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Brand Name
Apo-Methotrexate
Common Name
methotrexate
How does this medication work? What will it do for me?

Methotrexate is used to treat certain types of cancer such as leukemia, non-Hodgkin's lymphoma, breast cancer, head and neck cancer, stomach cancer, bladder cancer, and choriocarcinoma (a type of uterine cancer). It is also used to treat rheumatoid arthritis, psoriatic arthritis, and psoriasis (a chronic skin disorder that produces patchy scales).

When used to treat cancer, methotrexate works by blocking an enzyme process in cancer cells so they cannot grow. Used for this purpose, methotrexate is known as an anti-metabolite.

For rheumatoid arthritis, it works by reducing inflammation and by suppressing the immune system. For psoriasis, methotrexate works by attacking the rapidly-dividing cells that are involved in causing psoriasis. Under these circumstances, methotrexate is known as a disease modifying antirheumatic drug (DMARD).

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How should I use this medication?

Cancer: The dose of methotrexate varies depending on the type of cancer being treated and body weight or size. Your doctor may recommend either the tablet or injectable form of this medication.

If your doctor recommends the injectable form of methotrexate, the appropriate dose is usually injected one or more times weekly, either in cycles (i.e., some weeks no injections are given) or on a regular basis, depending on the type of cancer being treated. The tablet form of the medication can be given twice a week or daily, depending on the type of cancer being treated.

Rheumatoid arthritis: The usual adult dose of methotrexate is 7.5 mg taken as one dose once weekly by mouth or 2.5 mg taken every 12 hours for 3 doses once weekly. Doses are sometimes adjusted gradually according to response but don't usually exceed 20 mg weekly. The benefits of treatment usually appear about 3 to 6 weeks after starting the medication.

Psoriasis: The usual adult starting dose of methotrexate is 10 mg to 25 mg per week in one dose (tablet or injection) or 2.5 mg (tablet) taken every 12 hours for 3 doses once weekly. Doses can be adjusted gradually but don't usually exceed 30 mg weekly.

Children: Methotrexate has been used to treat cancer in children. Methotrexate has also been used under close supervision of a doctor to treat other conditions in children.

Methotrexate may sometimes cause nausea. If you feel ill after taking methotrexate, do not stop taking the medication without first talking with your doctor. Your doctor or pharmacist may be able to help you with ideas to reduce the nausea associated with taking this medication.

Many things can affect the dose of medication that a person needs, such as age, body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor because there may be specific reasons why it is different.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, use it as soon as possible and contact your doctor for advice on when to take the next dose. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

If you miss an appointment to receive the injection form of this medication, contact your doctor as soon as possible to reschedule your appointment.

Store this medication at room temperature and keep it out of the reach of children. The injectable form of this medication should be protected from light.

This medication is available under multiple brand names and in several different forms. Any specific brand name of this medication may not be available in all of the forms listed here. The forms available for the specific brand you have searched are listed under "What form(s) does this medication come in?"

What form(s) does this medication come in?

Each small, round, yellow, uncoated tablet, engraved "M" over "2.5" on one side, contains methotrexate 2.5 mg. Nonmedicinal ingredients: cornstarch, lactose, magnesium stearate, microcrystalline cellulose, polysorbate 80, and starch pregelatinized. This medication does not contain colouring agents or preservatives.

Who should NOT take this medication?

Do not use this medication if you:

  • are allergic to methotrexate or any ingredients of this medication
  • are breast-feeding
  • are pregnant or are planning on becoming pregnant

Do not use this medication for rheumatoid arthritis or psoriasis if you:

  • have alcohol use issues
  • have an immunodeficiency syndrome (e.g., HIV)
  • have anemia or other blood diseases
  • have chronic liver disease including alcoholic liver disease
What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is used in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who uses this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people using this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • dizziness
  • hair loss
  • loss of appetite
  • nausea or vomiting
  • upset stomach

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • black, tarry stools
  • blurred vision
  • chest pain
  • confusion
  • cough or hoarseness
  • dark urine
  • diarrhea
  • drowsiness
  • fever or chills
  • lower back or side pain
  • mood changes
  • mouth sores
  • painful or difficult urination
  • pinpoint-sized red spots on skin
  • ringing in the ears
  • sensitivity to sunlight
  • shortness of breath
  • skin rash
  • sore eyes
  • stomach pain
  • unusual bleeding (e.g., vomiting blood, coughing up blood, blood in urine or stools) or bruising
  • unusual tiredness or weakness
  • yellow eyes or skin

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • convulsions (seizures)
  • severe skin reaction (e.g., blistering or peeling skin)
  • symptoms of a severe allergic reaction (e.g., hives, difficulty breathing, swelling of the face, mouth, tongue, or throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

HEALTH CANADA ADVISORY

October 19, 2012

Health Canada has issued new restrictions concerning the use of methotrexate. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.

