Patient Information Leaflet

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1 Patient Information Leaflet METHOTREXATE We hope this fact sheet will provide you with some information about Methotrexate and answer some of the questions you may have. Methotrexate is available in tablet form (2.5mg or 10 mg tablets), medicine or liquid form (in different strengths usually with 2 mg of drug in each ml of liquid) or as an injection under the skin (subcutaneous). Important points Do not handle Methotrexate if you think you might be pregnant. Do not get pregnant whilst on Methotrexate Limit your alcohol intake (see later) If possible keep Methotrexate liquid in a locked container in the bottom of the fridge so it cannot spill onto food. Methotrexate tablets do not need to kept in a fridge. Always take the exact dose prescribed by your doctor. Do not have live vaccinations whilst on Methotrexate (see later) Always attend for your blood tests whilst taking Methotrexate Inform your doctor or rheumatology nurse if you develop chicken pox whilst taking Methotrexate If you have a raised temperature (more than 37.5 o C) contact your rheumatology nurse or doctor before taking the methotrexate Why have I been prescribed Methotrexate? Methotrexate is a powerful medication used to treat young people and children who suffer from juvenile arthritis and other rheumatic conditions. It helps reduce the activity of the cells which cause inflammation, and is used when anti-inflammatory drugs are not enough. 1

2 Is it a cure for rheumatic conditions? It is not a cure but it should help to control your condition by reducing the symptoms and the need for other medicines. What does Methotrexate do? Methotrexate when given in higher doses is a cytotoxic drug. This means that it can be destructive to cells and therefore can be used to treat some forms of cancer. This is not why you are being treated with Methotrexate. Much smaller doses are used when treating rheumatic diseases because Methotrexate also alters the way the body s immune system works. Methotrexate is a special treatment prescribed for you and must be stored safely so it cannot be used by anyone else. Methotrexate has been used in children, young people and adults for many years and we know it is very safe and well tolerated. Will Methotrexate stop the pain? Methotrexate is not a pain-killing drug so you may still need to take anti-inflammatory drugs or pain killers. Once the Methotrexate is working you may find that you can stop them. You should discuss this with your doctor or rheumatology nurse before discontinuing any medication. When and how should I take Methotrexate? Methotrexate is taken once a week either by tablet, medicine, or injection. Injections tend to be chosen if a higher dose is required, or if taking the tablets makes you feel very sick, or for very young children. You or your parents can be taught to give the injection at home. If you prefer not to, arrangements can be made for a nurse to give you the injection. If Methotrexate is being taken in medicine form you will be given a container to get rid of your used bottles and spoons/medicine syringes. You should return this to the hospital when full and you will be given a new one. What doses of Methotrexate will I take? Your rheumatology doctor will decide with you what dose will best work for you. Initially you may start on a low dose, which may be increased for instance as you grow or to better control your disease. How long will I be taking methotrexate? This will be determined by your consultant. The usual practice is to remain on methotrexate until you are in remission (no active inflammation) for 1-2 years. On average, most young people are on methotrexate for a minimum of 2-3 years. What are the possible side effects? All medication can have side effects but most patients do not experience them. In some patients Methotrexate can cause nausea (feeling of sickness), vomiting, loss of appetite and diarrhoea. These side effects can be overcome by giving Methotrexate by injection. 2

3 Other side effects can include: Mouth ulcers ) May be helped by folic acid Sore gums ) (a vitamin) Sore throat ) Disturbance in the blood counts ) Usually return to normal once Upset liver function ) methotrexate is reduced or stopped Skin rash Lung problems with shortness of breath have been reported in adults, but are not expected in children. Methotrexate has been used in children with rheumatic diseases for more than fifteen years. Side effects have been minimal but benefits in treating these illnesses are very impressive. Methotrexate has revolutionised the care of children with rheumatic disease. Can I take other medication whilst I am taking Methotrexate? Most medication can be safely taken with Methotrexate. However some drugs such as co-trimoxazole and trimethoprim (antibiotics) do interact with it and it is therefore a wise precaution to check any new medication with your doctor dentist or pharmacist to ensure that they do not interact with Methotrexate. This also includes herbal remedies. How long will it take before I notice an improvement? It may take between six to eight weeks before you begin to notice a gradual improvement. In some people it may take up to three months. What will happen if I miss a dose? If you miss a dose and remember the following day you can take your usual dose of Methotrexate. If however you only remember a few days later then miss the Methotrexate that week and start taking it again the following week. Missing one dose doesn t usually cause a return of symptoms. Can I chose which day to take methotrexate? Methotrexate should be taken on the same day each week. You can chose which day you would like to take methotrexate. If necessary, it can be given the day before or the day after your usual day. What will happen if I take an extra dose? If you take an extra dose by mistake it is unlikely to cause any problems but if you notice any unusual symptoms, contact the rheumatology nurse or your doctor for advice. If a large dose is taken by accident, seek urgent medical help at your nearest hospital Accident and Emergency Department. Can I drink alcohol whilst I am taking Methotrexate? You can drink 5 units of alcohol a week. There is 1 unit in half a pint of beer, one small wine or short. In the pre-mixed bottled drinks e.g. Bacardi Breezers etc there are 2.5 units. Binge drinking is harmful (for anyone). If you drink on certain nights, it may be best to choose a day to take methotrexate when you will not be having alcohol. 3

