Methotrexate

Brand names of methotrexate

  • Abitrexate
  • Folex
  • Folex PFS
  • Methotrexate
  • Mexate
  • Mexate AQ
  • Rheumatrex Dose Pack

Methotrexate, an antimetabolite drug falls in the category of drugs used to block cells' metabolism. The metabolism process of cells includes generation of energy for cellular activity, production of cell components and their further destruction. For this specific reason the drug has been found useful in treatment of diseases where the cells grow rapidly, for example, breast cancer and psoriasis, etc. Methotrexate has also proved its usefulness for patients suffering from ectopic pregnancy by causing miscarriage. Methotrexate stops the growth of placenta cells and thus helps in inducing miscarriage. In some cases of rheumatoid arthritis, methotrexate has been quite effective but the reason behind its effectiveness in curing the disease is still unclear. Its effectiveness may be attributed to the fact that it alters the immunity, thus helping in curing rheumatoid arthritis.

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Things you need to tell your physician before taking methotrexate

In case of starting methotrexate medication, a patient must communicate with his doctor whether he is allergic to the medicine or has any other allergy. Methotrexate has some constituents which may result in allergic reactions. The use of methotrexate is not advisable in the case of some specific medical conditions. The doctor must be informed prior if the patient has any of the following disease: pulmonary fibrosis or other lung disease, kidney disease, liver disease, disorders related to blood cell or bone marrow, alcohol use, suppressed immune system.

The doctor should review the medical history of the patient and check whether the patient has any history of stomach/intestinal diseases like ulcerative colitis and peptic ulcer, any infection like chickenpox etc., deficiency of folic acid, kidney disease. The drug has some constituents which can lead to dizziness or drowsiness. Patients are advised to avoid any task which needs alertness such as driving a vehicle. During the period of medication, the patient should stay away from alcohol. The medicine could also result in some side effects like the skin becoming sensitive towards sun light. In case of any outdoor visits, a patient should cover himself with clothing and must use sunscreen.

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Doctors should not prescribe methotrexate to pregnant women. The side effects of the medicine can pass on to the baby. In case there is a doubt over the pregnancy, a doctor should be informed. Both men and women should follow steps to control birth for a minimum period of three months before the treatment and after the treatment is over. There are chances that the constituents of methotrexate may pass into the breast milk which will harm the child. While using this drug, do not breast feed. Without the approval of a doctor, a patient should avoid vaccinations and immunizations. Patients should also avoid contact with those who have recently undergone immunization. Patient must be careful to avoid bruises and cuts and thus should remain away from sharp things. Hands should be washed regularly to keep away infections.

Usage

Methotrexate is among the most important medicines used to cure particular types of cancer or for controlling rheumatoid arthritis or psoriasis. Methotrexate works by slowing down the growth of cells and curbing down the immune system. In case of rheumatoid arthritis and if methotrexate is used, it helps in controlling the damage to joints and protects joint function. Methotrexate has also proved to be useful in treatment of disorders like psoriatic arthritis and lupus.

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How to use methotrexate

Methotrexate is available in the market in the forms of tablets. The dosage of methotrexate should be taken as per the prescription of the doctor. It may vary from person and depends on the condition of the patient and how much the body reacts to this medicine.

Methotrexate is generally prescribed to a patient on a rotating schedule in which the patient has to take the medicine on specific days or weeks. The instructions given by the doctor must be followed strictly and in case of any confusion about the timings to take medicine, the patient must consult his doctor.

In case of rheumatoid arthritis or psoriasis, methotrexate must be consumed once in a week. All the guidelines given by the doctor must be followed. There have been several mishaps where the patients have consumed methotrexate once in a day instead of a week and this has led to severe side effects or even to death of patients.

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Looking into the sensitivity of the medicine, the pharmaceutical company prints all the necessary information on the labels. Patients should read the information on the label and may even ask the doctor for further explanation in case of any confusion. The consumption of methotrexate must be in accordance with the directions given by the doctor. Over dosage or under dosage may prove to be critical for the patients.

For the treatment of rheumatoid arthritis or psoriasis, doctors start the use of methotrexate with a low dose and may increase the dosage slowly. Generally during the treatment of rheumatoid arthritis, it takes three to six weeks time before the symptoms start improving and may take twelve of more weeks for the patient to realize the benefits of methotrexate. In case a patient feels improvement, he should not stop the dose and must continue till the doctor asks him to stop.

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How methotrexate works

Methotrexate works by inhibiting the metabolic activities of a cell by inhibiting the enzyme activity required for various cellular activity such as replication. As a result, the cells cannot divide and proliferate quickly. These cells include the cells present in the bladder, intestine, mouth, cells forming the bone marrow, and cancer cells. When methotrexate is consumed, it not only harms the cancer cells but also affects the healthy cells of the body, thus resulting in severe side effects. It is still not clear how methotrexate works in controlling rheumatoid arthritis; however it results in affecting the immune system of the body.

Side effects

Serious:
  • blood in stools or urine
  • bloody vomit
  • bruising
  • chills or fever
  • confusion
  • cough
  • dark urine
  • diarrhea
  • dizziness
  • drowsiness
  • headache
  • hoarseness
  • joint pain
  • pain in lower back or side
  • painful or difficult urination
  • redness or flushing of skin
  • red spots on skin
  • seizures
  • shortness of breath
  • sores in mouth and on lips
  • stomach pain
  • swollen lower legs or feet
  • tarry, black stools
  • unusual bleeding
  • unusual fatigue
  • yellow-tinged eyes or skin
Common:
Less common:

Possible interactions

Herbal medicines or minerals:
In order to improve the immune systems, Echinacea is used by some patients. However, Echinacea is not advisable for those having damaged immune systems. The use of Echinacea is very harmful if it is used regularly or used over a long period of time and can damage the immune system. St. John's wort may lead to sensitivity towards sun rays. Thus, this combination must be avoided by any means.
Foods:
During the treatment period, the following foods should be liberally consumed: non vegetarian food such as lamb, pork, chicken or lamb and vegetarian food such as spinach, navy beans, asparagus and kale. Any consumption of food will result in decrease in peak methotrexate level. Any food which could be irritating must be avoided. Additional supplements of folic acid can be given to those who are taking methotrexate on a regular basis.
Alcohol:
Drinking alcohol should be avoided.
Marijuana smoking:
Marijuana smoking is very harmful and can cause damage to the immune system.
Exposure to sun:
Users must be cautious as the medicine can cause sensitivity towards sun rays. Ultraviolet lamps should be avoided.

Storage instructions

The drug should be stored carefully and must be kept only in the container it was bought in. The container must be closed tightly so that air does not pass through. The drug container should be placed safely away from children. The container should be stored at room temperature. Storage places with excess of moisture and heat are not advisable. Outdated medication should not be used and must be disposed of right away. Disposal methods should be followed as per the directions of the pharmacist.

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