More Information on Methotrexate

[Guest guest]

Along with the information that Stack provided on methotrexate, I am

including and additional article that was in our Psoriatic Arthritis News and

Views. of March 1, 2003 Volume 3 Issue 3

Editor’s note: Since Methotrexate is part of our everyday language and many

of us are currently using it, the following information is provided for

educational and reference purposes.

EVERYTHING YOU EVER WANTED TO KNOW ABOUT METHOTREXATE

GENERIC NAME: methotrexate - BRAND NAMES: Rheumatrex, Trexall

DRUG CLASS AND MECHANISM: Methotrexate is classified as an antimetabolite

drug, which means it is capable of blocking the metabolism of cells. As a result

of this effect, it has been found helpful in treating certain diseases

associated with abnormally rapid cell growth, such as cancer of the breast and

psoriasis. Recently, methotrexate has been shown to be effective in inducing

miscarriage, for example in patients with ectopic pregnancy. This effect of

methotrexate is attributed to its action of killing the rapidly growing cells of

the

placenta. It has also been found very helpful in treating rheumatoid arthritis,

although its mechanism of action in this illness is not known. It seems to

work, in part by altering aspects of immune function, which may play a role in

causing rheumatoid arthritis.

PRESCRIPTION: yes - GENERIC AVAILABLE: yes

PREPARATIONS: Injectable: 25mg/ml; Tablet: 2.5mg (Rheumatrex), and 5, 7.5, 10

and 15 mg (Trexall).

STORAGE: Store between 59 and 77degrees F in a sealed container, avoid light.

PRESCRIBED FOR: Methotrexate is used for cancer treatment generally in higher

doses than for other uses, and is often administered intravenously or

intramuscularly. Methotrexate is used to treat psoriasis, an inflammatory skin

disease, as well as the arthritis that occurs in 10 percent of these patients

(psoriatic arthritis). It is also used to treat active rheumatoid arthritis in

adults and children. It is also used to treat other rheumatic diseases,

including

polymyositis and systemic lupus erythematosus. Methotrexate has been used to

induce miscarriage in patients with ectopic pregnancy.

DOSING: May be taken with or without food. For rheumatoid arthritis and

psoriasis, the dose of methotrexate is given WEEKLY, whether by injection or

orally. For psoriasis, the weekly dose is often divided into three doses given

at

12-hour intervals each week. This has been shown to be more effective, as it

relates to the natural growth cycling of the skin.

DRUG INTERACTIONS: Because methotrexate can cause serious liver disease,

patients with alcoholism or liver disease should not receive it. Patients should

curtail alcohol consumption while taking methotrexate. Methotrexate can

suppress the body's immunity. Therefore, any symptoms of infection should be

reported

to the doctor. Patients with underlying immune deficiency diseases should not

receive methotrexate. A dry, non-productive cough can be a result of rare

lung toxicity. Methotrexate can impair fertility, decrease sperm count and cause

menstrual dysfunction. Safety and effectiveness has not been established in

children.

PREGNANCY: Methotrexate should not be used in pregnancy, as it can be toxic

to the embryo and can cause fetal defects and spontaneous abortion

(miscarriage). It should be discontinued prior to conception if used in either

partner.

Male patients should stop taking methotrexate at least 3 months prior to a

planned conception and females should discontinue use for at least one ovulatory

cycle before conception.

SIDE EFFECTS: Methotrexate can be well tolerated, but also can cause severe

toxicity, which is usually related to the dose taken. The most frequent

reactions include mouth sores, stomach upset, and low white blood counts.

Methotrexate can cause severe toxicity of the liver and bone marrow, which

require

regular monitoring with blood testing. It can cause headache and drowsiness,

which

may resolve if the dose is lowered. Methotrexate can cause itching, skin rash,

dizziness, and hair loss. A dry, non-productive cough can be a result of a

rare lung toxicity.

Methotrexate is a Disease Modifying Anti Rheumatic Drug (DMARD). Originally

used as a chemotherapy drug to treat certain kinds of cancer, methotrexate was

found to be beneficial in those with inflammatory arthritis and/or psoriasis.

It may be taken by mouth or via injection.

