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Jylamvo 2mg/ml Oral Solution
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Indications & Clinical Uses
- Jylamvo 2 mg/mL is a ready-made oral solution of methotrexate, an antimetabolite and folate antagonist.
- In the United States it is approved for maintenance treatment of acute lymphoblastic leukaemia, for mycosis fungoides and for relapsed or refractory non-Hodgkin lymphoma, and for severe active rheumatoid arthritis, polyarticular juvenile idiopathic arthritis and severe psoriasis that has not responded adequately to other treatment.
- In the European Union the same 2 mg/mL solution is authorised from 3 years of age for juvenile idiopathic arthritis and leukaemia maintenance.
- THE DOSE IS TAKEN ONCE A WEEK, NOT EVERY DAY, for rheumatoid arthritis, juvenile arthritis, psoriasis, psoriatic arthritis and leukaemia maintenance.
- Patients have died after taking methotrexate daily by mistake.
- A liquid makes swallowing easier for children and adults who cannot take tablets, but it also makes dosing errors easier, so the oral dosing syringe supplied with the bottle must always be used.
Side Effects
- The US label for Jylamvo carries a BOXED WARNING for severe and sometimes fatal toxic reactions, including embryo-fetal toxicity and fetal death, and it states plainly that deaths have occurred from medication errors in which methotrexate was taken daily instead of weekly.
- The commonest side effects are ulcerative stomatitis (mouth ulcers and a sore mouth), low white cell counts, nausea and abdominal distress; diarrhoea, tiredness, hair thinning, anaemia, low platelets and raised liver enzymes are also common.
- Serious reactions include bone marrow suppression, liver damage and fibrosis, lung inflammation with a dry cough and breathlessness, kidney damage, severe skin reactions and serious or opportunistic infections.
- Get urgent help for fever, sore throat, unusual bruising or bleeding, mouth ulcers that stop you eating or drinking, a new dry cough or breathlessness, yellowing of the skin or eyes, or a widespread blistering rash.
Precautions & Warnings
- Take Jylamvo exactly once a week on the same named day; the prescriber must write the day on the prescription, and you should check the day and the measured volume every single time.
- Never take an extra dose to make up for a missed one.
- Full blood count, liver function and kidney function are checked before treatment and regularly during it, with closer monitoring after any dose increase.
- Folic or folinic acid is usually prescribed alongside for non-cancer uses.
- Jylamvo is contraindicated in pregnancy for non-cancer disease, in breastfeeding, in severe kidney impairment, in significant liver disease or alcohol misuse, in pre-existing bone marrow disorders, in immunodeficiency and active infection including tuberculosis and HIV, in mouth or gastrointestinal ulceration, and with live vaccines.
- Both women and men need effective contraception during treatment and for a period afterwards.
- Store the bottle at room temperature, keep it tightly closed and out of reach of children, and discard it 3 months after first opening.
Avoid Interactions
- Methotrexate levels and toxicity are increased by NSAIDs such as ibuprofen, naproxen and high-dose aspirin, by proton pump inhibitors such as omeprazole and pantoprazole, by penicillins, sulfonamides including co-trimoxazole, probenecid, ciprofloxacin and tetracyclines, and by other folate antagonists such as trimethoprim and pyrimethamine, which can cause severe bone marrow suppression.
- Alcohol and other liver-toxic medicines including retinoids, leflunomide and azathioprine increase the risk of liver damage and should be avoided.
- Nitrous oxide anaesthesia increases methotrexate toxicity.
- Live vaccines, including MMR, yellow fever, live typhoid and varicella, must not be given during treatment because of the risk of serious disseminated infection.
- Folic acid supplements taken at the wrong time can reduce the effect of methotrexate in cancer treatment, so follow the exact schedule you are given.
- Tell your healthcare provider about every medicine, herbal remedy and supplement, including over-the-counter painkillers and indigestion remedies.
References
Frequently Asked Questions
Jylamvo (methotrexate) 2 mg/mL oral solution treats severe rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, severe psoriasis and psoriatic arthritis, and is used for maintenance in acute lymphoblastic leukaemia, mycosis fungoides and non-Hodgkin lymphoma. The liquid form suits children and anyone who cannot swallow tablets.
Jylamvo (methotrexate) is taken ONCE A WEEK, on the same day each week, for arthritis, psoriasis and leukaemia maintenance. It is never taken daily. Measure every dose with the oral syringe supplied. Taking methotrexate daily by mistake has killed patients, so check the day and the volume every time.
Jylamvo (methotrexate) commonly causes mouth ulcers, nausea, abdominal discomfort, diarrhoea, tiredness, low white cells and raised liver enzymes. Its boxed warning covers severe toxic reactions, harm to an unborn baby, and deaths caused by daily instead of weekly dosing. Report fever, bruising, a new dry cough or breathlessness urgently.
Avoid alcohol, and avoid NSAIDs such as ibuprofen and naproxen, proton pump inhibitors, co-trimoxazole, trimethoprim, penicillins and probenecid unless your prescriber agrees, because they raise methotrexate levels and toxicity. Live vaccines, including MMR and yellow fever, must not be given while you take Jylamvo.
Full blood count, liver function and kidney function are checked before Jylamvo (methotrexate) starts and regularly during treatment, more often after a dose increase. A chest X-ray may be needed if you develop a cough. Folic acid is usually prescribed for non-cancer uses to reduce mouth ulcers and nausea.
No. Jylamvo (methotrexate) can cause fetal death and birth defects and is contraindicated in pregnancy for non-cancer conditions, and during breastfeeding. Both women and men need effective contraception during treatment and for a period afterwards. Tell your prescriber immediately if pregnancy is suspected.
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