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Methotrexate  (Rheumatrex, Trexall )  

Warning: Methotrexate can cause very severe side effects and has caused death on rare occasions. Because of these risks, this medication should only be used as directed by a doctor for the treatment of certain cancers, as well as severe diseases such aspsoriasis and rheumatoid arthritis that are caused by overactive immune systems.

 

Methotrexate can cause death to unborn babies and can cause severe birth defects. This medication must not be taken if you are pregnant or breastfeeding, and proper precautions, including contraception, should be taken to insure that you do not become pregnant while taking this medication.

This drug can cause severe bone marrow suppression in rare instances that can restrict your body’s natural ability to fight off infection and in rare cases can result in fatality. This drug can also cause mild or severe intestinal bleeding if taken in conjunction with non-steroidal anti-inflammatory drugs (NSAIDS). Consult with your physician regarding any other possible side effects before taking this medication.  

Indications: Methotrexate is a very helpful treatment for certain types of cancer because it is an antimetabolite drug that is able to block the metabolism (energy production) of cells, such as abnormal cancer cells. It is also sometimes used to treat psoriasis and to induce miscarriages in rare situations like ectopic pregnancy. It is also used for the treatment of rheumatoid arthritis, although it is not currently known exactly what mechanism it uses to treat this condition.

While this medication is normally well-tolerated, it can sometimes cause mild symptoms and on rare occasions may cause very severe symptoms. Some of the possible mild symptoms that this medication may cause include dizziness, headaches, upset stomach and nausea, hair loss, mouth sores and skin rash. Some rare severe symptoms include kidney, liver, lung, or bone marrow toxicity. If you experience any mild or severe symptoms from taking this medication, inform your physician immediately.

Dosage:  Never exceed dosage instructions for this medication, as doing so could result in severe symptoms or even fatality in rare circumstances. Your physician will give you dosage instructions based on your specific needs, and those dosage instructions should be followed exactly. Your physician will closely monitor your blood, liver, and kidney functions to determine if your dosage needs to be raised, lowered, or discontinued. The medication may be taken with or without food, depending on your physician’s specific instructions.  

Methotrexate can be taken several ways:

  • by mouth, in pill form 
  • intravenous infusion (into the vein IV) 
  • intramuscular injection (into the muscle) 
  • intraventricular infusion (within a ventricle) 
  • Intrathecal infusion (inside the spinal canal). 

Overdose:  when methotrexate is given in hospital by professionals, the risk of overdose is almost nonexistent; however, accidental overdose or administrative mistake can happen. When the drug is taken by mouth chance of overdose increases. An overdose of methotrexate can cause a decrease in the number of blood cells in your bone marrow, which can lead to severe health problems and even death. Even in absence of therapeutic overdose, Methotrexate intoxication can lead to:  

  • damage to the lining of the mouth, stomach or intestines  
  • severe skin reactions 
  • lung Infections such as pneumonia  
  • bone and soft tissue damage  
  • severe damage to the liver, kidney, lungs, and gastrointestinal tract  
  • lymphoma, a cancer that rises in the lymphocytes of the immune system  
  • Tumor lysis syndrome, a life-threatening complication of cancer treatment.   

If you experience any symptom that may indicate presence of these medical conditions, contact your physician or emergency clinic/hospital as soon as possible. Even in the absence of signs, it is important to see your doctor regularly during the treatment; do not neglect the appointments with your doctor and the laboratory.  

Missing dose: when methotrexate is given by injection, it is administered in hospital; missing dose is basically difficult if you keep all your doctor’s appointments. If for some reasons you cannot be present at the hospital for the treatment, contact your health care provider before the date scheduled for the injection.  

If you are recommended to take methotrexate by mouth in tablet form, it may happen you forget to take it. If you miss a dose, take it as soon as you remember it if it is not almost time to take the next dose. If you forgot to take the medicine, and it is almost time for the nest dose, wait for the next one; in any case, do not double the dose.  

Contraindications: Do not take this medication if you currently have, or have a history of excess body water fluid retention in the stomach area or around the lungs without first consulting your physician. The medication is not recommended to patients who have severe kidney problems.

The medication is contraindicated or should be used with precaution in the following medical conditions :

  • alcohol consumption  
  • low number of blood cells  
  • liver failure  
  • pregnancy 
  • breast-feeding 
  • allergy to methotrexate or any of its ingredients   
  • allergy to antimetabolites in general   
  • Elderly, infants or children should be treated with methotrexate only under medical supervision. 

Interactions: Do not take this medication in conjunction with non-steroidal anti-inflammatory drugs and notify your physician of any other medications you are currently taking before taking Methotrexate.

Side effects: methotrexate not only attack cancer cells but also healthy cells, which often leads to, in most patients, the following side effects:  

  • dry skin 
  • itching 
  • rash 
  • acne 
  • mouth sores 
  • weight loss 
  • weakness 
  • hair loss 
  • decreased appetite 
  • trouble sleeping 
  • Mild nausea and vomiting 

If the side effects above persist for weeks, contact your oncologist. In addition, contact your doctor immediately if you experience symptoms that indicate:  

Damage to the liver, heart or lung: persistent nausea, extreme tiredness, pain in the upper right part of the stomach, dry cough, fast and irregular heartbeat, fever, shortness of breath or any flu-like symptom.  

Damage to the lining of the mouth, stomach or intestine: mouth sores, persistent diarrhea, black, tarry or bloody stools, sore throat, or bloody vomitting. 

Damage to the skin or bone: bone pain, fever, rash, blisters, peeling skin, yellowing of the skin or eyes, or  purple, blue or black discoloration of the skin

Other problems  : anxiety, severe depression symptoms,  dehydration, nose bleeding, vision changes, red itchy eye, or intense headaches.