METHOTREXATE

Brand & Generic Names

Amethopterin
Folex
Folex PFS
Mexate
Mexate AQ
Rheumatrex

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? Yes
• Drug class: Antimetabolite, antipsoriatic

Uses

• Treatment for some kinds of cancer.
• Treatment for psoriasis in patients with severe problems.
• Treatment for severe rheumatoid arthritis.

Dosage & Usage Information

How to take:
Tablet--Swallow with liquid.

When to take:
At the same time each day.

If you forget a dose:
Skip the missed dose. Don't double the next dose.

What drug does:
Inhibits abnormal-cell reproduction.

Time lapse before drug works:
May require 6 weeks for maximum effect.

Don't take with:
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Headache, stupor, seizures.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• If patient is unconscious and not breathing, give mouth-to- mouth breathing. If there is no heartbeat, use cardiac massage and mouth-to-mouth breathing (CPR). Don't try to make patient vomit. If you can't get help quickly, take patient to nearest emergency facility.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

Hives, rash, intense Seek emergency itching, faintness treatment immediately. soon after a dose (anaphylaxis).

Common:

• Black stools or bloody vomit.
• Sore throat, fever, mouth sores; chills; unusual bleeding or bruising.
• Abdominal pain, nausea, vomiting.

Infrequent:

• Seizures.
• Dizziness when standing after sitting or lying, drowsiness, headache, confusion, blurred vision, shortness of breath, joint pain, blood in urine, jaundice, diarrhea, red skin, back pain.
• Cough, rash, sexual difficulties in male.
• Acne, boils, hair loss, itchy skin.

Rare:

• Convulsions.
• Painful urination.

Warnings & Precautions

Don't take if:
You are allergic to any antimetabolite.

Before you start, consult your doctor:

• If you are alcoholic.
• If you have blood, liver or kidney disease.
• If you have colitis or peptic ulcer.
• If you have gout.
• If you have an infection.
• If you plan to become pregnant within 3 months.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons.

Pregnancy:

• Psoriasis--Risk to unborn child outweighs drug benefits. Don't use.
• Cancer--Consult doctor.

Breast-feeding:
Drug passes into milk. Avoid drug or discontinue nursing.

Infants & children:
Use only under special medical supervision.

Prolonged use:

• Adverse reactions more likely the longer drug is required.
• Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check liver function, kidney function, complete blood counts (white blood cell count, platelet count, red blood cell count, hemoglobin, hematocrit).

Skin & sunlight:
Increased sensitivity to sunlight.

Driving, piloting or hazardous work:
Avoid if you feel dizzy, drowsy or confused. Otherwise, no problems expected.

Discontinuing:
Don't discontinue without doctor's advice until you complete prescribed dose, even though symptoms diminish or disappear. Some side effects may follow discontinuing. Report to doctor blurred vision, convulsions, confusion, persistent headache.

Others:

• Drink more water than usual to cause frequent urination.
• Don't give this medicine to anyone else for any purpose. It is a strong drug that requires close medical supervision.
• Report for frequent medical follow-up and laboratory studies.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Anticoagulants*,	Increased anticoagulant effect.
Anticonvulsants,	Possible methotrexate toxicity.
Antigout drugs*	Decreased antigout effect. Toxic
	levels of methotrexate.
Asparaginase	Decreased methotrexate effect.
Clozapine	Toxic effect on bone marrow.
Diclofenac	May increase toxicity.
Etretinate	Increased chance of toxicity to
	liver.
Flurouracil	Decreased methotrexate effect.
Folic acid	Possible decreased methotrexate
	effect.
Isoniazid	Increased risk of liver damage.
Leukovorin calcium	Decreased methotrexate toxicity.
Levamisole	Increased risk of bone marrow depression.
Non-steroidal	Possible increased methotrexate
anti-inflammatory	toxicity.
Oxyphenbutazone	Possible methotrexate toxicity.
Phenylbutazone	Possible methotrexate toxicity.
Phenytoin	Possible increased methotrexate
	toxicity.
Probenecid	Possible methotrexate toxicity.
Pyrimethamine	Increased toxic effect of
	methotrexate.
Salicylates*	Possible methotrexate toxicity.
Sulfadoxine and	Increased risk of toxicity.
Sulfa drugs*	Possible methotrexate toxicity.
Tetracyclines*	Possible methotrexate toxicity.
Tiopronin	Increased risk of toxicity to bone
	marrow and kidneys.
Vaccines, live	Increased risk of toxicity or
or killed	reduced effectiveness of vaccine.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Likely liver damage. Avoid.
Beverages:	Extra fluid intake decreases chance
	of methotrexate toxicity.
Cocaine:	Increased chance of methotrexate
	adverse reactions. Avoid.
Foods:	None expected.
Marijuana:	None expected.
Tobacco:	None expected.