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Methotrexate may cause very serious, life-threatening side effects. You should only take methotrexate to treat cancer or certain other conditions that are very severe and that cannot be treated with other medications. Talk to your doctor about the risks of taking methotrexate for your condition.
Precautions
Tell your doctor if you have or have ever had excess fluid in your stomach area or in the space around your lungs and if you have or have ever had kidney disease.
Also tell your doctor if you are taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, choline magnesium trisalicylate (Tricosal, Trilisate), ibuprofen (Advil, Motrin), magnesium salicylate (Doan’s), naproxen (Aleve, Naprosyn), or salsalate. These conditions and medications may increase the risk that you will develop serious side effects of methotrexate. Your doctor will monitor you more carefully and may need to give you a lower dose of methotrexate or stop your treatment with methotrexate.
Side effects
Methotrexate may cause a decrease in the number of blood cells made by your bone marrow. Tell your doctor if you have or have ever had a low number of any type of blood cells or any other problem with your blood cells. Call your doctor immediately if you experience any of the following symptoms: sore throat, chills, fever, or other signs of infection; unusual bruising or bleeding; excessive tiredness; pale skin; or shortness of breath.
Methotrexate may cause liver damage, especially when it is taken for a long period of time. If you drink or have ever drunk large amounts of alcohol or if you have or have ever had liver disease, your doctor may tell you not to take methotrexate unless you have a life-threatening form of cancer because there is a higher risk that you will develop liver damage. The risk that you will develop liver damage may also be higher if you are elderly, obese, or have diabetes.
Tell your doctor if you are taking any of the following medications: acitretin (Soriatane), azathioprine (Imuran), isotretinoin (Accutane), sulfasalazine (Azulfidine), or tretinoin (Vesanoid). Ask your doctor about the safe use of alcoholic beverages while you are taking methotrexate.
Symptoms
Call your doctor immediately if you experience any of the following symptoms: nausea, extreme tiredness, lack of energy, loss of appetite, pain in the upper right part of the stomach, yellowing of the skin or eyes, or flu-like symptoms. Your doctor may order liver biopsies (removal of a small piece of liver tissue to be examined in a laboratory) before and during your treatment with methotrexate.
Methotrexate may cause lung damage. Tell your doctor if you have or have ever had lung disease. Call your doctor immediately if you experience any of the following symptoms: dry cough, fever, or shortness of breath.
Taking methotrexate may increase the risk that you will develop lymphoma (cancer that begins in the cells of the immune system). If you do develop lymphoma, it might go away without treatment when you stop taking methotrexate, or it might need to be treated with chemotherapy.
Methotrexate may cause serious or life-threatening skin reactions. If you experience any of the following symptoms, call your doctor immediately: fever, rash, blisters, or peeling skin.
Methotrexate may decrease the activity of your immune system, and you may develop serious infections. Tell your doctor if you have any type of infection and if you have or have ever had any condition that affects your immune system. Your doctor may tell you that you should not take methotrexate unless you have life-threatening cancer. If you experience signs of infection such as a sore throat, cough, fever, or chills, call your doctor immediately.
If you take methotrexate while you are being treated with radiation therapy for cancer, methotrexate may increase the risk that the radiation therapy will cause damage to your skin, bones, or other parts of your body.
The basics
Methotrexate (brand name- Rheumatrex) is an FDA-approved treatment for severe psoriasis (a skin disease in which red, scaly patches form on some areas of the body), severe active rheumatoid arthritis (RA; a condition in which the body attacks its own joints, causing pain, swelling, and loss of function) that other treatments cannot control.
It is also used to treat certain types of cancer, including cancers that begin in the tissues that form around a fertilized egg in the uterus, breast cancer, lung cancer, certain cancers of the head and neck, certain types of lymphoma, and leukemia (cancer that begins in the white blood cells). Methotrexate is in a class of medications called antimetabolites.
Methotrexate treats cancer by slowing the growth of cancer cells. It treats psoriasis by slowing the growth of skin cells to stop scales from forming. Methotrexate may treat rheumatoid arthritis by decreasing the activity of the immune system.
let us walk you through key things you need to know about methotrexate.
How should I take methotrexate (Rheumatrex)?
Methotrexate comes as a tablet to take by mouth. Your doctor will tell you how often you should take methotrexate. The schedule depends on your condition and how your body responds to the medication.
Follow these directions carefully and ask your doctor or pharmacist if you do not know when to take your medication. Take methotrexate exactly as directed. Do not take more or less of it or more often than your doctor prescribes.
If you are taking methotrexate, it may take weeks for your symptoms to begin to improve. Continue to take methotrexate even if you feel well. Do not stop taking methotrexate without talking to your Doctor. You can help them by tracking your side effects in Ankr.
What are the side effects of methotrexate (Rheumatrex)?
Common side effects
- swollen, tender gums
- decreased appetite
- reddened eyes
- hair loss
- blurred vision or sudden loss of vision
- diarrhea
- dry cough
- fever
- peeling skin
- sore throat
- chills
- infection
Methotrexate may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online or by phone (1-800-332-1088).
Use the free Ankr platform or Ankr app to track your symptoms.
What special precautions should I follow?
Before taking methotrexate (Rheumatrex)
- tell your doctor about your allergies
- tell your doctor about other intakes
- tell your doctor if you have or have ever had any of the disease, symptom, or treatment
While you are on methotrexate (Rheumatrex)
- if you or your partner becomes pregnant while taking methotrexate, call your doctor immediately. Methotrexate may harm the fetus.
- do not breast-feed while you are taking methotrexate.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking methotrexate.
- methotrexate may make your skin sensitive to sunlight or ultraviolet light.
- do not have any vaccinations during your treatment with methotrexate without talking to your doctor.
I forgot a dose. What should I do?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
In case of an emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.
How should I safely store and dispose of methotrexate (Rheumatrex)?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
You should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
Brand names
- Rheumatrex®
- Trexall®
Other names
- Amethopterin
- MTX
Last Revised -06/20/2023, FDA updated- 04/15/2017, SG
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