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Methotrexate

Generic Name: methotrexate (oral) (meth oh TREX ate)
Brand Names: Rheumatrex Dose Pack, Trexall, Xatmep

Medically reviewed on May 16, 2018.

What is methotrexate?

Methotrexate interferes with the growth of certain cells of the body, especially cells that reproduce quickly, such as cancer cells, bone marrow cells, and skin cells.

Methotrexate is used to treat certain types of cancer of the breast, skin, head and neck, or lung. It is also used to treat severe psoriasis and rheumatoid arthritis.

Methotrexate is usually given after other medications have been tried without successful treatment of symptoms.

Important Information

Methotrexate is usually not taken every day. You must use the correct dose for your condition. Some people have died after taking methotrexate every day by accident.

Do not use methotrexate to treat psoriasis or rheumatoid arthritis if you have low blood cell counts, a bone marrow disorder, liver disease (especially if caused by alcoholism), or if you are pregnant or breast-feeding.

Methotrexate can cause serious or life-threatening side effects. Tell your doctor if you have diarrhea, mouth sores, cough, shortness of breath, upper stomach pain, dark urine, numbness or tingling, muscle weakness, confusion, seizure, or skin rash that spreads and causes blistering and peeling.

Call your doctor if you have unusual bruising or bleeding, or signs of infection (fever, chills, body aches).

Do not use methotrexate if you are pregnant or breast-feeding a baby.

Before taking this medicine

You should not use methotrexate if you are allergic to it. Methotrexate should not be used to treat psoriasis or rheumatoid arthritis if you have:

  • alcoholism, cirrhosis, or chronic liver disease;

  • low blood cell counts;

  • a weak immune system or bone marrow disorder; or

  • if you are pregnant or breast-feeding.

Methotrexate is sometimes used to treat cancer even when patients do have one of the conditions listed above. Your doctor will decide if this treatment is right for you.

Tell your doctor if you have:

  • kidney disease;

  • lung disease;

  • any type of infection; or

  • radiation treatments.

Methotrexate can harm an unborn baby or cause birth defects, whether the mother or father is taking this medicine.

  • If you are a woman, do not use methotrexate to treat psoriasis or rheumatoid arthritis if you are pregnant. You may need to have a negative pregnancy test before starting this treatment. Use an effective form of birth control while you are taking this medicine, and for 6 months after your last dose.

  • If you are a man, use a condom to keep from causing a pregnancy while you are using methotrexate. Continue using condoms for at least 3 months after your last dose.

  • Tell your doctor right away if a pregnancy occurs while either the mother or the father is taking methotrexate.

This medicine may affect fertility (ability to have children) in both men and women. However, it is important to use birth control to prevent pregnancy because methotrexate may harm the baby if a pregnancy does occur.

You should not breast-feed while using this medicine.

Do not give this medicine to a child without the advice of a doctor.

How should I take methotrexate?

Take methotrexate exactly as it was prescribed for you Follow all directions on your prescription label and read all medication guides or instruction sheets.

Methotrexate is sometimes taken once or twice per week and not every day. You must use the correct dose. Some people have died after taking methotrexate every day by accident. Ask your doctor or pharmacist if you have questions about your dose or how often to take it.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Methotrexate can be toxic to your organs, and may lower your blood cell counts. Your blood will need to be tested often, and you may need an occasional liver biopsy. Your cancer treatments may be delayed based on the results.

If you need to be sedated for dental work, tell your dentist you currently use this medicine.

Store tablets at room temperature away from moisture and heat.

Store the liquid medicine in the refrigerator, do not freeze.

You may also store the liquid at room temperature for up to 60 days.

Methotrexate dosing information

Usual Adult Dose for Acute Lymphoblastic Leukemia:

Induction: 3.3 mg/m2/day orally or IM (in combination with prednisone 60 mg/m2).

Maintenance (during remission): 15 mg/m2 IM or orally twice a week.
Alternate remission dosing: 2.5 mg/kg IV every 14 days.

Usual Adult Dose for Choriocarcinoma:

15 to 30 mg IM or orally daily for 5 days. Repeat courses 3 to 5 times with a rest period of greater than or equal to 1 week between courses, until any manifesting toxic symptoms subside.

Effectiveness of therapy is ordinarily evaluated by 24 hour quantitative analysis of urinary chorionic gonadotropin (hCG), which generally will return to normal or less than 50 intl units/24 hours usually after the third or fourth course and usually followed by a complete resolution of measurable lesions in 4 to 6 weeks. One to two courses of methotrexate after normalization of hCG is usually recommended.

Usual Adult Dose for Trophoblastic Disease:

15 to 30 mg IM or orally daily for 5 days. Repeat courses 3 to 5 times with a rest period of greater than or equal to 1 week between courses, until any manifesting toxic symptoms subside.

Effectiveness of therapy is ordinarily evaluated by 24 hour quantitative analysis of urinary chorionic gonadotropin (hCG), which generally will return to normal or less than 50 intl units/24 hours usually after the third or fourth course and usually followed by a complete resolution of measurable lesions in 4 to 6 weeks. One to two courses of methotrexate after normalization of hCG is usually recommended.

Usual Adult Dose of Methotrexate for Lymphoma:

For Burkitt's tumor in Stages I-II: 10 to 25 mg orally once a day for 4 to 8 days

Malignant lymphoma in Stage III: 0.625 to 2.5 mg/kg orally daily as a part of combination chemotherapy.

