Methotrexate

Methotrexate is used to treat severe psoriasis (a skin disease in which red, scaly patches form on some areas of the body). Methotrexate is also used to treat rheumatoid arthritis (RA; a condition in which the body attacks its own joints, causing pain, swelling, and loss of function). Methotrexate is also used in children to treat polyarticular juvenile idiopathic arthritis (PJIA; a type of childhood arthritis that affects five or more joints during the first six months of the condition, causing pain, swelling, and loss of function). Methotrexate is also used in combination with other chemotherapy medications to treat acute lymphoblastic leukemia (ALL; also called acute lymphoblastic leukemia and acute lymphatic leukemia; a type of cancer that begins in the white blood cells) and non-Hodgkin's lymphoma (NHL; a type of cancer that begins in a type of white blood cells that normally fights infection) that has returned or did not respond to other medications. and Methotrexate is also used alone or combination with other chemotherapy medications to treat mycosis fungoides,a type of cutaneous T-cell lymphoma ([CTCL], a group of cancers of the immune system that first appear as skin rashes). Methotrexate is in a class of medications called antimetabolites. Methotrexate treats cancer by slowing the growth of cancer cells. Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming. Methotrexate may treat rheumatoid arthritis and polyarticular juvenile idiopathic arthritis by decreasing the activity of the immune system.

Methotrexate comes as a tablet and solution (liquid) to take by mouth. Your doctor will tell you how often you should take methotrexate. The schedule depends on the condition you have and on how your body responds to the medication. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any part you do not understand. Take methotrexate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you are taking methotrexate to treat psoriasis, rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, acute lymphoblastic leukemia, or mycosis fungoids, your doctor may tell you to take the medication once a week. Pay close attention to your doctor's directions. Some people who mistakenly took methotrexate once daily instead of once weekly experienced very severe side effects or died.

If you are taking methotrexate to treat psoriasis, rheumatoid arthritis, or polyarticular juvenile idiopathic arthritis, your doctor may start you on a low dose of the medication and gradually increase your dose. Follow these directions carefully. Your doctor will probably tell you to take another medication, folic acid (a vitamin), to decrease some of the side effects of this medication. Take this medication exactly as directed.

If you are taking methotrexate to treat rheumatoid arthritis or polyarticular juvenile idiopathic arthritis, it may take 3 to 6 weeks for your symptoms to begin to improve, and 12 weeks or longer for you to feel the full benefit of methotrexate. Continue to take methotrexate even if you feel well. Do not stop taking methotrexate without talking to your doctor.

Your doctor may decrease your dose of methotrexate or permanently or temporarily stop your treatment. This depends on how well the medication works for you and the side effects you experience. Be sure to tell your doctor how you are feeling during your treatment with methotrexate.

If you are taking methotrexate liquid, use the bottle adapter and oral syringe (measuring device) provided by the manufacturer to accurately measure and take your dose of methotrexate solution. Do not use a household teaspoon to measure the solution. You should wear disposable gloves to prevent contact with the medication. Follow the manufacturer's instructions about how to use and clean the oral syringe. Ask your doctor or pharmacist if you if you have any questions.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Methotrexate is also sometimes used to treat Crohn's disease (condition in which the immune system attacks the lining of the digestive tract, causing pain, diarrhea, weight loss and fever), multiple sclerosis (MS; condition in which the immune system attacks the nerves, causing weakness, numbness, loss of muscle coordination, and problems with vision, speech, and bladder control), and other autoimmune diseases (conditions that develop when the immune system attacks healthy cells in the body by mistake). Methotrexate is also used sometimes to treat gestational trophoblastic tumors (a type of tumor that forms inside a woman's uterus while she is pregnant). Ask your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking methotrexate,

• tell your doctor and pharmacist if you are allergic to methotrexate, any other medications, or any of the ingredients in methotrexate tablets. Ask your doctor or pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• the following nonprescription products may interact with methotrexate: Proton pump inhibitors such as esomeprazole (Nexium^®), lansoprazole (Prevacid^®), omeprazole (Prilosec^® OTC, in Zegerid^® OTC). Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking methotrexate. Do not start any of these medications while taking methotrexate without discussing with your healthcare provider.
• tell your doctor if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section, a low level of folate in your blood, radiation therapy to the head or brain, pleural effusions (a condition when fluid collects in the lungs), or ascites (swelling of the stomach caused by liver disease).
• tell your doctor if you plan to breastfeed or are breastfeeding. You should not breastfeed while you are taking methotrexate and for 1 week after you final dose.
• you should know that methotrexate may cause permanent infertility in men and women, stop sperm production in men, and interfere with the normal menstrual cycle (period) in women. Talk to your doctor about the risks of taking this medication.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking methotrexate.
• plan to avoid unnecessary or prolonged exposure to sunlight or ultraviolet light (tanning beds and sunlamps) and to wear protective clothing, sunglasses, and sunscreen. Methotrexate may make your skin sensitive to sunlight or ultraviolet light. If you have psoriasis, your sores may get worse if you expose your skin to sunlight while you are taking methotrexate.
• do not have any vaccinations during your treatment with methotrexate without talking to your doctor.

Unless your doctor tells you otherwise, continue your normal diet.

If you miss a dose of methotrexate, call your doctor right away. Do not take a double dose to make up for a missed one.

Methotrexate may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness
• drowsiness
• headache
• swollen, tender gums
• reddened eyes
• hair loss

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• blurred vision or sudden loss of vision
• seizures
• confusion
• weakness or difficulty moving one or both sides of the body
• loss of consciousness

Methotrexate may increase the risk that you will develop other cancers, such as lymphoma (cancer that begins in the cells of the immune system) and skin cancer. Talk to your doctor about the risks of receiving this medication.

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 (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

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 light and excess heat and moisture (not in the bathroom). Dispose of any unused oral oral solution 90 days after opening the bottle for the first time.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, 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 (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. 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. https://www.upandaway.org

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.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.