About Methotrexate.
What is Methotrexate?
Methotrexate belongs to a group of drugs used to treat many kinds of cancer. It is also used to treat other non-cancerous conditions such as psoriasis, juvenile rheumatoid arthritis and Crohn's disease.
How Does Methotrexate Work?
Methotrexate blocks an enzyme needed by cells in the body to stay alive. It interferes with the growth of certain cells, in cancer and other conditions, which are growing rapidly. These are eventually destroyed. Since the growth of normal cells may also be affected by Methotrexate, other effects will also occur. Folinic Acid is used as an antidote after high doses have been given.
How is Methotrexate Given?
Methotrexate can be given in many ways.
 | By mouth (oral), as tablets |
| Injection or infusion into a vein (intravenous) |
| Injection into a muscle (intramuscular) |
| Injection under the skin (subcutaneous) |
| Injection into the spinal fluid during a lumbar puncture (intrathecal). |
Possible Side Effects
| Immediate (within 48 hours)
 | Headache, backache, stiff neck, vomiting, fever and lethargy after an intrathecal injection. |
| Nausea and vomiting |
| Loss of appetite |
| Increased sensitivity to sunlight, causing sunburn |
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| Delayed (up to 2 to 3 weeks)
| Mouth ulcers - ensure good mouth hygiene. |
| Diarrhoea |
| Temporary thinning or loss of hair |
| Liver and kidney damage (with high doses). |
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| Long Term (rare)
| Lung damage |
| Osteoporosis |
| Intrathecal injections may cause learning difficulties and seizures. |
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How to Take Oral Methotrexate
| Doses should be given in the evening, at bedtime, on an empty stomach, unless you are told otherwise. |
| Doses are almost always given once a week, although sometimes smaller doses are given more often |
| If you have had a lumbar puncture during the week, the dose or Methotrexate given that week must be reduced by the amount given by intrathecal injection. |
| Do not crush the tablets |
| After handling and giving the tablets, wash your hands immediately |
| If a dose is missed or vomited, do not give another dose or double the next dose. Contact your hospital, doctor or pharmacist for advice. |
Storing the Medication
Keep tablets and liquid prepared in syringes in a cool, dry place, out of reach of children.
Important Information.
| If you are to have high dose Methotrexate, there are special written instructions about what must be done the day before and the day of admission. Make sure you have a copy of this. IT IS VERY IMPORTANT THAT THESE ARE FOLLOWED. Folinic Acid (also called Leocuvorin) tablets, to be taken at home, will be ordered when you child is discharged. IT IS VERY IMPORTANT THAT THESE ARE TAKEN AS DIRECTED. |
| Apply anaesthetic cream/gel and a patch to the appropriate area(s) one hour before the injections(s), if you have been instructed to do this. This may need
to be done before you leave home to come to the doctor or hospital. |
| Avoid prolonged exposure to sunlight. Protective clothing should be worn and sunblock applied. |
| Do not give Aspirin, Aspirin-containing products or anti-inflammatory drugs while having Methotrexate. If you are not sure which products contain these, ask your doctor or pharmacist. |
| Drink extra fluid during treatment with Methotrexate, e.g. water or cordial |
| Alcohol must not be consumed throughout the course of Methotrexate treatment |
| Caffeine e.g. coffee, tea and cola drinks, should only be given in moderation (if at all), as these can dehydrate the body. |
| Contact your doctor or hospital
| If you experience severe mouth ulcers or diarrhoea. |
| If you suffer severe sunburn. |
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Monitoring
| Regular blood tests will be done. |
| If you are having high-dose Methotrexate, fluid intake and urine output will be measure and tested. |
Use of Other Medication.
Care must be taken when giving Methotrexate with some other medications. Check with your doctor or pharmacist before giving any medicine, including those you buy without a prescription from a pharmacy, supermarket or health shop.
It is important to avoid giving:
| Multivitamin preparations containing folate or folic acid. |
| Aspirin (found in some cold medicines) |
| Phenytoin (use in epilepsy) |
| Acyclovir, co-trimoxazole and some other antibiotics. |
Handling of Body Waste
| Urine, blood, faeces and vomit need to be treated with caution during treatment and for 24 hours after. |
| Put items containing body fluids (e.g. tampons, menstrual pads) in a plastic bag and then dispose of in household rubbish. |
| Double flush the toilet after you use it. |
| If you wet or soil the bed, remove the bedclothes, put them through a rinse cycles on their own, then through a normal wash cycle. |
| If you vomit, use a bowl you do not use for anything else, tip the contents into the toilet and double flush. Wash the bowl after each use and discard in to normal garbage when no longer needed. |
Disposal of Syringes or Unused Medication.
Dispose of used syringes in a sharps container and return this and/or any unused medication to the hospital.
General information.
Contact your doctor or hospital immediately if you have:
| A temperature above 38.5 degrees. |
| Contact with a person who has chicken pox, shingles or measles. |
| Nose or gum bleeds, red spots of blood under the skin, black tarry bowel motions or persistent bruising; in this case do not take Aspirin or Aspirin-containing products (including mouth ulcer products e.g.
Bonjela) |
| Avoid contact with people who have infections including colds or flu |
| Mouth care is important while you have low blood counts. |
| Talk to your doctor before any immunisations |
| Effective contraception should be used, if appropriate, for the duration of treatment. |
Tablet Description.
| 2.5mg - yellow tablet market M2.5, F on reverse OR scored, marked MI, LL on reverse. |
| 10mg - yellow tablet marked M10, scored on reverse. |
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