Re: Re: MTX Non Preservative Question

[Guest guest]

Sophie's dose is small, as well (0.4 ml) and we waste an incredible amount

each week. We get her monthly supply through our insurance's mail-order

pharmacy. That way, our co-pay is only $4.30.

I found this information on the web and thought I'd pass it along to you.

It doesn't mention the possibility of storing in the 'fridge. It only says

use once and discard. The site address is:

http://www.medsafe.govt.nz/profs/datasheet/m/Methotrexateinjmayne.htm

Here is the storage info. it provided:

Pharmaceutical Precautions Instructions for Use/Handling

The following protective recommendations are given due to the toxic nature

of this substance:

- personnel should be trained in good handling technique,

- pregnant staff should be excluded from working with this drug,

- personnel handling injectable methotrexate should wear protective

clothing including goggles, gowns and disposable gloves and masks,

- a designated area should be assigned for preparation (preferably

under a laminar flow system), with the work surface protected by disposable,

plastic-backed, absorbent paper,

- all items used for administration or cleaning, including gloves,

should be placed in high-risk, waste disposal bags for high temperature

incineration,

- accidental contact with the skin or eyes should be treated

immediately by copious lavage with water or sodium bicarbonate solution;

medical attention should be sought.

Stability

The liquid vials are preservative-free and should therefore be used once

only and discarded.

Methotrexate Injection, when diluted to a concentration of 1 mg/mL with

sodium chloride 0.9% injection, glucose 5% injection, Hartmann's Injection,

Ringer's Injection and 5% glucose in 0.9% sodium chloride injection, retains

its potency for 24 hours when stored at room temperature in the presence and

absence of fluorescent light.

However, because of microbiological contamination hazards, infusion of the

admixed solutions should commence as soon as possible after preparation, and

in any case, should be completed within 24 hours. Storage of admixed

solutions should be at 2 to 8°C.

Incompatibilities

Methotrexate has been reported to be incompatible with cytarabine,

fluorouracil and prednisolone.

Special Precautions for Storage

Methotrexate Injection should be stored below 25°C and protected from light.

Methotrexate Tablets should be stored below 30°C.

Weber

Professional Mom to:

Sophie (rapidly approaching 5) - pauci/panuveitis

Charlie (coming up on the big ONE) - it's a good thing she's so cute...

On 5/23/06, ztaimw <nsigns@...> wrote:

>

> Hi Sandy,

>

> We too get the mtx vials and our daughter's dose is so small-0.3ml

> that we waste the remainder of the 2ml in the vial. (Don't know if

> this is the smaller vial or the larger vial you are referring too.)

> We chose to start doing the injections at home because of the expense

> of taking her to the office once a week to have it done. We did our

> first last week-my husband had to do it because I just couldn't. Is

> giving her the injections yourself an option for you?

>

> Sorry I can't be of more help-but also interested in what the others

> say about refrigerating a dose to use the next week.

>

> Tracey (Madi-14mo systemic)

>

>

>

> >

> > Hi ya'll - hope everyone is doing great with the warming

> tempartures. My

> > questions is for many of the older sight members. We recently

> stopped taking

> > Hunter to the Hospital Oncology Department to get her MTX shot.

> We were not

> > pleased with some of the choices the department were making and

> have chosen

> > to hire a private nurse to give the shot at our home. Our

> pharmacist has

> > only been able to receive the non preservative MTX and it is in a

> large vial.

> > Isn't it possible to draw off one extra injection and keep it

> refrigerated for

> > one week? I thought I remembered reading this back when there was

> a MTX

> > shortage. Our insurance will not pay for the home care (even the

> MTX). When we

> > go to Atlanta in July - there is a pharmacy we went to before (two

> years

> > ago) that has the smaller vials - will go there and stock up.

> Any advice would

> > be appreciated. See you all in Atlanta. Sandi Ken and Hunter

> > (Systemic/Asthmatic 7)

> >

> >

> >

[Guest guest]

Hi everyone,

Here's what we were told, if it helps at all. My son

has been on MTX injections with preservatives for

about a year. When he started, there was a shortage,

and we were told to reuse the vial. I don't know if

there is still a shortage, but we're still following

those directions. Last October, I was at a local AJAO

event where this discussion came up. Some of the

parents specifically said they could only get the

non-preservative kind. They draw up as many syringes

as they can from one vial and refrigerate.

Also, MTX is a low-dose of chemotherapy. There are

plenty of parents out there, me included, who have

given shots week after week without wearing all of the

gear mentioned previously. I was told to wash our

hands before and after, wash the counters after

drawing the syringe and not to go anywhere near the

MTX if I was pregnant. Other than storing the mtx out

of sunlight, no other instructions. The nurse at the

ped rheum office even let us practice on each other

before we left the office for the first time. We've

been fine. No trouble.

