Posted on April 28th, 2009 by
Generic Name: methotrexate (meth-oh-TRECKS-ate), amethopterin, methotrexate sodium, MTX
Trade Name: Rheumatrex®, Trexall®
How is this drug used? Methotrexate is FDA approved for the following cancers: gestational choriocarcinoma, chorioadenoma destruens and hydatidiform mole, acute lymphocytic leukemia, meningeal leukemia, breast cancer, epidermoid cancers of the head and neck, advanced mycosis fungoides, lung cancer, advanced non-Hodgkin’s lymphomas, and osteosarcoma. It is also used to control severe psoriasis or rheumatoid arthritis that has not responded to other treatments, and may also be used to control juvenile rheumatoid arthritis.
It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Methotrexate belongs to a group of agents classified as antimetabolites. Antimetabolites produce their anti-cancer effects by inhibiting the ability of a cell to produce or repair DNA, thereby making the cell unable to replicate or repair itself and ultimately causing cellular death.
How is methotrexate given (administered)? Methotrexate may be administered into a vein (intravenous), into a muscle (intramuscular), into the spinal fluid (intrathecal or intraventricular), or by mouth as a pill. The dose and method of administration depend on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient. Patients who are treated with high doses of methotrexate will often receive hydration in the form of intravenous fluids, prior to and after administration of the drug.
How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with methotrexate. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.
In addition, patients will be monitored for inflammation of the membrane surrounding the brain and spinal column (meninges), if they receive methotrexate intrathecally or intraventricularly. Inflammation of the meninges may cause stiff neck, (seizures), vomiting, fever, back pain and severe headache, which typically occur immediately following administration of the drug. Patients will also be monitored for side effects affecting the central nervous system, which may produce paralysis of the arms and legs, difficulty with speaking, confusion, sleepiness, seizures, or coma. These symptoms may occur up to approximately 6 days following treatment, so patients experiencing any of these symptoms should contact their healthcare provider immediately.
What are the common (occur in 30% or more of patients) side effects of treatment with methotrexate?
What are the less common (occur in 10% to 29% of patients) side effects of treatment with methotrexate?
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What can patients do to help alleviate or prevent discomfort and side effects?
Are there any special precautions patients should be aware of before starting treatment?
When should patients notify their physician?
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
Last updated on 09/16.
Important Limitations of Use
The information provided above on the drug you have selected is provided for your information only and is not a substitute for consultation with an appropriate medical doctor. We are providing this information solely as a courtesy and, as such, it is in no way a recommendation as to the safety, efficacy or appropriateness of any particular drug, regimen, dosing schedule for any particular cancer, condition or patient nor is it in any way to be considered medical advice. Patients should discuss the appropriateness of a particular drug or chemotherapy regimen with their physician.
As with any printed reference, the use of particular drugs, regimens and drug dosages may become out-of-date over time, since new information may have been published and become generally accepted after the latest update to this printed information. Please keep in mind that health care professionals are fully responsible for practicing within current standards, avoiding use of outdated regimens, employing good clinical judgment kin selecting drugs and/or regimens, in calculating doses for individual patients, and verifying all dosage calculations.
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