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All about: methotrexate

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Generic Name: methotrexate (meth oh TREX ate)
Brand Names: Rheumatrex Dose Pack, Trexall

What is methotrexate?

Methotrexate interferes with the growth of certain cells of the body, especially cells that reproduce quickly, such as cancer cells, bone marrow cells, and skin cells.

Methotrexate is used to treat certain types of cancer of the breast, skin, head and neck, or lung. Methotrexate is also used to treat severe psoriasis and rheumatoid arthritis.

Methotrexate is usually given after other medications have been tried without successful treatment of symptoms.

Methotrexate may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about methotrexate?

Methotrexate can cause serious or life-threatening side effects on your liver, lungs, kidneys, and bone marrow (immune system). Do not take this medication in larger amounts, or take it for longer than prescribed. Follow the directions on your prescription label. Do not use methotrexate to treat psoriasis or rheumatoid arthritis if you have liver disease (especially if caused by alcoholism), a blood cell or bone marrow disorder, or if you are breast-feeding a baby. This medication can cause birth defects in an unborn baby. Do not use methotrexate to treat psoriasis or rheumatoid arthritis if you are pregnant. Use an effective form of birth control, whether you are a man or a woman. Tell your doctor if you or your sexual partner become pregnant during treatment.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled visits to your doctor.

There are many other medicines that can interact with methotrexate. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

What should I discuss with my healthcare provider before taking methotrexate?

Do not use this medication if you are allergic to methotrexate. Do not use methotrexate to treat psoriasis or rheumatoid arthritis if you have:
  • liver disease;

  • alcoholism or cirrhosis of the liver;

  • a blood cell disorder such as anemia (lack of red blood cells) or leukopenia (lack of white blood cells);

  • a bone marrow disorder; or

  • if you are breast-feeding a baby.

Methotrexate is sometimes used to treat cancer even when patients do have one of the conditions listed above. Your doctor will decide if this treatment is right for you.

Before using methotrexate, tell your doctor if you are allergic to any drugs, or if you have:

  • kidney disease;

  • liver disease;

  • lung disease or pneumonia;

  • stomach ulcers;

  • any type of infection; or

  • if you are receiving radiation treatments.

If you have any of these conditions, you may not be able to use methotrexate, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category X. Methotrexate can cause birth defects in an unborn baby. Do not use methotrexate to treat psoriasis or rheumatoid arthritis if you are pregnant. Tell your doctor right away if you become pregnant during treatment.

Use birth control to prevent pregnancy while you are using methotrexate, whether you are a man or a woman. Methotrexate use by either parent may cause birth defects.

Before you start taking methotrexate, your doctor may want you to have a pregnancy test to make sure you are not pregnant.

If you are a man, use a condom to keep from causing a pregnancy while you are using methotrexate. Continue using condoms for at least 90 days after your treatment ends. If you are a woman, use an effective form of birth control while you are taking methotrexate, and for at least one cycle of ovulation after your treatment ends. Do not give this medicine to a child without the advice of a doctor.

Older adults may be more likely to have side effects from this medication.

How should I take methotrexate?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

You must use the correct dose of methotrexate for your condition. The medication is sometimes taken only once per week. Some people have died after taking methotrexate every day by accident. Ask your doctor if you have any questions about your dose of methotrexate or how often to take it.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

It is important to use methotrexate regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested, and you may need an occasional liver biopsy. Do not miss any scheduled visits to your doctor.

Store methotrexate at room temperature away from moisture and heat.

What happens if I miss a dose?

Call your doctor if you miss a dose of methotrexate.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of methotrexate can be fatal.

Symptoms of a methotrexate overdose may include pale skin, easy bruising or bleeding, unusual weakness, mouth sores, nausea, vomiting, black or bloody stools, coughing up blood or vomit that looks like coffee grounds, and urinating less than usual or not at all.

What should I avoid while taking methotrexate?

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds), especially if you are being treated for psoriasis. Methotrexate can make your skin more sensitive to sunlight and your psoriasis may worsen. Avoid drinking alcohol while taking methotrexate.

Methotrexate side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using methotrexate and call your doctor at once if you have any of these serious side effects:
  • dry cough, shortness of breath;

  • diarrhea, vomiting, white patches or sores inside your mouth or on your lips;

  • blood in your urine or stools;

  • urinating less than usual or not at all;

  • fever, chills, body aches, flu symptoms;

  • sore throat and headache with a severe blistering, peeling, and red skin rash;

  • pale skin, easy bruising or bleeding, weakness; or

  • nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Keep using methotrexate and talk to your doctor if you have any of these less serious side effects:

  • nausea, vomiting, upset stomach;

  • dizziness, tired feeling;

  • headache;

  • bleeding of your gums; or

  • blurred vision.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect methotrexate?

Before taking methotrexate, tell your doctor if you are using any of the following drugs:

  • azathioprine (Imuran);

  • chloramphenicol (Chloromycetin);

  • hydroxychloroquine (Plaquenil, Quineprox);

  • retinol, tretinoin (Retin-A), isotretinoin (Accutane);

  • steroids (prednisone and others);

  • sulfa drugs such as Azulfidine, Bactrim, or Septra;

  • phenytoin (Dilantin);

  • probenecid (Benemid);

  • tetracycline (Brodspec, Panmycin, Sumycin, Tetracap);

  • theophylline (Elixophyllin, Slo-Bid, Theobid, Theo-Dur);

  • gold treatments such as auranofin (Ridura) or aurothioglucose (Solganol);

  • oral diabetes medications such as acetohexamide (Dymelor), chlorpropamide (Diabinese), glipizide (Glucotrol), glimepiride (Amaryl), or tolbutamide (Orinase);

  • penicillin antibiotic such as ampicillin (Principen), amoxicillin (Amoxil, Trimox), carbenicillin (Geocillin), cloxacillin (Cloxapen), dicloxacillin (Dynapen), nafcillin (Unipen), oxacillin (Bactocill), penicillamine (Cuprimine, Depen), or Bee-Pen, Pen-Vee K, Veetids;

  • salicylates such as aspirin, Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others; or

  • NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), piroxicam (Feldene), and others.

If you are using any of these drugs, you may not be able to use methotrexate, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect methotrexate. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist has information about methotrexate written for health professionals that you may read.

What does my medication look like?

Methotrexate is available with a prescription under the brand names Rheumatrex and Trexall. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2006 Cerner Multum, Inc. Version: 7.02. Revision Date: 1/13/07 5:14:14 PM.

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