Andy first started out just fine with the shots, then

as the dose increased, the medicine began burning.

When that started, it would take 2 people to hold him

down and me to give the shot. He's 7. No fun at all.

Per the doctor's request, we started giving him

benedryl about an hour before the shot to help calm

him down. That worked for a little while, but then he

caught on. Then we started giving it to him at night

during his sleep. That worked for a little while, then

he caught on to that. One day, maybe it was that he

was tired of fighting it every week, he calmed down,

took his shot without any kicking, screaming or

crying. Yeah, it hurt, but he knows he's going to lose

the battle. Now I can do it myself without anyone else

around. What a relief!

Andy's had a rough time with the side effects of mtx.

He immediately throws up after getting the shot. I can

only believe that is due from nerves. However, the 24

hours follwing the shot, he's also sick. The doctor

doubled his folic acid intake, and worked for a little

while, but this last month hasn't been so good. That

aside, the mtx must be helping because at his last

appointment in March, his arthritis was doing much

better and his psoriasis was pretty much under

control. : ) Good luck to all of you. Take care.

(son Andy, almost 8, psoriatic)

--- Jo & Grant <joking70@...> wrote:

> Hi Tracey,

> One of the other JIA mums whose daughter has

> injectable Mtx at the

> hospital each week, says the nurses wear the whole

> head-to-toe-with-

> gloves, and she's not allowed in the room even when

> her daughter has

> the shots.

> Our Paed Rheumy says the dosage kids have for

> Arthritis really isn't

> that big or bad and not necessary to wear all that.

> One of the

> Community Nurses from our local hospital says oh

> yeah ya gotta wear all

> that, 'cause it's toxic and dangerous and all.

> Another nurse says we

> shouldn't be doing it at home at all (and actually

> seemed to know

> bugger-all about arthritis in children!)

> The chemist/pharmacist said he'd do the initial

> couple of shots for us,

> as he is also a RN, but then said it would be better

> getting it done at

> the doctor's office...but Bayly's treating doctor at

> the hospital, says

> he hasn't any experience of them doing them at the

> Paed Clinic Bayly

> attends!

>

> Add my hubby's needle-phobia-

>

> See why I'm a tad worried?

> J

>

>

> > Hi Jo,

> >

> > We are newbies (well, about 2 months into the

> whole thing) and we are

> > currently giving our daughter mtx injections at

> home also. She is

> > almost 15mo old, and she's a trooper. We've

> noticed she's a lot

> > calmer with us giving it to her than going to the

> peds office and

> > having it done. So that's been a plus :-) What

> kind of conflicting

> > advice have you gotten from your rheumy and ped,

> etc? We weren't

> > told to begin with that we shouldn't re-use the

> vial so we did(we

> > used it orally to begin with), but have now

> started to use a new one

> > with each injection. Which part of the whole

> thing is scary-maybe as

> > newbies we are missing the boat!

> > Tracey

> > (Madi, 14 mo, systemic)

>

>

>

>

>

__________________________________________________

[Guest guest]

In a message dated 5/28/2006 6:37:11 P.M. Eastern Daylight Time,

hburger64@... writes:

It will become very routine after awhile. I do not wear gloves. I

just wipe the MTX bottle with a wipe, draw up the meds. stick the

covered end of the syringe in my teeth to hold it while i wipe

Nick's belly with another wipe. Wait a few seconds for it to dry,

pull out the needle from the cover in my mouth, stick and squirt.

Nick rubs his belly afterwards for a few seconds and goes on his

merry way.

HELEN,

Your directions are awesome!!! I wish someone could do that for me for

enbrel, lots of steps with that one. Kinda made me nervous. She had her

first injection last night. I do have a question though......how do you all

spread it out??? And do you give mtx the same day as the enbrel?? Talk to

you soon!!!

Luv and hugs,

Aj and Holly (12 yrs old, systemic jra since 9/94)

_www.caringbridge.org/visit/holly_ (http://www.caringbridge.org/visit/holly)

[Guest guest]

- is n using Qvar (inhaler) just wondered, Hunter used it for 3

weeks in the Spring - it worked wonders. Hope she is doing better really soon

- keep us posted. Sandi Ken Hunter (7 Systemic)

[Guest guest]

HI Helen

Thanks for the tip of watching the video....it really explained a lot!!!

She did very well with it actually....we have been doing her shots at

night, but I told her I would like to get it done this time at least while I

was

awake and alert as I was nervous. She agreed and didn't pitch a fit or cry,

lol. She did very well. Hope it continues to be this way. I am just praying

this is the answer to getting my kiddo back.

Luv and hugs,

Aj and Holly (12 yrs old, systemic jra since 9/94)

_www.caringbridge.org/visit/holly_ (http://www.caringbridge.org/visit/holly)

[Guest guest]

Hi ,

Keep me posted on how n is doing....MAS is so scary!!! Holly had

a mild case of MAS 4 years ago...and has done well since. Talk to you

soon!!!

