Methotrexate

TAKE ONCE A WEEK!

Fatal errors have happened when methotrexate was prescribed, dispensed, and/or taken daily instead of once or twice a week.

• Ask about the reasons. Ask your doctor to put the reason for your medicine on all prescriptions. You might take a medicine like methotrexate daily for a week at a time if you have cancer, but just once or twice a week if you have arthritis (joint disease) or psoriasis (a skin disease) or certain other conditions.
• Disclose all your medications. Tell your doctor about all prescription, nonprescription, and herbal products you take, particularly ibuprofen (Motrin, Advil), aspirin, echinacea, and vitamins.
• Avoid during pregnancy or breastfeeding. Tell your doctor if you are pregnant or trying to get pregnant. Methotrexate may cause birth defects or death of the unborn fetus if taken during pregnancy. Avoid pregnancy for at least 3 months following end of treatment with methotrexate. Do not take this medicine while breastfeeding, as it may reduce your infant’s ability to fight infections.
• Avoid direct sunlight. Methotrexate causes an abnormal skin reaction if you are exposed to sunlight. You could develop severe redness, pain, and peeling of the skin. If you are in the sun, use sunscreen on your skin and wear eye protection and a hat.
• Never take extra doses. Always take the medication on the same day of the week. Do not take extra doses for symptom relief. Relief of symptoms is gradual and begins in 3 to 6 weeks after starting the medicine. Continued improvement occurs during the first 12 weeks of taking the medicine.
• Report side effects. Let your doctor know about any side effects you experience, particularly a rash, fever, chills, trouble breathing, cough, racing heartbeat, bleeding, and changes in how often you urinate.

Common Brand Names	Rheumatrex, Rexall, Metoject
Common Uses	Cancer, psoriasis, rhematoid arthritis
Other Uses	Crohn’s disease, ectopic (tubal) pregnancy
Frequency of Use	Typically taken once or twice a week Do NOT use daily unless it is if for cancer and for no more than one week
Safe Dose Limits	No more than a total of 20 - 25 mg per week for psoriasis or rhematoid arthritis
Special Instructions & Precautions	Avoid alcohol Do not take any new medicine unless approved by your doctor Causes sun sensitivity, so use sunscreen and protective eyewear and clothing Do not take with milk-rich foods
Safety During Pregnancy & Breastfeeding	Do not take during pregnancy; may cause birth defects Do not take while breastfeeding Avoid pregnancy for at least 3 months following end of treatment
Do Not Take If You Have	Liver or kidney disease, AIDS, certain blood/bone marrow disorders
Tell Your Doctor If You Have	Peptic ulcer disease or ulcerative colitis
Storage & Disposal	Store at room temperature in a safe place and protect from light Avoid touching the tablets with your hands as much as possible Dispose of the medicine securely in the trash
Common Side Effects	Minimal side effects occur with low doses to treat psoriasis or rheumatoid arthritis Possible side effects include: nausea, vomiting, drowsiness Low-dose methotrexate has been associated with the rare development of cancervous lymphomas (tumors in lymph nodes)
Side Effects To Report To Your Doctor Immediately	Rash, excessive fatigue, mental confusion, fever, chills, mouth sores, shortness of breath, dry cough, rapid heartbeat or palpitations, unusual bleeding or bruising, black stools, persistent stomach upset, change in how often you urinate
Non Prescription Medicines/Herbals/ Vitamins To Avoid	Nonsteroidal anti-inflammatory agents (e.g., ibuprofen [Motrin, Advil]) or aspirin Vitamins that contain folate, echinacea
Prescription Medicines That Should Not Be Taken With Methotrexate	Check with your Doctor or Pharmacist; some of the medicines that may be a problem include: acitretin, cyclosporine, sulfonamides, trimethoprim, vaccines, clozapine, carbamazepine.
Special Tests Your Doctor May Prescribe	Blood tests may be prescribed every 1 to 4 months to make sure your kidneys and liver are functioning well and your body is making enough blood cells