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Methotrexate 25mg/mL Injection
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Indications & Clinical Uses
- Methotrexate Sodium Injection 25 mg/mL is a folate antagonist used both in cancer chemotherapy and in much lower, once-weekly doses for severe, active rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, and severe, disabling psoriasis that has not responded to other treatments.
- In oncology it is used, usually as part of combination regimens, for conditions such as acute lymphoblastic leukaemia, non-Hodgkin lymphoma, osteosarcoma, and certain breast, head and neck cancers, at doses far higher than the arthritis/psoriasis dose.
- This product is a distinct, much lower-strength and lower-dose-regimen formulation from high-dose methotrexate used with leucovorin rescue; the two are never interchangeable, and mixing up weekly low-dose with high-dose regimens has caused fatal errors.
Side Effects
- Common effects include mouth ulcers, nausea, abdominal discomfort, reduced white blood cell counts, fatigue, chills, fever, dizziness and increased susceptibility to infection.
- Serious, label-highlighted risks include severe bone marrow suppression, liver damage (which can progress to cirrhosis, sometimes without early symptoms), kidney injury, lung inflammation, severe skin reactions, and, in pregnancy, fetal death or birth defects.
- A critical, repeatedly fatal error has been patients or prescribers giving this medicine daily instead of once weekly for arthritis or psoriasis; methotrexate for these conditions must be taken exactly once a week, on the same day each week.
- Seek urgent care for unusual bruising or bleeding, mouth sores, yellowing skin, shortness of breath, or fever.
Precautions & Warnings
- Methotrexate carries a boxed warning covering fetal death and birth defects (embryo-fetal toxicity), severe hypersensitivity reactions, benzyl alcohol toxicity risk in neonates from preserved formulations, and serious effects on the bone marrow, kidneys, liver, nervous system, lungs, gut and skin, with regular blood tests required throughout treatment.
- It is contraindicated in pregnancy for non-cancer indications and must be avoided by anyone who is or could become pregnant unless effective contraception is used; men and women should discuss fertility and contraception with their provider before and after treatment, since methotrexate can also affect fertility.
- Liver disease, heavy alcohol use, significant kidney impairment, active infection and immunodeficiency all need careful assessment before starting.
- Live vaccines should be avoided during treatment.
Avoid Interactions
- Non-steroidal anti-inflammatory drugs (NSAIDs), including over-the-counter ibuprofen, can raise methotrexate levels and have caused unexpectedly severe, sometimes fatal, gastrointestinal and bone-marrow toxicity, so combinations need medical supervision.
- Folic acid or folinic acid supplements can reduce methotrexate's cancer-fighting effect if taken incorrectly, yet low-dose folic acid is often deliberately prescribed alongside arthritis or psoriasis dosing to reduce side effects.
- Proton pump inhibitors, penicillins, sulfonamide antibiotics, and other highly protein-bound drugs can increase methotrexate exposure and toxicity.
- Alcohol increases liver toxicity risk.
- Live vaccines should be avoided, and every other medicine and supplement should be discussed with your healthcare provider before starting methotrexate.
References
Frequently Asked Questions
Methotrexate (methotrexate sodium) treats certain cancers as part of chemotherapy, and, at much smaller once-weekly doses, severe rheumatoid arthritis, juvenile arthritis and severe psoriasis. The dose and schedule differ enormously between these uses.
Methotrexate is given by injection, timing and dose set by your prescriber. For arthritis or psoriasis it is given only once a week, on the same day each week - never daily. Cancer doses follow a different, specialist-set schedule.
Methotrexate carries a boxed warning for fetal death and birth defects, severe bone marrow, liver, kidney and lung toxicity, and serious hypersensitivity reactions. Taking arthritis or psoriasis doses daily instead of weekly has caused fatal overdoses.
Avoid NSAIDs like ibuprofen without medical advice, as they can raise methotrexate levels to toxic levels. Avoid alcohol, live vaccines, and unplanned pregnancy; use effective contraception, since methotrexate can cause fetal death or birth defects.
Regular blood tests, checking blood counts and liver and kidney function, are required before starting and throughout treatment. Testing frequency depends on your dose and condition; your prescriber will set a monitoring schedule.
No. Methotrexate is contraindicated in pregnancy for arthritis and psoriasis, and can cause fetal death or birth defects at any dose. Effective contraception is essential during treatment and for a period afterward for both men and women.
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