Methotrexate and sarcoid DRAFT. Patient Information Leaflet

Transcription

1 Methotrexate and sarcoid DRAFT Patient Information Leaflet

2 Why am I being prescribed methotrexate? You are being prescribed methotrexate because you have sarcoidosis and we do not want to prescribe steroids. The long term use of steroids can cause unwanted side effects such as skin thinning, diabetes, weight gain, weak bones and cataracts. You have been prescribed methotrexate to try to reduce the amount of steroids being used to control your sarcoidosis and the associated side effects of steroids. Methotrexate works by preventing and slowing down the growth of cells called granulomas which replace normal cells in organs including the lung. One of its actions is to reduce the activity of the immune system, so it is always used with care. When and how do I take methotrexate? Methotrexate is usually taken in tablet form ONCE A WEEK on the same day. It should be taken with food. The tablets should be swallowed whole and not crushed or chewed. What dose do I take? Methotrexate tablets are usually 2.5 mg. A 10 mg tablet is also available, although less often dispensed, to avoid confusion. It is recommended that only the 2.5 mg tablet be used. The two strengths are different shapes but are a very similar colour, so you should always check the dose is correct. Your doctor will advise you what dose you should start on. Usually you will start on a low dose of 7.5mg as a once a week dose.

3 You will then be reviewed every 4 weeks by your GP. If you are tolerating the methotrexate and your blood results are stable, the dose will be increased by 2.5mg at each four weekly visit until a total dose of 15mg a week is achieved. You will be reviewed in the interstitial lung disease (ILD) clinic every 3 months. Methotrexate is only ever taken as a ONCE A WEEK dose. How long will methotrexate take to work? Methotrexate does not work immediately. It may take up to 12 weeks before you notice any benefit. Do not attempt to reduce your steroids unless you have discussed this first with your doctor. What are the possible risks or side-effects? In some patients methotrexate can cause nausea, vomiting, diarrhoea, mouth ulcers, hair loss and skin rashes. If you develop any of these symptoms, please contact your doctor or specialist nurse. Taking methotrexate can affect the blood count and can make you more likely to develop infections. If you develop a sore throat or other infection, a fever, unexplained bruising or bleeding, jaundice (eyes or skin turning yellow), or any new symptoms after starting methotrexate, you should tell your doctor or nurse specialist straight away. If any of these symptoms are severe, you should stop methotrexate and see your doctor immediately. Rarely, methotrexate causes inflammation of the lung with breathlessness. If you become breathless, you should stop methotrexate and see your doctor immediately.

4 If you have not had chickenpox but come into contact with someone who does, or if you develop chickenpox or shingles, you should stop methotrexate and see your doctor immediately as you may need special treatment. This is because these conditions can be severe in people on treatment such as methotrexate. Therefore you may require antiviral treatment. Most doctors prescribe folic acid tablets to patients who are taking methotrexate as this can reduce the likelihood of sideeffects. It is recommended that folic acid is taken only once a week only and should not be taken on the same day as methotrexate. Do I need any special checks while on methotrexate? Methotrexate can affect the blood count and sometimes cause liver problems, your doctor will arrange for you to have a blood test before you start treatment and at regular intervals. You may be asked to keep a record booklet with your blood test results. Bring this with you when you visit your GP or the hospital. You must not take methotrexate unless you are having regular checks. May I take other medicines along with methotrexate? Methotrexate may be prescribed along with other drugs in treating your condition. Some drugs interact with methotrexate, so you should discuss any new medications with your doctor before starting them. You should always tell any other doctor treating you that you are taking methotrexate.

5 Special care is needed with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibruprofen and nurofen. You may only take NSAIDs if they are prescribed to you by your doctor. You should also avoid the drugs trimethoprim and co-trimoxazole (Septrin), which may be prescribed for infections. Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, specialist nurse or pharmacist. Can I have immunisations while on methotrexate? It is recommended that you should not be immunised with 'live' vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age). Your doctor will discuss the possible risks and benefits of the immunisation with you. Pneumovax and yearly flu vaccines are safe and recommended. May I drink alcohol while taking methotrexate? Alcohol should only be consumed in small amounts because methotrexate and alcohol can interact and damage your liver. Discuss this with your doctor. Does methotrexate affect pregnancy? Methotrexate should not be taken in pregnancy because it is likely to harm an unborn baby. Both men and women using this drug should take contraceptive precautions. After stopping methotrexate you should continue taking contraceptive precautions for at least 3 months, and some doctors advise up to

6 6 months. If you are planning a family, or if you become pregnant while taking methotrexate, you should discuss this with your doctor as soon as possible. What about breastfeeding? You should not breastfeed if you are taking methotrexate. Does methotrexate affect fertility? Methotrexate can reduce fertility, please discuss this with your doctor if you have any concerns. Editorial Board number: 1079/13 Next review date: March 2015 Further information is available from: North West Lung Centre, Wythenshawe Hospital Wythenshawe Hospital medicines information helpline on