Methotrexate, Oral/Injection

What are other names for this medicine?

Type of medicine: antineoplastic (anticancer); disease modifying antirheumatic drug

Generic and brand names: methotrexate, injection; methotrexate, oral; Folex; Folex PFS; Methotrexate LPF; Rheumatrex Dose Pack; Trexall

What is this medicine used for?

This medicine is taken by mouth or given by injection to treat various types of cancer. It is also used to treat severe psoriasis and rheumatoid arthritis when other less potent medicines are not effective.

It may be used for other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• a weakened immune system from diseases such as HIV/AIDS or from cancer chemotherapy, radiation therapy, or steroid medicine
• anemia or other blood disorders
• diabetes
• kidney disease
• liver disease
• stomach ulcers or ulcerative colitis

Also tell your healthcare provider if you drink alcohol on a regular basis.

Men: This medicine can affect sperm and cause birth defects. Use birth control during treatment and for 3 months after you stop taking this medicine.

Females of childbearing age: Do not take this medicine if you are pregnant. This medicine has been reported to cause birth defects. Do not become pregnant during treatment and for at least one menstrual period after you stop taking the medicine. Also, do not breast-feed while you are taking this medicine.

How do I use it?

This is a very strong medicine that can cause serious side effects. Check the label on the medicine for directions about your specific dose. Take it exactly as your healthcare provider prescribes. Do not take more of it or take it longer than prescribed.

For psoriasis or rheumatoid arthritis, take this medicine by mouth once a week. If you are having injections, be sure to keep all your appointments.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: pale skin, unusual bruising or bleeding, unusual weakness, mouth sores, nausea, vomiting, black or bloody stools, coughing blood, vomit that looks like coffee grounds, decreased urination.

What should I watch out for?

You need to have lab tests to determine how the medicine is affecting you. Keep all appointments for these tests.

Do not drink alcohol or take aspirin while receiving this medication. It may increase the risk of bleeding. Report any unusual bleeding or bruising to your healthcare provider.

You may get infections more easily when you are taking this medicine. Stay away from people with colds, flu, or other infections. Also, do not have any vaccines without getting your healthcare provider's approval first.

This medicine may make your skin more sensitive to the sun and may cause you to sunburn more easily. While you are taking this medicine, avoid long exposure to the sun. While you are in the sun, wear protective clothing and sunscreen lotion until you know how you will react to the sun. Do not use a sunlamp. If you get a severe sunburn, contact your healthcare provider right away.

This medicine may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (contact your healthcare provider right away): Diarrhea, abdominal pain, black tarry stools, fever and chills, sore throat, unusual bleeding or bruising, sores in your mouth, dry cough, yellowish skin or eyes, dark urine, swelling in your feet or legs, joint pain, seizures.

Other: Nausea, vomiting, diarrhea, loss of appetite, hair loss, skin rash, dizziness, drowsiness, weakness, tiredness, headache, blurred vision.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• alcohol
• antacids such as omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) rabeprazole (AcipHex), and esomeprazole (Nexium)
• antibiotics such as chloramphenicol (Chloromycetin), tetracycline (Achromycin, Sumycin), doxycycline (Vibramycin), minocycline (Minocin), penicillin (Pen VK, Veetids), amoxicillin (Amoxil, Augmentin), piperacillin (Zosyn, Pipracil), ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), gatifloxacin (Tequin), and trimethoprim/sulfamethoxazole (Bactrim, Septra)
• anticancer drugs such as cisplatin (Platinol)
• corticosteroids such as cortisone (Cortone), fludrocortisone (Florinef), hydrocortisone (Cortef), methylprednisolone (Medrol), prednisone (Meticorten), and prednisolone (Delta-Cortef)
• diuretics such as triamterene (Dyazide, Maxzide, Dyrenium) and hydrochlorothiazide (Oretic)
• echinacea
• folic acid and multivitamins containing folic acid
• immunosuppressants such as cyclosporine (Neoral, Sandimmune) and azathioprine (Imuran)
• live vaccines
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Motrin IB, Advil, Nuprin), naproxen (Naprosyn, Aleve, Anaprox), ketoprofen, diclofenac (Voltaren, Cataflam), etodolac (Lodine), diflunisal (Dolobid), indomethacin (Indocin), and piroxicam (Feldene)
• phenytoin (Dilantin)
• probenecid
• salicylates such as aspirin (Ascriptin, Bufferin, Ecotrin), bismuth subsalicylate (Pepto Bismol), and choline magnesium trisalicylate (Trilisate)
• skin products that contain retinoids such as Renova and Retin-A
• sulfasalazine (Azulfidine)
• theophylline

Because of the potent nature of this medicine, be sure to tell your healthcare provider about ALL medicines you are taking.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.

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