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Methotrexate Drug information

Methotrexate is used to treat a number of conditions, including and . Methotrexate should effectively Methotrexate can also be used by treat your condition, and stop it doctors who treat other conditions causing damage to your joints. that have nothing to do with It has been tested and has helped arthritis. For example it is used to many people. However, as with treat some forms of , but all drugs some people will have the dose used for cancer is usually side-effects. This leaflet sets much higher than for arthritis. out what you need to know. When and how do I What is methotrexate take methotrexate? and how is it used? Methotrexate is usually taken in tablet Methotrexate is a disease-modifying form once a week on the same day. anti-rheumatic drug (DMARD). It The tablets should be swallowed reduces the activity of the body’s defence mechanism (immune whole and not crushed or chewed. system), which may be overactive Methotrexate tablets come in two in some conditions. Methotrexate strengths, 2.5 mg and 10 mg. To avoid modifies the underlying disease confusion it’s recommended that only process to limit or prevent joint the 2.5 mg tablet is used. The two damage and disability, rather than strengths are different sizes but are simply treating the symptoms. a very similar colour, so you should It’s a long-term treatment, so it may be always check the dose is correct. 3–12 weeks before you start to notice the benefits. Unless you have severe side-effects (in which case please see a health professional) it’s important to keep taking methotrexate: • even if it doesn’t seem to Methotrexate be working at first • even when your symptoms can limit or improve (as it will help to keep prevent joint the disease under control). damage, or Methotrexate can be disability, caused prescribed for people with: by inflammatory • rheumatoid arthritis arthritis. • psoriatic arthritis • juvenile idiopathic arthritis • . In the early stages of a condition it’s You must not take methotrexate often treated more aggressively and unless you’re having regular blood so the starting dose can range from checks. These are usually done 7.5–15 mg per week. Your doctor every two weeks when you start may then increase this dose if it isn’t on methotrexate and the dose is helping your symptoms, but it won’t being built up, then every six weeks usually go higher than 25 mg weekly. when you are on a stable dose. Alternatively, methotrexate may Because methotrexate affects the be given once a week by injection, , it can make you more usually subcutaneous, if there likely to develop infections. You should are side-effects with tablets. A tell your doctor or nurse specialist is given into straight away if you develop any of the a layer of fat between the skin and following after starting methotrexate: muscle, rather than intravenously which means directly into a vein. • a sore throat, fever or any other signs of infection Possible risks and side-effects • shortness of breath • unexplained bruising or bleeding As with all medications, methotrexate • yellowing of the skin or can sometimes cause side- eyes (jaundice) effects. Methotrexate may cause • any other new symptoms or nausea (feeling sick), vomiting, anything else that concerns you. diarrhoea, mouth ulcers, hair loss (usually minor) and skin rashes. You should stop methotrexate and see your doctor immediately if any of It can also affect the blood (causing these symptoms are severe or you’re fewer blood cells to be made) and becoming very unwell. In rare cases, your . You’ll therefore need to methotrexate causes inflammation of have blood tests before starting the lung with breathlessness. If this methotrexate and at regular intervals happens to you, see your doctor. while you’re taking it. You may be asked to keep a record of your You should also see your doctor if blood test results in a booklet, and you develop chickenpox or shingles you should take it with you when or come into contact with someone you visit your GP or the hospital. who has chickenpox or shingles. Methotrexate can affect the lungs These infections can be severe in so you’ll have a chest X-ray before people on methotrexate. You may starting it. Patients suffering need antiviral treatment, and you from long-term lung diseases like may be advised to stop taking fibrosis or emphysema are often methotrexate until you’re better. not suitable for methotrexate. In rare cases, methotrexate causes inflammation of the lung with breathlessness. If this happens to you, see your doctor. Most doctors prescribe folic Folic acid can acid tablets to patients who are reduce possible taking methotrexate as this can side-effects from reduce the likelihood of side- effects. Some doctors advise methotrexate. that it shouldn’t be taken on the same day as methotrexate.

