Methotrexate
Methotrexate
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Methotrexate

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prescription

What is this medication?

Methotrexate, Otrexup/Rasuvo/Trexall/Xatmep/Metoject
Antineoplastic; antirheumatic; Disease Modifying Immunosuppressant Agent (DMARD)

Methotrexate, Otrexup/Rasuvo/Trexall/Xatmep/Metoject is officially indicated for rheumatoid arthritis, psoriasis, and various cancers.  It is also prescribed off-label for dermatomyositis/polymyositis, Crohn disease, sarcoidosis, and systemic lupus erythematosus. (may be used for conditions not listed)

How does this medication work? 

Methotrexate, Otrexup/Rasuvo/Trexall/Xatmep/Metoject inhibits dihydrofolate reductase which normally forms reduced folates and thymidylate synthetase thereby reducing the production of purine and thymidylic acid.  These agents are important in the S-phase of DNA replication, so methotrexate essentially interferes with DNA synthesis, repair and cellular replication.  Fast dividing cells are more sensitive to this medication since DNA replication is required to divide.  The mechanism for the treatment of various autoimmune conditions is not fully understood but it is expected to do with immunomodulation.  For psoriasis it is believed that the rapidly proliferating epithelial cells in the skin are slowed by the medication. 

How should I take this medication? 

The dosage and frequency of methotrexate varies greatly based on the condition it is used for.  2.5-25mg orally or injected once weekly are common for autoimmune diseases such as rheumatoid arthritis but much larger doses are calculated based off body surface area are common for various cancers and some other conditions.  Commonly combined with folic acid or folinic acid (Leucovorin Calcium) to reduce toxicity/adverse reactions.

How to Take: Follow instructions provided by physician/pharmacy label, administer consistently at same days and times unless otherwise directed, store at room temperature, take after food or milk to reduce gastrointestinal upset if administered orally.

You Need to Avoid: Avoid excessive alcohol consumption as it may increase liver toxicity, do not skip blood tests or follow up appointments while on this medication they are important to monitor for serious adverse reactions

What should I watch for while using this medication? 

Before starting Methotrexate, Otrexup/Rasuvo/Trexall/Xatmep/Metoject make sure your physician is aware of any allergies, medications you currently take, knows your full medical background and current/past medical conditions, or are pregnant or breastfeeding.   Bloodwork will likely be required before initiating this medication for long term use.

Patients must be monitored closely by their physicians while on this medication.  Risk of acute kidney failure, bone marrow suppression, neurotoxicity, dermatological reactions, gastrointestinal toxicity, liver toxicity, increased risk of infections, secondary malignancy etc.

Most of these are a concern when this medication is used for chemotherapy and the much lower dosages used for autoimmune conditions such as rheumatoid arthritis, but the patient should still be monitored closely in case any of them do occur.

For higher dosages, these effects are shared by many antineoplastic agents as inhibiting cell division affects every cell in your body, with fast dividing tissues such as stomach lining, skin, hair and nails being affected the most.  Fast dividing cancer cells are also susceptible to these effects, but since cancer cells are almost identical to regular human cells it is very difficult to create an agent that is toxic to them but not normal human cells whereas with something such as antibiotics for bacteria we can target cell components or functions that humans do not have which is much easier.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication?

Methotrexate, Otrexup/Rasuvo/Trexall/Xatmep/Metoject has many potential side effects, some of which are profoundly serious.  The risk varies with dosage.  For lower dosages dizziness, diarrhea, nausea, and abdominal distress are common.  Other common side effects are more likely to show up in blood work such as elevated liver enzymes, leukopenia, and thrombocytopenia.  

Note this is not a complete list of side effects.