methotrexate (injection)

Pronunciation: meth oh TREX ate

Brand: Methotrexate Sodium, Preservative Free, Otrexup, Rasuvo

What is the most important information I should know about methotrexate injection?

Do not use methotrexate to treat psoriasis or rheumatoid arthritis if you have low blood cell counts, a weak immune system, alcoholism or chronic liver disease, or if you are pregnant or breast-feeding.

Methotrexate can cause serious or life-threatening side effects. Tell your doctor if you have diarrhea, mouth sores, cough, shortness of breath, upper stomach pain, dark urine, numbness or tingling, muscle weakness, confusion, seizure, or skin rash that spreads and causes blistering and peeling.

What is methotrexate injection?

Methotrexate interferes with the growth of certain cells of the body, especially cells that reproduce quickly, such as cancer cells, bone marrow cells, and skin cells.

Methotrexate is used to treat leukemia and certain types of cancer of the breast, skin, head and neck, or lung. Methotrexate is also used to treat severe psoriasis and rheumatoid arthritis.

Methotrexate is usually given after other treatments have failed.

Methotrexate may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before receiving methotrexate injection?

You should not use methotrexate if you are allergic to it. Methotrexate should not be used to treat psoriasis or rheumatoid arthritis if you have:

  • alcoholism, cirrhosis, or chronic liver disease;
  • low blood cell counts;
  • a weak immune system or bone marrow disorder; or
  • if you are pregnant or breast-feeding.

Methotrexate is sometimes used to treat cancer even when patients do have one of the conditions listed above. Your doctor will decide if this treatment is right for you.

Tell your doctor if you have:

  • kidney disease;
  • lung disease;
  • any type of infection; or
  • radiation treatment.

Methotrexate can harm an unborn baby or cause birth defects, whether the mother or father is using this medicine.

  • If you are a woman, do not use methotrexate to treat psoriasis or rheumatoid arthritis if you are pregnant. You may need to have a negative pregnancy test before starting this treatment. Use an effective form of birth control while using methotrexate, and for at least one cycle of ovulation after your treatment ends.
  • If you are a man, use a condom to keep from causing a pregnancy while you are using methotrexate. Continue using condoms for at least 3 months after your last dose.
  • Tell your doctor right away if a pregnancy occurs while either the mother or the father is taking methotrexate.

This medicine may affect fertility (ability to have children) in both men and women. However, it is important to use birth control to prevent pregnancy because methotrexate may harm the baby if a pregnancy does occur.

You should not breast-feed while using methotrexate.

How is methotrexate injection given?

Your doctor will perform blood tests to make sure you do not have conditions that would prevent you from safely using methotrexate.

Methotrexate is injected into a muscle, under the skin, or as an infusion into a vein. A healthcare provider will give you this injection and may teach you how to properly use the medication by yourself.

Methotrexate may also be injected by a healthcare provider directly into a joint, or into the area around your spinal cord.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed. It is very important not to inject too much methotrexate when you are using methotrexate at home.

Read and carefully follow any Instructions for Use provided with your medicine. Do not use methotrexate if you don't understand all instructions for proper use. Ask your doctor or pharmacist if you have questions.

Prepare your injection only when you are ready to give it. Do not use this medicine if it has changed colors or has lumps or particles in it. Call your pharmacist for new medication.

Methotrexate can be toxic to your organs, and may lower your blood cell counts. Your blood will need to be tested often, and you may need an occasional liver biopsy or chest X-ray. Your cancer treatments may be delayed based on the results.

If you need to be sedated for dental work, tell your dentist you currently use methotrexate.

Store at room temperature away from moisture, heat, and light. Do not freeze.

Use a needle and syringe only once and then place them in a puncture-proof "sharps" container. Follow state or local laws about how to dispose of this container. Keep it out of the reach of children and pets.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your methotrexate injection, or if you forget to use the medicine at home.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of methotrexate injection can be fatal.

What should I avoid while receiving methotrexate injection?

Avoid drinking alcohol. It may increase your risk of liver damage.

Do not receive a "live" vaccine while using methotrexate, or you could develop a serious infection. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), and zoster (shingles).

This medicine can pass into body fluids (urine, feces, vomit). For at least 48 hours after you receive a dose, avoid allowing your body fluids to come into contact with your hands or other surfaces. Caregivers should wear rubber gloves while cleaning up a patient's body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Methotrexate may impair your thinking or reactions. Avoid driving or operating machinery until you know how this medicine will affect you.

Avoid exposure to sunlight or artificial UV rays (sunlamps, tanning beds, or PUVA treatment), especially if you have psoriasis. Methotrexate can make your skin more sensitive to sunlight and your psoriasis may worsen.

What are the possible side effects of methotrexate injection?

Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Call your doctor at once if you have:

  • fever, chills, swollen lymph glands, night sweats, weight loss;
  • vomiting, white patches or sores inside your mouth or on your lips;
  • diarrhea, blood in your urine or stools;
  • dry cough, cough with mucus, stabbing chest pain, wheezing, feeling short of breath;
  • seizure (convulsions);
  • kidney problems --little or no urination, swelling in your feet or ankles;
  • liver problems --stomach pain (upper right side), dark urine, jaundice (yellowing of the skin or eyes);
  • nerve problems --confusion, weakness, drowsiness, coordination problems, feeling irritable, headache, neck stiffness, vision problems, loss of movement in any part of your body; or
  • signs of tumor cell breakdown --confusion, tiredness, numbness or tingling, muscle cramps, muscle weakness, vomiting, diarrhea, fast or slow heart rate, seizure.

Common side effects may include:

  • fever, chills, tiredness, not feeling well;
  • mouth sores;
  • nausea, vomiting, stomach pain, indigestion, diarrhea;
  • rash;
  • headache, dizziness;
  • runny or stuffy nose, sore throat, trouble breathing;
  • abnormal liver function tests;
  • temporary hair loss;
  • being more sensitive to light; or
  • burning sensation of psoriasis skin lesions.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect methotrexate injection?

Methotrexate can harm your liver, especially if you also use certain other medicines for infections, tuberculosis, depression, birth control, hormone replacement, high cholesterol, heart problems, high blood pressure, seizures, or pain or arthritis medicines (including acetaminophen, Tylenol, Advil, Motrin, and Aleve).

Many drugs can affect methotrexate. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

Where can I get more information?

Your doctor or pharmacist can provide more information about methotrexate injection.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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