Blood counts: Methotrexate can cause a decrease in the number of white blood cells, red blood cells, and platelets in your blood, especially when higher doses are used to treat cancer. This may increase your risk of bleeding or infections. Your doctor will monitor your blood counts with regular blood tests.

If you are using this medication to treat cancer and already have a blood disorder such as anemia, reduced white blood cell counts, or reduced platelet counts, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

To help prevent infections, avoid contact with people with contagious infections, wash your hands frequently, and do not touch your eyes or the inside of your nose unless you have just washed your hands. Tell your doctor if you begin to notice signs of an infection, such as fever or chills.

Also, tell your doctor about any signs that your blood is not clotting as quickly. Such symptoms may include black and tarry stools, blood in the urine, pin-point red spots on your skin, easy bruising, or cuts that won't stop bleeding. Be careful when you are flossing or brushing your teeth and check with your doctor before having dental work. Take care not to cut yourself when using sharp objects such as a knife, scissors, or a razor.

Cancer: This medication may cause lymphoma (cancer of the immune cells) that may resolve when the medication is stopped. Your doctor will monitor for this.

Dizziness/fatigue: This medication may cause dizziness and fatigue. Do not drive or operate machinery until you are certain that taking this medication does not impair your ability to safely perform these tasks.

Infection: If you are using this medication to treat rheumatoid arthritis and have an infection, talk to your doctor about whether you need to temporarily stop this medication until the infection resolves. If you are using this medication to treat cancer, refer to the information above under "blood counts".

Kidney function: If you have reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you are using this medication to treat cancer, your doctor may want you to drink extra fluids to help prevent kidney problems.

Liver problems: Methotrexate can cause liver problems. Your doctor will check your liver function with blood tests before starting this medication and regularly during treatment. If you have liver problems or reduced liver function discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Do not drink alcohol while you are taking this medication as this can increase the chance of liver problems.

Lung problems: Methotrexate may cause lung problems. If you experience symptoms of lung problems (e.g., dry, non-productive cough, fever, shortness of breath), contact your doctor immediately.

Stomach and intestinal problems: If you have stomach or intestinal ulcers or ulcerative colitis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Sun sensitivity: You may be more sensitive to the sun while using this medication. Avoid excessive sun exposure and do not use sunlamps or sun beds until you know how this medication affects your skin.

Vaccines: Vaccines may be ineffective if given during treatment with methotrexate. Live virus vaccines (e.g., smallpox, measles, mumps, rubella, chickenpox, shingles) are not recommended during treatment with methotrexate.

Pregnancy: There is a possibility of birth defects if either partner is using methotrexate at the time of conception. If it is used during pregnancy, methotrexate may also cause birth defects or harm the baby.

Effective birth control should be practiced if either partner is using this medication, including for a period of time after the medication is stopped. Talk to your doctor about how long you should wait to become pregnant after you or your partner stop taking methotrexate. If you become pregnant while taking this medication, contact your doctor immediately.

If you have rheumatoid arthritis or psoriasis, you should not use this medication if you are pregnant. If you might be pregnant, do not start methotrexate until you know for sure that you are not pregnant.

Breast-feeding: Women who are using methotrexate should not breast-feed.

Children: Methotrexate has been used to treat cancer in children. Methotrexate has also been used under close supervision of a doctor to treat other conditions in children.

Seniors: If you are a senior, you may be more at risk of experiencing side effects (including serious ones) and your doctor will monitor you very closely while you are using this medication.

What other drugs could interact with this medication?

There may be an interaction between methotrexate and any of the following:

  • acitretin
  • alcohol
  • aminoglycosides (e.g., tobramycin)
  • amphotericin B
  • azathioprine
  • chloramphenicol
  • cyclosporine
  • echinacea
  • eltrombopag
  • folic acid
  • leflunomide
  • live vaccines (e.g., BCG, yellow fever, measles, mumps, rubella)
  • mercaptopurine
  • natalizumab
  • neomycin
  • nitrous oxide
  • nonsteroidal anti-inflammatory medications (NSAIDs; e.g., ibuprofen, naproxen)
  • penicillins (e.g., amoxicillin, ampicillin, penicillin, cloxacillin)
  • phenytoin
  • pimecrolimus
  • polymyxin B
  • probenecid
  • retinoids (e.g., tretinoin, retinol)
  • roflumilast
  • salicylates (e.g., ASA, salsalate)
  • sulfonamides (e.g., sulfasalazine, sulfamethoxazole, sulfadiazine)
  • tacrolimus
  • tetracyclines (e.g., doxycycline, tetracycline)
  • theophylline
  • trimethoprim
  • vancomycin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.





The contents of this site are for informational purposes only. Always seek the advice of your physician or other qualified healthcare provider regarding any questions you may have about a medical condition.
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