Methotrexate Injection

pronounced as (meth'' oh trex' ate)

Brand Name(s): Abitrexate®, Folex®, Mexate®, Otrexup®, Rasuvo®, Reditrex®, also available generically

Why is this medicine prescribed?

Methotrexate injection is used alone or in combination with other medications:

  • to treat certain types of acute lymphocytic leukemia (ALL) in adults and children;
  • to treat or prevent meningeal leukemia (cancer in the covering of the spinal cord and brain) in adults and children;
  • to treat certain types of non-Hodgkin's lymphoma (types of cancer that begin in a type of white blood cells that normally fights infection) in adults and children;
  • to treat osteosarcoma (cancer that forms in bones) after surgery to remove the tumor in adults and children;
  • to treat cutaneous T-cell lymphoma (CTCL, a group of cancers of the immune system that first appear as skin rashes);
  • to treat breast cancer in adults;
  • to treat certain cancers of the head and neck in adults;
  • to treat gestational trophoblastic tumors (a type of tumor that forms inside a woman's uterus when pregnant) in adults;
  • to treat rheumatoid arthritis (RA; a condition in which the body attacks its own joints, causing pain, swelling, and loss of function) in adults;
  • to treat polyarticular juvenile idiopathic arthritis (pJIA; a type of childhood arthritis that affects five or more joints during the first six months of the condition, causing pain, swelling, and loss of function) in children; and
  • to treat severe psoriasis (a skin disease in which red, scaly patches form on some areas of the body) in adults.

Methotrexate is in a class of medications called antimetabolites. Methotrexate treats cancer by slowing the growth of cancer cells. Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming. Methotrexate may treat rheumatoid arthritis and polyarticular juvenile idiopathic arthritis by decreasing the activity of the immune system.

Are there other uses for this medicine?

Methotrexate is also sometimes used in combination with other medications to treat bladder cancer. It is also sometimes used to treat Crohn's disease (condition in which the immune system attacks the lining of the digestive tract, causing pain, diarrhea, weight loss and fever) and other autoimmune diseases (conditions that develop when the immune system attacks healthy cells in the body by mistake). Ask your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Methotrexate injection comes as a powder to be mixed with liquid to be injected intramuscularly (into a muscle), intravenously (into a vein), subcutaneously (just under the skin), or intrathecally (into the fluid-filled space of the spinal canal). The length of treatment depends on the types of drugs you are taking, how well your body responds to them, and the type of cancer or condition you have.

Your doctor may give you medication(s) to prevent or treat side effects from methotrexate injection.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

What special precautions should I follow?

Before receiving methotrexate injection,

  • tell your doctor and pharmacist if you are allergic to methotrexate, any other medications, benzyl alcohol, or any of the ingredients in methotrexate injection. Ask your pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: certain antibiotics such as chloramphenicol (Chloramycetin), penicillins, and tetracylcines; folic acid (available alone or as an ingredient in some multivitamins); other medications for rheumatoid arthritis; phenytoin (Dilantin); probenecid (Benemid); proton pump inhibitors (PPIs) such as esomeprazole (Nexium), omeprazole (Prilosec, Prilosec OTC, Zegerid), pantoprazole (Protonix); sulfonamides such as co-trimoxazole (Bactrim, Septra), sulfadiazine, sulfamethizole (Urobiotic), and sulfisoxazole (Gantrisin); and theophylline (Theochron, Theolair). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section, seizures, or a low level of folate in your blood.
  • do not breastfeed while you are receiving methotrexate injection and for at least 1 week after your final dose.
  • you should know that this medication may decrease fertility in women and men. Talk to your doctor about the risks of taking this medication if you have concerns about fertility.
  • you should know that methotrexate may cause dizziness or make you feel drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
  • plan to avoid unnecessary or prolonged exposure to sunlight or ultraviolet light (tanning beds and sunlamps) and to wear protective clothing, sunglasses, and sunscreen. Methotrexate may make your skin sensitive to sunlight or ultraviolet light. If you have psoriasis, your sores may get worse if you expose your skin to sunlight while you are receiving methotrexate.
  • do not have any vaccinations during your treatment with methotrexate without talking to your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are receiving methotrexate injection.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget to take a dose?

Call your doctor right away if you cannot keep an appointment to receive methotrexate injection.

What should I do in case of overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at . If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

  • sores in the mouth and throat
  • sore throat, chills, fever, ongoing cough and congestion, or other signs of infection
  • unusual bruising or bleeding
  • black and tarry or bloody stools
  • bloody vomit
  • vomited material that looks like coffee grounds

What side effects can this medicine cause?

Methotrexate may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • joint or muscle pain
  • reddened eyes
  • swollen gums
  • hair loss

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

  • vomiting
  • blurred vision or sudden loss of vision
  • sudden fever, severe headache, and stiff neck
  • seizures
  • confusion or memory loss
  • weakness or difficulty moving one or both sides of the body
  • difficulty walking or unsteady walking
  • loss of consciousness
  • impaired speech
  • decreased urination
  • swelling of the face, arms, hands, feet, ankles, or lower legs

Some people who received methotrexate injection developed other forms of cancer. Talk to your doctor about the risks of receiving this medication.

Methotrexate may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( ) or by phone (1-800-332-1088).

What other information should I know?

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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