Royal Manchester Children s Hospital. Methotrexate Information For Parents and Young People
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1 Royal Manchester Children s Hospital Methotrexate Information For Parents and Young People
2 What is Methotrexate and how does it work? Whenever there is an injury, infection or irritation, the body s immune system reacts by causing inflammation (redness and swelling). Methotrexate helps reduce the activity of the cells which cause inflammation. Methotrexate is a powerful medicine used to treat children and young people who suffer from chronic inflammatory conditions like inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), rheumatic conditions, inflammation of the eyes (uveitis) and skin (psoriasis). How and when is the medicine taken? Methotrexate is available as an injection, a 2.5mg and a 10mg tablet or as syrup 5mls which equals 10mgs. Injection tends to be chosen to treat IBD or if a high dose is required or if the oral medicine causes nausea (feeling sick). Parents and young people can be taught how to give the injection or may choose to let a Nurse carry on giving it. Methotrexate is taken once each week on the same day every week. Folic Acid supplements should also be given three days after the Methotrexate dose. Folic Acid helps to reduce the side effects of Methotrexate. How long will it take to work? Methotrexate does not work straight away. It may take as long as 8 to 12 weeks before any benefit is noticed. 2
3 What are the side effects of Methotrexate? Like other medicines, Methotrexate has some side effects. Most patients do not experience any problems whilst taking Methotrexate. The more common side effects are nausea (feeling sick), vomiting (being sick) and diarrhoea. Other side effects are headaches, mouth ulcers, skin rashes, increased risk of infection, cough or breathlessness. There may be possible disturbances in the blood cell counts and the function of the liver these usually return to normal when Methotrexate has stopped. The Doctor or Nurse Specialist should be informed straight away if the following are noticed: Fever or flu-like symptoms. Contact with chicken pox or measles. Lung problems with shortness of breath has been seen in adults but not in children or young people with low dose Methotrexate. Are there any special checks needed? While Methotrexate is being taken, regular blood tests must be taken to check the blood cell counts, liver and kidney function. If any of these are affected, the Doctor may advise that the Methotrexate be stopped and then restarted at a smaller dose. Methotrexate should not be taken unless these monitoring tests are being done. What other medicines can be taken? Some other medicines should not be taken with Methotrexate for example, antibiotics like trimethoprim or co-trimoxazole (septrin). Always check with the Doctor or pharmacy that any new medications or herbal remedies will not interact with Methotrexate. 3
4 Can immunisations be given? Inactivated vaccines such as tetanus, meningitis C and diphtheria can be given. Live vaccines such as BCG and MMR must not be given during Methotrexate therapy and for 6 months after it has stopped. Vaccines against the 'flu are safe and recommended. If you are travelling abroad where live vaccinations are required, please discuss this with your Doctor or Nurse. The Heaf Test (to test for TB) should be avoided while you are taking Methotrexate. What if a dose is missed? If a dose is forgotten, then give the missed dose as soon as you remember, within a day or two. However if it is missed by more than 3 days then leave it out and take the next dose at the normal time. Never give a double dose. Contact the Doctor for advice if needed. Inform the Doctor of any missed doses at the next visit. What about fertility and pregnancy? It is important that pregnancy be avoided when taking Methotrexate due to its harmful effects on the fetus (baby). When the time comes for having sex, both male and females should use contraception while taking Methotrexate and for 6 months after it has stopped. Methotrexate should not be taken during pregnancy or while breast-feeding. Methotrexate does not make young people infertile or act as a contraceptive. 4
5 Can alcohol be given? Young people should avoid alcohol due to disturbances with liver function. What about smoking? All young people are advised not to start smoking, or to stop if currently smoking. If support is required, the GP can prescribe Nicotine Replacement Therapy and can make a referral to a stop smoking clinic, if available in the area. What should I do if I spill Methotrexate medicine? Spillage in the eyes should be washed out using plenty of water. Contact the Doctor if you experience any side-effects. Spillage onto floors and work surfaces should be covered with absorbent paper and cleaned with soap and water. Paper tissue should be double wrapped and disposed of into the bin. Spillages onto clothes should be blotted dry with tissue paper and clothes changed and washed separately from other items. Is there any other information? Methotrexate can also increase the risk of infection and some diseases like chicken pox, shingles and measles can be more serious in patients taking Methotrexate. If a person has not had these illnesses in the past they should take particular care to avoid contact with people with these infections. You should contact the Doctor or Nurse if you come into contact with these infections. 5
6 Further supplies The tablets and medicine can be obtained from your GP. The injection is supplied by Royal Manchester Children s Hospital using a homecare delivery service. If you need any further help or information, please contact: Paediatric Gastroenterology Secretary: Monday Friday 9.00 am to 4.00 pm (not Bank Holidays) /5458/5051 Paediatric Gastroenterology Nurse Specialists: Monday Friday 7.00 am 4.30 pm (not Bank Holidays) Paediatric Rheumatology Nurse Specialist: Monday Thursday 8.00 am 6.00 pm Paediatric Rheumatology Secretary: Monday Friday 8.00 am 4.00 pm (not Bank Holidays) /5597 Pharmacy Medicines Helpline: Monday Friday 9.00 am 5.00 pm
7 Notes/dates of blood tests 7
8 No Smoking Policy The NHS has a responsibility for the nation s health. Protect yourself, patients, visitors and staff by adhering to our no smoking policy. Smoking is not permitted within any of our hospital buildings or grounds. The Manchester Stop Smoking Service can be contacted on Tel: (0161) ( Translation and Interpretation Service Do you have difficulty speaking or understanding English? /6342 Royal Manchester Children s Hospital Oxford Road Manchester M13 9WL Tel: (Switchboard) Copyright to Central Manchester University Hospitals NHS Foundation Trust TIG 44/07 Produced December 2007 Updated December 2010 Review Date December 2012 (SF Taylor CM3586)
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