METHOTREXATE (Rheumatrex)

Description
Methotrexate (Rheumatrex) is one of the most effective and commonly used medicines to
treat various forms of arthritis and other rheumatic conditions. It is known as a disease-
modifying antirheumatic drug (DMARD) ecause it not only decreases the !ain and swelling of
arthritis ut also can reduce damage to "oints and the risks of long-term disaility.
Uses
Methotrexate has een in use for decades to treat !soriasis and some cancers. In #$%%& it
gained 'DA a!!roval for the treatment of rheumatoid arthritis. (ince then& it has een used to
treat other ty!es of rheumatic diseases& including !soriatic arthritis& lu!us& some forms of
childhood arthritis& and vasculitis.
How it works
Methotrexate interferes with several en)ymes involved in the immune system. *y locking an
en)yme in the ody called dihydrofolate reductase& methotrexate hinders the !roduction of a
form of folic acid im!ortant for actively growing cells such as those com!rising the skin& lood&
gastrointestinal tissues and immune system. +owever& it is not entirely clear how
methotrexate decreases the severity of arthritis .
Dosing
Methotrexate comes in ,.- milligram (mg) talets. Adults with rheumatoid arthritis ty!ically
egin with a starting dose of ..- to #/ mg& or 0 to 1 !ills& taken all together once a week. 2he
dose may e increased to ,/ to ,- mg a week over time if needed. 2he medication can e
given as an in"ection (which comes as ,- mg !er # milliliter 3ml4 or cuic centimeter 3cc4)
under the skin& like insulin& to reduce side effects or when higher doses are needed. Adults
with other rheumatic conditions may take similar doses. In children with "uvenile arthritis& the
dose is ased on the !atient5s weight.
Time to efect
Im!rovements in arthritis and other rheumatic conditions ty!ically are first seen in 0 to 6
weeks& ut the full enefit of methotrexate may not e noticeale until #, weeks of treatment.
Side Efects
2he most common side effects of methotrexate include nausea or vomiting and anormalities
in liver function tests. 2hese side effects are more likely to occur at higher doses. Aout # to 0
!ercent of !atients develo! mouth sores (called stomatitis)& rash& diarrhea and anormalities
in lood counts. Methotrexate has een associated with cirrhosis (scarring) of the liver& ut
this side effect is rare and more likely to occur in !atients who have underlying liver !rolems
or are taking other drugs toxic to the liver.
7ung !rolems (!ersistent cough or unex!lained shortness of reath) can occur when taking
methotrexate. 2hese side effects are more common in !eo!le with !oor lung function.
8ersistent cough or shortness of reath should e re!orted to your doctor.
(low hair loss is seen in some !atients& ut hair grows ack when the medication is sto!!ed.
Methotrexate can increase the sensitivity of the skin to sunlight& so limiting sun ex!osure and
the use of sunscreen is advised.
2he use of folate su!!lements (folic and folinic acid)& which are * vitamins& can decrease side
effects during methotrexate treatment.
It is im!ortant to rememer that most !atients do not ex!erience any side effects and many of
the minor side effects will im!rove with time. Methotrexate treatment should e discontinued
efore attem!ting to ecome !regnant. 9ven though methotrexate cannot e taken during
!regnancy& it does not reduce a woman:s chance of ecoming !regnant in the future.
Points to remember
Methotrexate cannot e taken if you are !regnant or !lan to ecome !regnant& or if kidney or
liver function is not normal.
It is im!ortant to take methotrexate exactly as directed. ;enerally this medication should e
taken one day a week& ut the dose is occasionally s!lit into two doses !er week to avoid side
effects. <our doctor may !rescrie a folic acid (folate) vitamin su!!lement to decrease the
chance of side effects. (ome side effects do not cause sym!toms& so it is im!ortant to have
routine lood tests !erformed every % to #, weeks.
If you miss a dose& you can generally take it u! to 1 to - days later. If you do not reali)e that
you missed a dose until the next dose is scheduled& talk to your doctor aout what to do. If
you are aout to have surgery& talk to your doctor aout whether or not to discontinue
methotrexate. =hen methotrexate treatment is discontinued& its eneficial effects on arthritis
sym!toms gradually disa!!ear over a !eriod of , to % weeks.
Alcohol significantly increases the risk for liver damage while taking methotrexate& so alcohol
intake should e eliminated or minimi)ed to no more than two drinks !er month.
Methotrexate can cause serious birth defects and complications during pregnancy,
so it is important to discuss birth control and pregnancy plans with your physician
while taking this medication. An effective form of contrace!tion is critical while taking
methotrexate and for at least three months after sto!!ing the medication.
*e sure to talk with your doctor efore receiving any vaccines or undergoing any surgeries
while taking this medication
Drug interactions
2ell your doctor aout all of the medications you are taking& including over-the-counter drugs
and natural remedies as these could increase the risk of methotrexate toxicity. 2rimetho!rim
(Bactrim)& an antiiotic used for res!iratory and urinary infections& may increase the toxicity of
methotrexate. 2he level of methotrexate can e affected y nonsteroidal antiinflammatory
drugs (>(AIDs)& although these are often !rescried together for the management of
rheumatoid arthritis.
For more information
2he American ?ollege of Rheumatology has com!iled this list to give you a starting !oint for
your own additional research. 2he A?R does not endorse or maintain these =e sites& and is
not res!onsile for any information or claims !rovided on them. It is always est to talk with
your rheumatologist for more information and efore making any decisions aout your care.
>ational Institutes of +ealth@ Medline 8lus link
htt!@AAwww.nlm.nih.govAmedline!lusAdruginfoAus!diA,/,0-6.html
Updated June 2006.
=ritten y Michael ?annon& MD& and reviewed y the American ?ollege of Rhematology 8atient
9ducation 2ask 'orce.
B,//6 American ?ollege of Rheumatology