Generic Name: methotrexate (METH-oh-TREX-ate)
Brand Name: Examples include Rheumatrex and Trexall
Trexall may cause severe and sometimes fatal side effects. These may include bone marrow, blood, liver, lung, kidney, or skin problems. For this reason, Trexall is only used to treat certain patients who have life-threatening cancer or who have severe psoriasis or rheumatoid arthritis that is not relieved by other treatments. Your doctor will perform lab tests to check for side effects while you take Trexall. Keep all doctor and laboratory appointments. Talk with your doctor and be sure you understand the risks and benefits of using Trexall.
Trexall may cause birth defects or fetal death. Do not use Trexall to treat psoriasis or rheumatoid arthritis if you are pregnant. Tell your doctor before you take Trexall if you are pregnant or think you may be pregnant. Do not become pregnant or father a child while using Trexall. Talk to your doctor about using an effective form of birth control.
Certain medicines and conditions may increase your risk for side effects. Tell your doctor if you take a nonsteroidal anti-inflammatory drug (NSAID) (eg, ibuprofen, celecoxib) or salicylate (eg, aspirin), or if you receive radiation therapy. Tell your doctor if you have excess fluid in your stomach or around your lungs, or if you have any liver, kidney, lung, blood, bone marrow, stomach, bowel, or immune system problems. Tell your doctor right away if you develop any new or worsening symptoms, including black, tarry stools; dry, nonproductive cough; mouth sores; red, swollen, blistered, or peeling skin; severe or persistent diarrhea or vomiting; shortness of breath or trouble breathing; signs of infection (eg, fever, chills, persistent sore throat); stomach pain; unusual bruising or bleeding; unusual tiredness or weakness; or yellowing of the skin or eyes.
Trexall may cause a serious and possibly fatal condition called tumor lysis syndrome (TLS) in certain patients with cancer. Contact your doctor right away if you develop symptoms such as fast or irregular heartbeat; fainting; decreased urination; muscle weakness or cramps; nausea, vomiting, diarrhea, or loss of appetite; or sluggishness.
Trexall may increase the risk of developing a certain type of cancer (lymphoma). Discuss any questions or concerns with your doctor.
Trexall is used for:
Treating certain types of cancer. It is also used to control severe psoriasis and severe rheumatoid arthritis in certain patients. It may be used alone or with other medicines. It may also be used for other conditions as determined by your doctor.
Trexall is an antimetabolite. It works to treat cancer and psoriasis by slowing the growth of cancer cells and abnormal skin cells. Exactly how Trexall works to treat rheumatoid arthritis is unknown. It reduces symptoms of inflammation (eg, pain, swelling, stiffness) caused by rheumatoid arthritis.
Do NOT use Trexall if:
- you are allergic to any ingredient in Trexall
- you are breast-feeding
- you are treating psoriasis or rheumatoid arthritis and any of the following apply to you:
- you are pregnant
- you have alcoholism, liver problems caused by alcohol, or chronic liver problems
- you have a weakened immune system or certain blood problems (eg, anemia, bone marrow depression, low white blood cell count, low blood platelet count)
- you are taking acitretin
- you have taken or will be taking palifermin within 24 hours of taking Trexall
Contact your doctor or health care provider right away if any of these apply to you.
Before using Trexall:
Some medical conditions may interact with Trexall. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
- if you are pregnant, planning to become pregnant, or are breastfeeding
- if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
- if you have allergies to medicines, foods, or other substances
- if you are able to become pregnant or father a child
- if you have a history of lung problems, immune system problems, nervous system problems (eg, seizures), liver problems (eg, hepatitis), kidney problems, diabetes, or blood problems (eg, anemia, low white blood cell levels, low blood platelet levels)
- if you have an active infection, severe vomiting or diarrhea, or dehydration
- if you have mouth sores, excess fluid in your stomach or around your lungs, stomach or bowel ulcers, bowel inflammation (eg, ulcerative colitis), or a blockage of your stomach or bowel
- if you have a folic acid deficiency, are in very poor health or are very overweight, or have a history of alcohol abuse
- if you are receiving chemotherapy or radiation
Some MEDICINES MAY INTERACT with Trexall. Tell your health care provider if you are taking any other medicines, especially any of the following:
- Palifermin because if mouth or tongue sores develop, they may be more severe or last longer
- Medicines that may harm the kidney (eg, amphotericin B; tacrolimus; aminoglycoside antibiotics such as gentamicin) or the liver (eg, azathioprine; retinoids such as acitretin or isotretinoin; acetaminophen; ketoconazole; isoniazid; certain medicines for HIV infection) because the risk of kidney or liver side effects may be increased. Ask your doctor if you are unsure if any of your medicines might harm the kidney or liver
- Chloramphenicol, ciprofloxacin, corticosteroids (eg, prednisone), cyclosporine, dantrolene, hydantoins (eg, phenytoin), hydroxychloroquine, leflunomide, NSAIDs (eg, ibuprofen, celecoxib, ketorolac), penicillamine, penicillin antibiotics (eg, amoxicillin), phenylbutazone, pristinamycin, probenecid, proton pump inhibitors (PPIs) (eg, omeprazole), salicylates (eg, aspirin), sulfonamide medicines (eg, sulfamethoxazole, sulfasalazine), tetracycline antibiotics (eg, doxycycline), trimethoprim, or vancomycin because they may increase the risk of Trexall's side effects
- Folic acid because it may decrease Trexall's effectiveness
- Digoxin because its effectiveness may be decreased by Trexall
- Mercaptopurine, oral anticoagulants (eg, warfarin), or theophylline because the risk of their side effects may be increased by Trexall
This may not be a complete list of all interactions that may occur. Ask your health care provider if Trexall may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
How to use Trexall:
Use Trexall as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Take Trexall by mouth with or without food. However, you should take it the same way each time in relation to food.