Luv and hugs,

Aj and Holly (12 yrs old, systemic jra since 9/94)

_www.caringbridge.org/visit/holly_ (http://www.caringbridge.org/visit/holly)

[Guest guest]

Aj,

have you gone to the enbrel site and watched the little video about mixing

and administering the enbrel??? It really helped me in the begining.

When Nick was on enbrel and MTX we did Enbrel Monday and Thursday and MTX on

Saturday.

After awhile we switched to just one enbrel a week ( doubled up dose) and

did this on Tuesday. MTX stayed the same on Saturday.

When Nick started to get less and less help from the enbrel we went back to

2 doses a week ( it has a very short half life) but that didnt help for

every long.

How did Holly do with her 1st shot??

hugs Helen and (8,systemic)

Hugs..Helen

DH Dan

(22)(16)(13)Zachary(11)(8)

(6)

----Original Message Follows----

From: ajaomom@...

Reply-

Subject: Re: Re: MTX Non Preservative Question

Date: Sun, 28 May 2006 18:42:19 EDT

In a message dated 5/28/2006 6:37:11 P.M. Eastern Daylight Time,

hburger64@... writes:

It will become very routine after awhile. I do not wear gloves. I

just wipe the MTX bottle with a wipe, draw up the meds. stick the

covered end of the syringe in my teeth to hold it while i wipe

Nick's belly with another wipe. Wait a few seconds for it to dry,

pull out the needle from the cover in my mouth, stick and squirt.

Nick rubs his belly afterwards for a few seconds and goes on his

merry way.

HELEN,

Your directions are awesome!!! I wish someone could do that for me

for

enbrel, lots of steps with that one. Kinda made me nervous. She had her

first injection last night. I do have a question though......how do you all

spread it out??? And do you give mtx the same day as the enbrel?? Talk

to

you soon!!!

Luv and hugs,

Aj and Holly (12 yrs old, systemic jra since 9/94)

_www.caringbridge.org/visit/holly_ (http://www.caringbridge.org/visit/holly)

[Guest guest]

Hi AJ,

n takes her mtx on Saturday nights, and the enbrel on Monday and

Thursdays.

On another subject, I brought n to the pumonologist about her

cough. It is the remnants of the MAS, or the MAS trying to come

back. The cough surfaced as we tapered the prednisone. She has been

given numerous pulmonary function tests and has failed all of them.

She was put on inhaled steroids and we have stopped the prednisone

taper until a more sophisticated pulmonary test is done on June 6th.

She can't inhale or exhale the normal amount. (n, 17,

systemic)

On May 28, 2006, at 3:42 PM, ajaomom@... wrote:

>

> In a message dated 5/28/2006 6:37:11 P.M. Eastern Daylight Time,

> hburger64@... writes:

>

> It will become very routine after awhile. I do not wear gloves. I

> just wipe the MTX bottle with a wipe, draw up the meds. stick the

> covered end of the syringe in my teeth to hold it while i wipe

> Nick's belly with another wipe. Wait a few seconds for it to dry,

> pull out the needle from the cover in my mouth, stick and squirt.

> Nick rubs his belly afterwards for a few seconds and goes on his

> merry way.

>

>

>

> HELEN,

> Your directions are awesome!!! I wish someone could do that

> for me for

> enbrel, lots of steps with that one. Kinda made me nervous. She

> had her

> first injection last night. I do have a question though......how

> do you all

> spread it out??? And do you give mtx the same day as the

> enbrel?? Talk to

> you soon!!!

>

> Luv and hugs,

> Aj and Holly (12 yrs old, systemic jra since 9/94)

> _www.caringbridge.org/visit/holly_ (http://www.caringbridge.org/

> visit/holly)

>

>

>

>

>

[Guest guest]

Yes, she is using QVar. It has calmed the cough and hopefully, the

inflammation that is going on. (n, 17, systemic)

On May 28, 2006, at 5:56 PM, deerhuntert6@... wrote:

> - is n using Qvar (inhaler) just wondered, Hunter used

> it for 3

> weeks in the Spring - it worked wonders. Hope she is doing better

> really soon

> - keep us posted. Sandi Ken Hunter (7 Systemic)

>

>

>

[Guest guest]

AJ, Can you tell me about Holly's bout with MAS? (n, 17,

systemic)

On May 28, 2006, at 7:50 PM, ajaomom@... wrote:

> Hi ,

> Keep me posted on how n is doing....MAS is so scary!!!

> Holly had

> a mild case of MAS 4 years ago...and has done well since. Talk

> to you

> soon!!!

>

> Luv and hugs,

> Aj and Holly (12 yrs old, systemic jra since 9/94)

> _www.caringbridge.org/visit/holly_ (http://www.caringbridge.org/

> visit/holly)

>

>

>

>

>