FDA approved: December 1953. Average annual cost: $605.86 - 17.5mg orally per

week

Brand Names and International Availability:

Abitrexate (US); Biotrexate (India); Brimexate (Italy); Canceren (Korea);

Emthexat (Sweden); Emthexate (Netherlands, Belgium, Norway, Portugal, Spain,

Greece, Hong-Kong, Philippines, Taiwan, Thailand, Korea, Israel); Farmitrexat

(Germany, Indonesia); Farmotrex (Denmark); Folex (US); Lantarel (Germany);

Ledertrexate (Australia, New-Zealand, Netherlands, Belgium, France, Portugal,

Finland, Mexico); Maxtrex (England, Philippines); Mexate (Philippines); Metex

(Germany); Methoblastin (Australia, New-Zealand); Methotrexate (Australia, Peru,

Japan, Hong-Kong, Indonesia, Malaysia, Philippines, Taiwan, Thailand,

South-Africa, Israel, US); Methotrexato (Argentina); Metotrexato (Colombia);

Mexate (US);

MTX (Malaysia, Korea); Neotrexate (India); Rheumatrex (US); Texate (Mexico);

Texate-T (Mexico); Tremetex; Trexan (Finland, Taiwan); Trixilem (Mexico); Xaken

(Mexico);

How does it work? It is not known exactly how methotrexate works in

inflammatory arthritis. It is suspected the benefit comes from its effect on the

immune

system.

Methotrexate tablets are available in 2.5mgs. Usual dosage is 7.5mg –20mg

weekly. Higher doses may be used to treat more severe cases and psoriasis.

When used for the treatment of rheumatic diseases and psoriasis, methotrexate

is almost always taken ONCE A WEEK. Oral methotrexate may be taken with or

without food. Injectable methotrexate may usually be self-injected after proper

instruction from a health care professional.

Methotrexate is known to cause miscarriages. DO NOT take methotrexate if you

suspect you may be pregnant. Pregnancy should be avoided if either partner is

receiving methotrexate.

Methotrexate should be avoided in nursing mothers.

Methotrexate should be avoided in those with a history of liver disease.

Drug Interactions: Oral antibiotics such as tetracycline may decrease the

absorption of methotrexate.

The potential for liver damage is increased with the use of alcohol while on

methotrexate. Alcohol should be avoided.

Because of the potent nature of this medicine, be sure to tell your doctor

about any other medicines you are taking, including nonprescription medicines

and vitamins.

These side effects are not considered serious but are certainly annoying for

those experiencing them.

The most frequently reported side effects include fatigue, nausea, headache,

dizziness, diarrhea, mouth sores, increased sensitivity to the sun, loss of

appetite, “brain fogâ€, mood alterations, and hair loss. Many of these side

effects are more noticeable the day of and the day following your weekly dose.

Many people have found that taking methotrexate before bed allows them to sleep

through many of annoying symptoms. These side effects may decrease over time.

The severity of these side effects may be decreased by taking oral folic acid

supplements.

More serious side effects that you should report right away include dry

non-productive cough, fever, black stools, unusual bleeding or bruising,

vomiting,

persistent sore throat, and yellow skin or eyes.

Methotrexate has the potential to cause liver damage, lung disease and bone

marrow suppression. Although usually seen with higher doses than used to treat

rheumatic diseases, these can occur with low, weekly doses.

Signs of a possible allergic reaction are rash, swelling and difficulty

breathing. These symptoms should be reported immediately.

Precautions & Special Notes: Due to the potential for sun sensitivity

exposure to direct sunlight should be avoided. If you are in the sun please wear

protective clothing and strong sun block.

You will be required to have frequent blood work while on this medication. It

is very important that you keep all lab and doctor’s appointments.

Never stop the use of methotrexate unless instructed by your physician. Avoid

the use of alcohol while on this drug.

Unless instructed otherwise, make sure you drink plenty of water the day

before and after your weekly dose.

You may want to schedule your dose on a day when you have no plans for the

next day, until you find out exactly how you react to the drug. Methotrexate

suppresses the immune system. Avoid exposure to illnesses and viruses when

possible.

Hope this helps. I would encourage members to check our newsletter archives

at http://www.wpunj.edu/pa/

Jack

Newsletter Editor

Cornishpro @aol.com