Treatment in all stages usually consists of several courses of the drug interposed with 7 to 10 day rest periods.

Usual Adult Dose for Meningeal Leukemia:

12 mg/m2 intrathecally every 2 to 5 days until the cell count of the CSF returns to normal. At this point, one additional dose is advisable. Administration at intervals of less than 1 week may result in increased subacute toxicity.

Usual Adult Dose for Mycosis Fungoides:

2.5 to 10 mg PO daily or 50 mg IM once a week or 25 mg IM twice a week.

Usual Adult Dose for Osteosarcoma:

Initial Dose: 12 g/m2 intravenously as a 4 hour infusion (in combination with other chemotherapeutic agents). If this dose is not adequate to achieve a peak serum concentration of 1000 micromolar at the end of the infusion, the dose may be increased to 15 g/m2.

Treatments may occur at 4, 5, 6, 7, 11, 12, 15, 16, 29, 30, 44, and 45 weeks after surgery.

If the patient is vomiting or unable to tolerate oral medication, leucovorin should be added to this regimen at the same dose and schedule as the methotrexate.

Usual Adult Dose for Psoriasis:

Single Dose: 10 to 25 mg/week orally, IM, or IV until adequate response is achieved.
Divided Dose: 2.5 mg orally, IM, or IV every 12 hours for 3 doses once a week.
Maximum weekly dose: 30 mg.

Usual Adult Dose for Rheumatoid Arthritis:

Single dose: 7.5 mg orally weekly.
Divided dose: 2.5 mg orally every 12 hours for 3 doses once a week.
Maximum weekly dose: 20 mg.

Usual Adult Dose for Neoplastic Diseases:

I.V.: Range is wide from 30-40 mg/m2/week to 100-12,000 mg/m2 with leucovorin rescue

Usual Pediatric Dose for Acute Lymphocytic Leukemia:

100 mg/m2 over 1 hour followed by a 35 hour infusion delivering 900 mg/m2/day.

Usual Pediatric Dose for Dermatomyositis:

15 to 20 mg/m2 orally once weekly.

Usual Pediatric Dose for Meningeal Leukemia:

less than 4 months: 3 mg/dose intrathecally.
greater than or equal to 4 months less than 1 year: 6 mg/dose intrathecally.
greater than or equal to 1 year less than 2 years: 8 mg/dose intrathecally.
greater than or equal to 2 years less than 3 years: 10 mg/dose intrathecally.
greater than or equal to 3 years: 12 mg/dose intrathecally.

The dose may be administered every 2 to 5 days until CSF counts return to normal followed by a dose administered once weekly for 2 weeks and monthly thereafter. Administration at intervals of less than 1 week may result in increased subacute toxicity.

Usual Pediatric Dose for Neoplastic Diseases:

7.5 to 30 mg/m2 IM or orally every 2 weeks.
Alternate dosing: 10 to 18,000 mg/m2 IV bolus or continuous infusion over 6 to 42 hours.

Usual Pediatric Dose for Rheumatoid Arthritis:

5 to 15 mg/m2 IM or orally once weekly.

Usual Pediatric Dose for Solid Tumors:

less than 12 years: 12000 mg/m2 IV.
greater than or equal to 12 years: 8000 mg/m2 IV.
Maximum dose: 18 grams.

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of methotrexate.

Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of methotrexate can be fatal.

What should I avoid while taking methotrexate?

Avoid drinking alcohol. It may increase your risk of liver damage.

See also: Methotrexate and alcohol (in more detail)

Do not receive a "live" vaccine while using methotrexate, or you could develop a serious infection. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), and zoster (shingles).

This medicine can pass into body fluids (urine, feces, vomit). Caregivers should wear rubber gloves while cleaning up a patient's body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds), especially if you are being treated for psoriasis. Methotrexate can make your skin more sensitive to sunlight and your psoriasis may worsen.

Methotrexate side effects

Get emergency medical help if you have signs of an allergic reaction to methotrexate (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Call your doctor at once if you have:

  • fever, chills, swollen lymph glands, night sweats, weight loss;

  • vomiting, white patches or sores inside your mouth or on your lips;

  • diarrhea, blood in your urine or stools;

  • dry cough, cough with mucus, stabbing chest pain, wheezing, feeling short of breath;

  • seizure (convulsions);

  • kidney problems - little or no urination, swelling in your feet or ankles;

  • liver problems - stomach pain (upper right side), dark urine, jaundice (yellowing of the skin or eyes);

  • nerve problems - confusion, weakness, drowsiness, coordination problems, feeling irritable, headache, neck stiffness, vision problems, loss of movement in any part of your body; or

  • signs of tumor cell breakdown - confusion, tiredness, numbness or tingling, muscle cramps, muscle weakness, vomiting, diarrhea, fast or slow heart rate, seizure.

Side effects may be more likely in older adults.

Common methotrexate side effects may include:

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect methotrexate?

Methotrexate can harm your liver, especially if you also use certain other medicines for infections, tuberculosis, depression, birth control, hormone replacement, high cholesterol, heart problems, high blood pressure, seizures, or pain or arthritis medicines (including acetaminophen, Tylenol, Advil, Motrin, and Aleve).

Many drugs can interact with methotrexate. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use methotrexate only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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