methotrexate (injection)

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Pronunciation: meth oh TREX ate

Brand: Methotrexate Sodium, Preservative Free, Otrexup, Rasuvo

What is the most important information I should know about methotrexate injection?

Methotrexate can be toxic to your organs, such as your stomach, liver, lungs, kidneys, nerves, skin, and bone marrow (immune system). Your blood and urine will need to be tested often, and you may need an occasional liver biopsy or chest X-ray.

Methotrexate can harm an unborn baby or cause birth defects. Do not use if you are pregnant.

Some medicines can cause unwanted or dangerous effects when used with methotrexate, especially a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others.

Call your doctor right away if you have a serious side effect: signs of stomach bleeding --diarrhea, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds; lung problems --sudden chest pain or discomfort, wheezing, dry cough or hack; signs of infection --sudden weakness or ill feeling, fever, chills, sore throat, mouth sores, red or swollen gums, trouble swallowing; or severe skin reaction --red or purple skin rash that spreads and causes blistering and peeling.

What is methotrexate injection?

Methotrexate interferes with the growth of certain cells of the body, especially cells that reproduce quickly, such as cancer cells, bone marrow cells, and skin cells.

Methotrexate injection is used to treat leukemia and certain types of cancer of the breast, skin, head and neck, or lung. Methotrexate injection is also used to treat severe psoriasis and rheumatoid arthritis.

Methotrexate injection is usually given after other medications have been tried without successful treatment of symptoms.

Methotrexate injection may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before receiving methotrexate injection?

You should not use methotrexate if you are allergic to it. Methotrexate injection should not be used to treat psoriasis or rheumatoid arthritis if you have:

  • chronic liver disease;
  • alcoholism or cirrhosis of the liver;
  • a blood cell disorder such as low red or white blood cell counts, or low levels of platelets in your blood;
  • a weak immune system or bone marrow disorder; or
  • if you are pregnant or breast-feeding.

Methotrexate injection is sometimes used to treat cancer even when patients do have one of the conditions listed above. Your doctor will decide if this treatment is right for you.

To make sure methotrexate is safe for you, tell your doctor if you have:

  • kidney disease;
  • liver disease;
  • lung disease or pneumonia;
  • stomach ulcer, ulcerative colitis;
  • any type of infection; or
  • if you are receiving phototherapy or radiation treatments.

This medication can harm an unborn baby or cause birth defects. Do not use methotrexate if you are pregnant. You may need to have a negative pregnancy test before starting this treatment. Tell your doctor right away if you become pregnant during treatment.

This medication may affect fertility (your ability to have children), whether you are a man or a woman. However, both men and women should use birth control to prevent pregnancy while receiving this medicine. Methotrexate use by either parent may cause birth defects.

If you are a woman, use an effective form of birth control while you are using methotrexate injection, and for at least one cycle of ovulation after your treatment ends.

If you are a man, use a condom to keep from causing a pregnancy while you are using methotrexate injection. Continue using condoms for at least 90 days after your treatment ends.

Methotrexate can pass into breast milk and may harm a nursing baby. Do not breast-feed while you are using methotrexate.

How is methotrexate injection given?

Your doctor will perform blood tests to make sure you do not have conditions that would prevent you from safely using methotrexate.

Methotrexate is injected under your skin, into a muscle, or into a vein through an IV. Methotrexate may also be injected directly into a joint, or into the area around your spinal cord. A healthcare provider will give you this injection.

You may be shown how to use injections at home. Do not self-inject this medicine if you do not understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Otrexup or Rasuvo (methotrexate injected under the skin) is for use only 1 time each week. Do not use Otrexup or Rasuvo every day.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions. It is very important not to inject too much methotrexate when you are using this medication at home.

Do not use this medicine if it has changed colors or has lumps or particles in it. Call your pharmacist for new medication.

Use a disposable needle and syringe only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

Use a disposable needle only once, then throw away in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Methotrexate can be toxic to your organs, such as your stomach, liver, lungs, kidneys, nerves, skin, and bone marrow (immune system). To check for harmful effects, your blood will need to be tested often. Your kidney or liver function may also need to be tested, and you may need an occasional liver biopsy or chest X-ray. Visit your doctor regularly.

Store at room temperature away from moisture, heat, and light. Do not freeze.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your methotrexate injection, or if you forget to use the medicine at home.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of methotrexate injection can be fatal.

What should I avoid while receiving methotrexate injection?

Do not drink alcohol. Serious side effects can occur when alcohol is combined with methotrexate.

Do not receive a "live" vaccine while using methotrexate, or you could develop a serious infection. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

This medicine can pass into body fluids (urine, feces, vomit). For at least 48 hours after you receive a dose, avoid allowing your body fluids to come into contact with your hands or other surfaces. Caregivers should wear rubber gloves while cleaning up a patient's body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Methotrexate may impair your thinking or reactions. Avoid driving or operating machinery until you know how this medicine will affect you.

Avoid exposure to sunlight or artificial UV rays (sunlamps, tanning beds, or PUVA treatment), especially if you have psoriasis. Methotrexate injection can make your skin more sensitive to sunlight and your psoriasis may worsen.

What are the possible side effects of methotrexate injection?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • nerve problems --confusion, weakness, coordination problems, drowsiness, feeling irritable, back pain, headache, neck stiffness, seizure (convulsions), vision problems, loss of movement in any part of your body;
  • signs of stomach bleeding --diarrhea, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
  • lung problems --sudden chest pain or tightness, wheezing, trouble breathing, dry cough or hack;
  • signs of infection --sudden weakness or ill feeling, fever, chills, sore throat, cough with mucus, vomiting, weight loss, night sweats, swollen glands, mouth sores, red or swollen gums, trouble swallowing;
  • kidney problems --swelling, rapid weight gain, little or no urinating; or
  • severe skin reaction --fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • nausea, vomiting, stomach pain or discomfort, diarrhea;
  • blisters or ulcers in your mouth, red or swollen gums, trouble swallowing;
  • mild skin rash;
  • headache, dizziness;
  • runny or stuffy nose, sore throat, wheezing, trouble breathing;
  • abnormal liver function tests;
  • easy bruising or bleeding;
  • temporary hair loss;
  • occasional headache, blurred vision; or
  • burning sensation of psoriasis skin lesions.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect methotrexate injection?

Many drugs can interact with methotrexate. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your medications and any you start or stop using during treatment with methotrexate.

Where can I get more information?

Your doctor or pharmacist can provide more information about methotrexate injection.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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