Methotrexate

Question 1

What is methotrexate used for?

Answer 1

• Crohn’s disease (treatment, maintenance and remission)
• Mod - Severe RA
• Severe Psoriasis

Question 2

What is the usual dose of methotrexate treatment?

Answer 2

anything from 2.5mg - 25mg - WEEKLY

• day of the week should be written in full on packaging
• patients should carry alert cards

Question 3

What are the contra-indications of Methotrexate?

Answer 3

• active infection
• ascites
• immunodeficiency syndroms
• significant pleural effusion
• avoid in hepatic impairment
• avoid in severe renal impairment

Question 4

What are the cautions of Methotrexate?

Answer 4

• photosensitivity
• dehydration - risk of toxicity
• diarrhoea
• caution in blood disorders
• peptic ulceration

Question 5

What are the reasons for stopping treatment?

Answer 5

• clinically significant drop in White Cell Counts or Platelet Counts withdraw immediately (bone marrow suppression)
• stomatitis/diarrhoea (first signs of GI toxicity)
• persistent increases in liver transaminases (liver cirrhosis)
• dyspnoea, cough, fever in rheumatoid arthritis (pulmonary toxicity)

Question 6

What are the common side effects with oral Methotrexate?

Answer 6

• anaemia/thrombocytopaenia
• diarrhoea/GI discomfort/nausea/vomiting
• increased risk of infection - avoid any live vaccines
• nephrotoxicity at high doses

Question 7

What can be done to prevent Methotrexate side effects?

Answer 7

Folic acid to reduce mucosal, GI and hepatic side effects

Taken on a DIFFERENT day to the Methotrexate

Question 8

Can Methotrexate be used if pregnant or breast-feeding?

Answer 8

no - AVOID, teratogenic

• effective contraception needed during and for 6 months after treatment in men and women
• discontinue breast-feeding, present in milk

Question 9

What monitoring is required with Methotrexate?

Answer 9

• exclude pregnancy
• full blood count (report all symptoms suggestive of an infection, especially sore throat, bruising, mouth ulcers)
• renal function test
• liver function tests (report nausea, vomiting, abdominal discomfort, dark urine)
• report respiratory effects (shortness of breath)

Question 10

What does Methotrexate interact with?

Answer 10

• avoid OTC Aspirin, Ibuprofen and other NSAIDs
• Amoxicillin, Penicillin
• Ciprofloxacin
• Flucloxacillin
• Trimethoprim
• All PPIs