Methotrexate Medication: Uses, Dosage, and Side Effects Explained

Summary of Key Points

Methotrexate is a prescription medication used to treat a variety of conditions, including rheumatoid arthritis, psoriasis, and certain types of cancer. It works by slowing down cell growth and suppressing the immune system. Methotrexate is available in different forms and strengths, with dosing tailored to the specific condition being treated. Always consult your healthcare provider before making any changes to your medication. Our telemedicine providers are available to assist you if needed.

Names of Methotrexate Medication

US Brand Names: Trexall, Otrexup, Rasuvo, Xatmep

Generic Name: Methotrexate

The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. The generic name is often listed in parentheses.

Pharmacologic Category of Methotrexate

Methotrexate belongs to the following pharmacologic categories:

1. Antimetabolite
2. Immunosuppressant
3. Antineoplastic Agent

Methotrexate Dosing Guidelines

Methotrexate is prescribed for a range of conditions, and the dosage depends on the specific disease being treated. Below are common dosing guidelines for adults. Always consult your doctor before adjusting your dose. If you need assistance, our telemedicine providers are available to help.

Methotrexate for Rheumatoid Arthritis

Initial dose: 7.5 mg once weekly. Your doctor may gradually increase the dose, with a maximum of 20-25 mg per week. Treatment is typically long-term and may require regular monitoring.

Methotrexate for Psoriasis

Initial dose: 10-25 mg once weekly. The dose may be adjusted based on your response. Treatment duration varies depending on the severity of the condition.

Methotrexate for Psoriatic Arthritis

Initial dose: 7.5-25 mg once weekly. The dose may be gradually increased under your doctor’s supervision. Treatment is generally long-term.

Methotrexate for Crohn’s Disease

Initial dose: 25 mg once weekly via injection. Maintenance dose: 15 mg once weekly. Treatment duration depends on the severity of the disease and your response to the medication.

Methotrexate for Ulcerative Colitis

Initial dose: 25 mg once weekly via injection. Maintenance dose: 15 mg once weekly. Your doctor will determine the treatment duration based on your condition.

Methotrexate for Non-Hodgkin Lymphoma

Dose: 10-25 mg/m² intravenously every 7-14 days. The length of treatment depends on the type and stage of lymphoma.

Methotrexate for Leukemia

Dose: 2.5 mg/kg intravenously every 14 days. The treatment plan is tailored to the type and stage of leukemia.

Methotrexate for Ectopic Pregnancy

Single dose: 50 mg/m² intramuscularly. Additional doses may be required depending on your response to treatment.

Methotrexate for Osteosarcoma

High-dose Methotrexate: 12 g/m² intravenously every 2 weeks. Treatment is typically combined with other chemotherapy agents.

Methotrexate for Systemic Lupus Erythematosus

Initial dose: 7.5-15 mg once weekly. The dose may be adjusted based on your response. Treatment is usually long-term.

Methotrexate Dosage Forms and Strengths

Methotrexate is available in the following forms and strengths:

1. Tablets: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg
2. Injection (solution): 25 mg/mL (available in various vial sizes)
3. Auto-injector (subcutaneous): 7.5 mg, 10 mg, 15 mg, 20 mg, 25 mg
4. Oral solution: 2.5 mg/mL

Administration Instructions for Methotrexate

Take Methotrexate exactly as prescribed by your healthcare provider. It is typically taken once a week, not daily, to avoid serious side effects. If you are taking the tablet form, swallow it whole with water. For injections, follow your healthcare provider’s instructions carefully. Never adjust your dose without consulting your doctor. If you have any questions, our telemedicine providers are available to guide you.

Methotrexate Side Effects and Adverse Reactions

Methotrexate can cause side effects, some of which may be serious. Contact your healthcare provider if you experience any of the following:

Common Side Effects (Occurring in more than 10% of patients):

1. Nausea and vomiting: Feeling sick or experiencing vomiting.
2. Fatigue: Unusual tiredness or weakness.
3. Mouth sores: Painful ulcers or sores in the mouth.

Less Common Side Effects (Occurring in 1-10% of patients):

1. Anemia: A decrease in red blood cells, leading to fatigue and weakness.
2. Hair loss: Thinning or loss of hair.
3. Diarrhea: Frequent, loose stools.

Rare but Serious Side Effects (Occurring in less than 1% of patients):

1. Liver damage: Symptoms may include yellowing of the skin or eyes (jaundice).
2. Lung problems: Shortness of breath or a persistent cough.
3. Severe skin reactions: Rash, blistering, or peeling of the skin.

Methotrexate Contraindications

A contraindication is a specific situation where a medication should not be used because it may cause harm. Methotrexate has several contraindications, meaning it is not safe for everyone. Below are situations where Methotrexate should not be taken and the reasons why:

Pregnancy: Methotrexate can cause serious birth defects or miscarriage. It is highly toxic to a developing fetus.

Liver disease: Methotrexate can further damage the liver, so it should not be used by patients with liver conditions such as cirrhosis or hepatitis.

Alcoholism or chronic alcohol use: Alcohol increases the risk of liver damage when combined with Methotrexate.

Severe kidney disease: Methotrexate is cleared through the kidneys. If the kidneys are not functioning properly, Methotrexate can accumulate to dangerous levels.