Reducing the risk of infection • Try to avoid close contact with people with severe active infections. • For advice on avoiding infection • Don’t take over-the-counter from food, visit: http://www.nhs. preparations or herbal remedies uk/conditions/food-poisoning/ without discussing this first pages/prevention.aspx with your healthcare team. • Some antibiotics can interact with methotrexate – for example, Taking other medicines and septrin should Methotrexate may be prescribed not be taken with methotrexate. along with other drugs to treat your If you have an infection that condition. Some drugs however, can requires antibiotics you may need interact with methotrexate. Check to stop your methotrexate until with your doctor before starting any you are better and off antibiotics. new medications, and remember to • Anti-epileptic medication mention you’re on methotrexate if (phenytoin) and anti-asthma you’re treated by anyone other than medication () should your usual team. be avoided as they may increase • You can carry on taking a levels of methotrexate in your non-steroidal anti-inflammatory blood. However, it’s important drug (NSAID) or painkillers if that you discuss this with your needed, unless your doctor rheumatology team and that you advises otherwise. don’t simply stop your phenytoin. Vaccinations Fertility, If you’re on methotrexate it’s and recommended that you avoid live Current guidelines state that vaccines such as yellow fever. Your methotrexate may harm the baby if GP will discuss the possible risks and taken during pregnancy. You can still benefits of any vaccinations with you. have a successful pregnancy if you If you’re offered a shingles stop taking methotrexate in plenty vaccination you should speak to your of time before trying for a baby. rheumatology team – you may be Women using this drug should take able to have the shingles vaccine if contraceptive precautions. After you are on low-dose methotrexate. stopping methotrexate you should Pneumococcal vaccine (which gives continue using contraception for protection against the commonest at least three months. You should cause of pneumonia) and yearly talk to your doctor as soon as flu vaccines don’t interact with possible if you’re planning to start methotrexate and are recommended. a family. If you become pregnant while taking methotrexate, you should stop taking it and see your doctor as soon as possible. You should only drink alcohol in Previously, there was concern that small amounts because alcohol and methotrexate may affect sperm and methotrexate can both affect your thus any fertilised egg but it has liver. It’s important to stay within not been shown to be a problem government guidelines, which state in research studies. Therefore, that adults shouldn’t drink more current guidelines advise that than 14 units per week and should men do not need to stop taking have alcohol free days without methotrexate before trying for ‘saving units up’ to drink in one go. a baby. You should talk to your Advice can vary and some rheumatologist about these matters. rheumatologists may suggest stricter The drug may pass into breast milk limits. If you’re concerned you and the effects upon your baby should discuss your alcohol intake are uncertain, so you shouldn’t with your rheumatology team. breastfeed if you’re on methotrexate. Arthritis Research UK Thank you for supporting Arthritis works to improve the Research UK. With your generosity we can keep doing our vital work. quality of life for people To donate visit with arthritis so that www.arthritisresearchuk.org/donate they can say they are in control, independent and recognised.

We’re dedicated to funding research into A team of people contributed to this leaflet. It the cause, treatment and cure of arthritis was written by Prof. Ariane Herrick and updated so that people can live pain-free lives. by Sue Brown and Dr Ian Giles. An Arthritis Research UK medical advisor, Prof. Anisur For more expert information visit our Rahman, is responsible for the content overall. website or if you would like to tell us what you think about our booklets email Please note: we have made every effort to [email protected] ensure that this content is correct at time of or write to the address below. publication, but remember that information about drugs may change. This information Arthritis Research UK sheet is for general education only and does not list all the uses and side-effects associated Copeman House with this drug. St Mary’s Gate Chesterfield S41 7TD 0300 790 0400 www.arthritisresearchuk.org

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Date published: 2015. Registered charity in England and Wales no. 207711, Scotland no. SC041156. ©Arthritis Research UK 2015 A Company registered in England and Wales. Limited by Guarantee no. 490500. 2247/D-METH/15-1