Hospital. All information and material found in this document are for purposes of information only and are not meant to substitute any advice provided by your own physician or other medical professionals.

PECC-PHA-ED-2017-025-v1


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