Blood disorders: Methotrexate can lower blood cell counts, so it should not be used in patients with pre-existing blood disorders such as anemia, leukopenia, or thrombocytopenia.

Immunodeficiency: Methotrexate suppresses the immune system, so it is not recommended for patients with weakened immune systems, such as those with HIV/AIDS.

Drug to Drug Interactions

Some medications can interact with Methotrexate, either increasing the risk of side effects or reducing its effectiveness. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below are some common medications that may interact with Methotrexate:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen (Advil, Motrin), Naproxen (Aleve) – These can elevate Methotrexate levels in the blood, increasing the risk of toxicity.
2. Antibiotics: Trimethoprim-Sulfamethoxazole (Bactrim), Penicillin – These can interfere with how Methotrexate is metabolized, raising the likelihood of side effects.
3. Proton pump inhibitors (PPIs): Omeprazole (Prilosec), Esomeprazole (Nexium) – These can slow the clearance of Methotrexate from the body, leading to higher concentrations in the bloodstream.
4. Diuretics: Furosemide (Lasix) – This can increase the risk of kidney damage when used alongside Methotrexate.
5. Anticoagulants: Warfarin (Coumadin) – Methotrexate can enhance the effects of blood thinners, increasing the risk of bleeding.

Methotrexate and Pregnancy Safety

Is it safe to take Methotrexate during pregnancy? No, Methotrexate is not safe for use during pregnancy. It is classified as a Category X medication by the FDA, meaning it can cause severe harm to a developing fetus, including birth defects and miscarriage. Women who are pregnant or planning to become pregnant should avoid Methotrexate. If you are of childbearing age and taking Methotrexate, it is essential to use effective contraception. Should you become pregnant while on Methotrexate, contact your healthcare provider immediately.

Methotrexate While Breastfeeding

Is it safe to take Methotrexate while breastfeeding? Methotrexate is not recommended during breastfeeding. It can pass into breast milk and may harm a nursing infant, potentially affecting their immune system or causing other adverse effects. If you are breastfeeding, discuss alternative treatment options with your healthcare provider.

Estimated Cost of Methotrexate Medication

The cost of Methotrexate can vary depending on the pharmacy and location. Without insurance, the estimated price for a 30-day supply of Methotrexate (2.5 mg tablets) using a GoodRx coupon ranges from $10 to $30. Prices may fluctuate, so it’s advisable to check with your local pharmacy or use a discount service like GoodRx for the most accurate pricing.

Possible Alternatives to Methotrexate

If Methotrexate is not suitable for you or if you experience side effects, there are alternative treatments and lifestyle changes that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to discuss these options with you.

1. Rheumatoid arthritis: Alternatives include biologic medications such as Etanercept (Enbrel) or Adalimumab (Humira). Lifestyle changes, including regular exercise, a balanced diet, and physical therapy, can also help manage symptoms.
2. Psoriasis: Topical treatments like corticosteroids or Vitamin D analogs (e.g., Calcipotriene) may be effective. Phototherapy and biologics such as Ustekinumab (Stelara) are also potential options.
3. Psoriatic arthritis: Biologics like Secukinumab (Cosentyx) or Tofacitinib (Xeljanz) may be considered. Physical therapy and anti-inflammatory diets may also provide symptom relief.
4. Crohn’s disease: Biologics such as Infliximab (Remicade) or Vedolizumab (Entyvio) are alternatives. Dietary adjustments, such as a low-residue diet, may help manage symptoms.
5. Ulcerative colitis: Aminosalicylates like Mesalamine (Asacol) or biologics like Golimumab (Simponi) are alternatives. Stress management and dietary modifications may also be beneficial.
6. Non-Hodgkin lymphoma: Chemotherapy regimens such as R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) are common alternatives.
7. Leukemia: Treatment options include chemotherapy, targeted therapies like Imatinib (Gleevec), and stem cell transplants.
8. Ectopic pregnancy: Surgical intervention is often required, though in some cases, Methotrexate may still be used under close medical supervision.
9. Osteosarcoma: Chemotherapy agents such as Doxorubicin or Cisplatin are common alternatives. Surgery is often necessary to remove the tumor.
10. Systemic lupus erythematosus: Alternatives include Hydroxychloroquine (Plaquenil) and corticosteroids. Lifestyle changes, such as sun protection and stress management, can also help manage symptoms.

Recent Updates on Methotrexate Research

Recent studies on Methotrexate have focused on its long-term safety and effectiveness, particularly in autoimmune diseases like rheumatoid arthritis and psoriasis. Some research has explored the potential for lower doses of Methotrexate to reduce side effects while maintaining its therapeutic benefits. Additionally, ongoing studies are investigating the use of Methotrexate in combination with newer biologic therapies to improve outcomes for patients with severe autoimmune conditions.

Another area of research is Methotrexate’s role in cancer treatment, particularly in combination with other chemotherapy agents. Researchers are exploring how Methotrexate can be used more effectively in certain cancers, such as osteosarcoma and leukemia, while minimizing toxicity.

As always, it’s important to stay informed about the latest research and discuss any concerns with your healthcare provider. If you have questions about Methotrexate or would like to explore alternative treatments, our telemedicine providers are available to help you make the best decision for your health.

James Kingsley

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