- Drinking extra fluids while you are taking Trexall is recommended. Check with your doctor for instructions.
- The dose of Trexall and how often you use it are based on your medical condition and response to treatment. It is very important that you follow your doctor's instructions carefully. Taking too much of Trexall may cause serious and sometimes fatal side effects. Be sure you understand exactly how much of Trexall to take and how often you should take it. Ask your doctor or pharmacist if you have any questions.
- It may take several weeks for the full benefit of Trexall to be seen in the management of psoriasis or rheumatoid arthritis. Do not stop taking Trexall without checking with your doctor.
- Trexall works best if each dose is taken at the scheduled time.
- Continue to take Trexall even if you feel well. Do not miss any doses.
- If you miss a dose of Trexall, contact your doctor right away. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Trexall.
Important safety information:
- Trexall may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Trexall with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
- Check with your doctor before you drink alcohol while you are taking Trexall.
- Nausea, vomiting, and loss of appetite are common with Trexall. Ask your doctor or pharmacist for ways to decrease these effects if they occur.
- If vomiting or diarrhea occurs, you will need to take care not to become dehydrated. Contact your doctor for instructions.
- Trexall may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Trexall. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
- Trexall may reduce the number of clot-forming cells (platelets) in your blood. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.
- Trexall may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills.
- Do not receive a live vaccine (eg, measles, mumps) while you are taking Trexall. Talk with your doctor before you receive any vaccine.
- Trexall may affect your ability to become pregnant or to father a child. Discuss any questions or concerns with your doctor.
- Men who take Trexall should always use a condom when having sex with a woman who may become pregnant. Do this for as long as you take Trexall and for 3 months after you stop taking it.
- Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.
- Lab tests, including complete blood cell counts, liver function, and kidney function, may be performed while you use Trexall. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
- Use Trexall with caution in the ELDERLY; they may be more sensitive to its effects.
- Trexall should be used with extreme caution in CHILDREN younger than 2 years old; safety and effectiveness in these children have not been confirmed.
- PREGNANCY and BREAST-FEEDING: Trexall may cause birth defects and fetal or newborn death if you take it while you are pregnant. Do not become pregnant while you are using it. Use an effective form of birth control while you take Trexall and for at least 1 ovulatory cycle after you stop taking it. If you think you may be pregnant, contact your doctor right away. Trexall is found in breast milk. Do not breast-feed while taking Trexall.
Possible side effects of Trexall:
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Seek medical attention right away if any of these SEVERE side effects occur:
Dizziness; drowsiness; general body discomfort; headache; loss of appetite; mild hair loss; mild stomach pain; nausea; tiredness.
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry stools; blood in the urine; bone pain; calf or leg pain, redness, swelling, or tenderness; change in the amount of urine produced; chest pain; confusion; coughing up blood; diarrhea or vomiting; difficult or painful urination; dry cough; enlargement of the breasts (in males); fainting; fever, chills, or persistent sore throat; menstrual changes; mental or mood changes; mouth or tongue sores or swelling; muscle weakness; night sweats; one-sided weakness; red, swollen, peeling, or blistered skin; seizures; severe or persistent dizziness or light-headedness; shortness of breath; speech changes; swollen glands; symptoms of liver problems (eg, dark urine, pale stools, persistent loss of appetite, severe stomach pain, yellowing of the skin or eyes); symptoms of pancreas inflammation (eg, severe stomach pain with or without nausea or vomiting); unexplained weight loss; unusual bleeding or bruising; unusual pain and discoloration of the skin; unusual tiredness or weakness; vaginal discharge; vision loss or other vision changes (eg, blurred vision); vomit that looks like coffee grounds.
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
If OVERDOSE is suspected:
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include black or bloody stools; change in the amount of urine produced; seizures; severe headache, nausea, vomiting, or stomach pain; swelling or soreness of the mouth or tongue; unusual bruising or bleeding; unusual tiredness or weakness; vomit that looks like coffee grounds.Proper storage of Trexall:
Store Trexall at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Trexall out of the reach of children and away from pets.
- If you have any questions about Trexall, please talk with your doctor, pharmacist, or other health care provider.
- Trexall is to be used only by the patient for whom it is prescribed. Do not share it with other people.
- If your symptoms do not improve or if they become worse, check with your doctor.
- Check with your pharmacist about how to dispose of unused medicine.
This information should not be used to decide whether or not to take Trexall or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Trexall. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to Trexall. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using Trexall.
Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.
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- Drug class: antimetabolites