Methotrexate, Oral/Injection

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KEY POINTS

• This medicine is taken by mouth or given by injection to treat cancer, psoriasis, or rheumatoid arthritis. Take it exactly as directed.
• This is a very strong medicine that can cause severe or life-threatening side effects, including bone marrow, liver, kidney, lung, skin, and digestive problems. It may increase your risk for lymphoma. You may get infections more easily when you are taking this medicine. Keep all appointments for tests to see how this medicine affects you.
• Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: antineoplastic (anticancer); disease modifying antirheumatic drug

Generic and brand names: methotrexate, injection; Otrexup; Rasuvo; Rheumatrex; methotrexate, oral; Rheumatrex Dose Pack; Trexall

What is this medicine used for?

This medicine is taken by mouth or given by injection to treat various types of cancer. It is also used to treat severe psoriasis and rheumatoid arthritis when other less potent medicines are not effective.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• A weakened immune system from diseases such as HIV/AIDS or cancer, or from taking chemotherapy, radiation therapy, or steroid medicine
• Anemia or other blood disorders
• Diabetes
• Fluid buildup in your abdomen (ascites)
• Kidney disease
• Liver disease
• Lung problems
• Problems with alcohol abuse
• Ulcers or ulcerative colitis

Also tell your healthcare provider if you drink alcohol on a regular basis. Tell your healthcare provider if you currently have a fever or an infection

This medicine may affect your ability to have a baby. Men may have a decreased sperm count and females may have changes to their menstrual cycle. Talk with your healthcare provider about this.

Men: This medicine can affect sperm and cause birth defects. Use birth control during treatment and for 3 months after you stop taking this medicine.

Females of childbearing age: Do not take this medicine if you are pregnant. The baby may die or be born with serious birth defects. Do not become pregnant during treatment and for at least one menstrual period after you stop taking the medicine. Talk with your healthcare provider about effective birth control. Also, do not breast-feed while you are taking this medicine.

How do I use it?

This is a very strong medicine that can cause serious side effects.

Check the label on the medicine for directions about your specific dose. Your healthcare provider will prescribe the exact dose of this medicine and tell you how often you will receive it. Take it exactly as your healthcare provider prescribes. Taking this medicine incorrectly may be life-threatening. Do not take more of it or take it longer than prescribed. If this medicine is prescribed to be used once a week, do not use it more often. Taking this medicine too often may cause death. Do not stop taking this medicine without your healthcare provider's approval. Ask your healthcare provider or pharmacist if you have any questions about how often to take your medicines.

Check with your healthcare provider before using this medicine in children. Some brands should not be used in children under a certain age.

The injection form of this medicine may be given as a slow infusion into a vein or artery or a shot just under the skin, into a muscle, or into your spine. You may be able to give yourself the shots, or have someone at home give them to you. Your healthcare provider will show you how to inject this medicine. If you are receiving high-dose therapy, or medicine into your spine, you must use the preservative-free form of this medicine. Be sure you understand when and how you are to receive your shots, and how to dispose of the medicine. Ask your healthcare provider or pharmacist about anything you do not understand.

What if I miss a dose?

If you miss a dose, contact your healthcare provider for instructions. Do not use double doses.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: pale skin, unusual bruising or bleeding, unusual weakness, mouth sores, nausea, vomiting, black or bloody bowel movements, coughing blood, vomit that looks like coffee grounds, decreased urination.

What should I watch out for?

This is a very strong medicine that can cause severe or life-threatening side effects, including bone marrow, liver, kidney, lung, and skin problems. It may also cause severe mouth sores or severe diarrhea. Only healthcare providers experienced with this drug should prescribe it. Be sure you understand the risks of taking this medicine. You need to have lab tests to determine how the medicine is affecting you. Keep all appointments for these tests.

Do not drink alcohol or take aspirin or NSAIDs while receiving this medicine unless your healthcare provider approves. It may increase the risk of severe or life-threatening bleeding. Report any unusual bruising or bleeding to your healthcare provider.

This medicine lowers the number of certain types of blood cells in your body. As a result, you may bleed or get infections more easily. Stay away from people with colds, flu, or other infections. Contact your healthcare provider right away if you any signs of infection, or any unusual bruising or bleeding. Do not have any vaccines without getting your healthcare provider's approval first.

This medicine may make your skin more sensitive to the sun and may cause you to sunburn more easily. While you are taking this medicine, avoid long exposure to the sun. While you are in the sun, wear protective clothing and sunscreen lotion until you know how you will react to the sun. Do not use a sunlamp. If you get a severe sunburn, contact your healthcare provider right away.

This medicine may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

This medicine may increase your risk for lymphoma or other tumors. Talk with your healthcare provider about this.