4 What will happen if become pregnant whilst taking Methotrexate? It is important that pregnancy be avoided because Methotrexate can cause damage to the unborn baby. When the time comes for having sex contraception is vital. When you do decide to start a family, it is recommended that Methotrexate be discontinued for six months before conceiving. Methotrexate does not make you infertile or act as a contraceptive. Can I have immunisations whilst I am taking Methotrexate? You can have inactivated vaccines such as tetanus, meningitis C and diphtheria etc. Live vaccines (such as MMR, BCG and varicella) should NOT BE GIVEN or given at least two weeks before starting Methotrexate. If you are visiting a foreign country where vaccinations are needed, you will need to avoid live vaccines and should discuss this with your doctor or nurse. If you have not had chicken pox in the past you may be advised to have the chicken pox vaccination before starting Methotrexate. If you require advice regarding immunisations contact the rheumatology nurse or your doctor. Do I need any special checks whilst I am taking Methotrexate? Methotrexate can affect the blood count and can sometimes cause problems with the liver. It is therefore important that you attend regularly for blood tests. Your doctor or nurse will arrange these. Is there anything else I need to know about Methotrexate? If you have not had chicken pox and come into contact with someone who has chicken pox or develop chicken pox or shingles yourself whilst you are taking Methotrexate, you should contact your rheumatology doctor, nurse or GP immediately. What should I do if I spill Methotrexate Medicine? Spillage in eyes: Wash your eyes using plenty of water. Contact your doctor for advice if you experience any side effects. Spillage onto floors and work surfaces: Cover the spillage using absorbent paper; wipe the area clean with water, then soap and water. All paper/cloths etc should be put in the special bin provided. Spillage onto clothes: Blot dry with a paper towel. As a precaution, clothing should be changed and washed separately to other items. Chickenpox Methotrexate may reduce your ability to fight infections therefore if you have never had chickenpox you may be at risk of a severe infection from the virus that causes chickenpox and shingles. Before starting the Methotrexate a blood test will be carried out to test if you have had chickenpox i.e. whether you are immune to chickenpox. If you are not immune then there may be an option of being vaccinated against chickenpox before starting Methotrexate. You should discuss this with your paediatric rheumatologist. If you have not had chicken pox it is wise to avoid anyone with chickenpox. If you do come into contact with the virus or think you may have been in contact with it get in touch with your rheumatology team or GP as soon as possible. It is important for the doctors to decide whether you 4

5 need special treatment. This may require that you have an injection or medication to help fight the chickenpox virus or prevent it occurring. If you develop chickenpox or shingles, contact your paediatric rheumatology team or GP as soon as possible as you will require special treatment. Stop your Methotrexate and any non steroidal antiinflammatory medication such as Ibruprofen, Naproxen etc. Your doctor will recommend when to restart these medications. Further information If you require further information or you have any worries regarding possible side-effects please contact your rheumatology nurse on This fact sheet only gives general information. You must always discuss your individual treatment with the appropriate member of staff. Do not rely on this fact sheet alone for information about your treatment. This leaflet has been produced for you by the British Society for Paediatric and Adolescent Rheumatology (BSPAR). Written by Jane Kelly and Liza McCann, and edited by BSPAR Clinical Affairs Committee and Nursing Group Approved by Royal Liverpool Children's Hospital Drugs and Therapeutics Committee and Lay Reader's Panel Approved by BSPAR executive committee 28 March 2007 Review date

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