Methotrexate: Comprehensive Medication Guide for Patients

Names of Medication

US Brand Name: Rheumatrex, Trexall (Methotrexate)

Pharmacologic Category

Methotrexate is an antimetabolite and antifolate drug. Other drugs in this category include Pemetrexed (Alimta), Pralatrexate (Folotyn), and Trimethoprim (Primsol, Bactrim).

Dosing

Remember to always consult your healthcare provider before making any adjustments to your medication dosages. Here are some general dosing guidelines for Methotrexate:

Rheumatoid Arthritis

: Initial dose is usually 7.5 mg once weekly, which can be increased up to 20 mg per week if needed.

Psoriatic Arthritis

: 7.5 to 25 mg once weekly.

Juvenile Idiopathic Arthritis

: 10 to 15 mg/m² per week.

Psoriasis

: 10 to 25 mg once weekly.

Ectopic Pregnancy

: Single dose of 50 mg/m².

Acute Lymphoblastic Leukemia

: Dose depends on the specific chemotherapy regimen used.

Non-Hodgkin’s Lymphoma

: Dose depends on the specific chemotherapy regimen used.

Breast Cancer

: Dose depends on the specific chemotherapy regimen used.

Head and Neck Cancer

: Dose depends on the specific chemotherapy regimen used.

Lung Cancer

: Dose depends on the specific chemotherapy regimen used.

Osteosarcoma

: Dose depends on the specific chemotherapy regimen used.

Bladder Cancer

: Dose depends on the specific chemotherapy regimen used.

Crohn’s Disease

: 15 to 25 mg once weekly.

Dosage Forms and Strengths

Methotrexate is available in the following forms and strengths:
Tablets: 2.5 mg, 5 mg, 7.5 mg, 10 mg, and 15 mg.
Injection: 25 mg/mL.

Administration Instructions

Tablets should be taken orally with a glass of water, preferably on an empty stomach. Methotrexate is usually taken once per week, not every day. The injection form is administered by healthcare professionals.

Adverse Reactions and Side Effects

Like all medications, Methotrexate can cause side effects. Some common and serious side effects include:

Nausea and Vomiting (common)

: This is caused by Methotrexate’s impact on the stomach lining. Taking the medication with food or at bedtime may reduce these effects.

Liver Damage (less common)

: Methotrexate can cause liver damage because it is processed by the liver. Regular liver function tests are necessary to monitor for this side effect.

Decreased Blood Cell Counts (less common)

: Methotrexate can decrease the production of blood cells in the bone marrow, leading to anemia, bleeding problems, and increased susceptibility to infections. Regular blood tests are required to monitor for this effect.

Lung Damage (rare)

: Methotrexate can cause lung damage, leading to symptoms like cough and difficulty breathing. Inform your doctor immediately if you experience these symptoms.

Contraindications to Taking Methotrexate

Contraindications refer to situations in which a drug should not be used because it may be harmful to the patient. Methotrexate is contraindicated in:

Pregnancy

:
Methotrexate can cause birth defects or fetal death. Women of childbearing age should use effective contraception during treatment.

Alcoholism or Liver Disease

: Methotrexate is metabolized in the liver and can exacerbate existing liver disease or be harmful to individuals with significant alcohol consumption.

Breastfeeding

: Methotrexate passes into breast milk and could harm a nursing infant.

Drug to Drug Interactions

Methotrexate can interact with several other medications. Some of these include:
Aspirin (Bayer, Ecotrin)
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Advil, Motrin) or Naproxen (Aleve)
Proton pump inhibitors like Omeprazole (Prilosec) or Esomeprazole (Nexium)

Methotrexate in Pregnancy

Methotrexate is classified as a Category X drug by the FDA, meaning it is contraindicated in pregnancy due to the risk of birth defects or fetal death.

Methotrexate While Breastfeeding

Methotrexate is excreted in breast milk and could potentially harm a nursing infant. Therefore, it is not recommended for use while breastfeeding.

Estimated Cost of Medication

The estimated cost for a 30-day supply of Methotrexate tablets (7.5 mg once weekly) without insurance, using a GoodRx coupon, is around $30 to $40. However, prices can vary depending on the pharmacy and location. Always remember that prices are subject to change based on negotiated agreements between pharmacies and pharmaceutical companies.

Brief Legal Disclaimer

This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.
Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.