Contact your healthcare provider if you have an illness or infection that causes fever, diarrhea, or vomiting. These problems may increase the side effects of this medicine.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat); sudden weakness, numbness, or tingling, especially on one side of your body; sudden or severe headache; sudden trouble with vision, speech, balance, or walking.

Serious (Report these to your healthcare provider right away.): Severe diarrhea, severe stomach pain, severe nausea or vomiting, black or tarry bowel movements, fever, chills, sore throat, unusual bruising or bleeding, sores in your mouth, chest pain, trouble breathing, dry cough, yellowing of your skin or eyes, dark urine, light-colored bowel movements, unexplained loss of appetite, unusual tiredness or weakness, swelling in your feet or legs, joint pain, seizures, decreased or trouble with urination, confusion, unexplained irritability; sudden or severe stiff neck; unusual numbness or weakness; skin rash, burning, redness, peeling, or blisters.

Other: Nausea, vomiting, diarrhea, loss of appetite, hair loss, dizziness, drowsiness, weakness, tiredness, headache, blurred vision.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Alcohol
• Antibiotics such as amoxicillin (Amoxil, Moxatag), azithromycin (Zithromax, Zmax), chloramphenicol, ciprofloxacin (Cipro), clarithromycin (Biaxin), dicloxacillin, doxycycline (Doryx, Monodox, Vibramycin), erythromycin (E.E.S., Ery-Tab, Erythrocin), levofloxacin (Levaquin), minocycline (Dynacin, Minocin, Solodyn), moxifloxacin (Avelox), penicillin (Penicillin-VK), piperacillin/tazobactam (Zosyn), rifampin (Rifadin), telithromycin (Ketek), and tetracycline
• Antifungal medicines such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), and voriconazole (Vfend)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), levetiracetam (Keppra), phenobarbital, phenytoin (Dilantin, Phenytek), and primidone (Mysoline)
• Aspirin and other salicylates
• Cholesterol-lowering medicines such as atorvastatin (Lipitor), cholestyramine (Prevalite), and colestipol (Colestid)
• Clozapine (Clozaril, FazaClo)
• Corticosteroids such as cortisone, dexamethasone, fludrocortisone, hydrocortisone (A-Hydrocort, Cortef), methylprednisolone (Medrol, Solu-Medrol), prednisolone (Omnipred, Orapred, Prelone), and prednisone (Prednisone Intensol)
• Diuretics (water pills) such as bumetanide, furosemide (Lasix), hydrochlorothiazide (Microzide), torsemide (Demadex), and triamterene (Dyrenium)
• Echinacea
• Everolimus (Afinitor, Zortress)
• Folic acid and multivitamins that contain folic acid
• Gold treatments such as auranofin (Ridaura) and gold sodium thiomalate (Myochrysine)
• Heart medicines such as amiodarone (Cordarone, Pacerone), dronedarone (Multaq), nicardipine (Cardene), quinidine, and verapamil (Calan, Covera, Verelan)
• HIV medicines such as atazanavir (Reyataz), darunavir (Prezista), delavirdine (Rescriptor), efavirenz (Sustiva), elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild), etravirine (Intelence), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), maraviroc (Selzentry), nelfinavir (Viracept), nevirapine (Viramune), rilpivirine (Edurant), ritonavir (Norvir), saquinavir (Invirase), tipranavir (Aptivus), and zidovudine (Retrovir)
• Hydroxychloroquine (Plaquenil)
• Immunosuppressants such as azathioprine (Azasan, Imuran), cyclosporine (Gengraf, Neoral, Sandimmune), mycophenolate (CellCept, Myfortic), sirolimus (Rapamune), tacrolimus (Astagraf, Prograf, Protopic), and temsirolimus (Torisel)
• Medicines to block or prevent stomach acid such as dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (AcipHex)
• Medicines to treat or prevent blood clots such as apixaban (Eliquis), cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine), dipyridamole/aspirin (Aggrenox), edoxaban (Savaysa), prasugrel (Effient), rivaroxaban (Xarelto), ticagrelor (Brilinta), and warfarin (Coumadin)
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as celecoxib (Celebrex), diclofenac (Cambia, Voltaren, Zipsor), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Anaprox, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• Other cancer medicines
• Probenecid
• Radiation therapy
• Skin products that contain retinoid medicines such as Renova and Retin-A
• St. John’s wort
• Sulfa antibiotics such as sulfadiazine, sulfamethoxazole/trimethoprim (Bactrim, Septra), and sulfasalazine (Azulfidine)
• Sulfasalazine (Azulfidine)
• Theophylline
• Vaccines

Because this medicine is so strong, be sure to tell your healthcare provider about ALL medicines you are taking.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.