Methotrexate: Frequently asked questions.
What is methotrexate?
Methotrexate is an immunosuppressive medication used to treat autoimmune diseases such as psoriasis and rheumatoid arthritis. It is also used in some forms of cancer chemotherapy. It is most commonly taken on a weekly basis.
What medications should I avoid while taking methotrexate?
Methotrexate interacts with many other drugs. You should inform your physicians that you are taking methotrexate, especially if you are starting another new medication. Substances that may interact with methotrexate include: alcohol, salicylates (aspirin), NSAIDs (Motrin, Advil, etc.), sulfonamides (trimethoprim, Bactrim, Septra, Dapsone), dipyridamole, probenecid, chloramphenicol, phenothiazines, phenytoin, tetracyclines, and systemic retinoids.
What are the possible side effects of methotrexate?
Methotrexate may cause damage to the liver resulting in fibrosis and cirrhosis. It may more rarely cause rapid inflammation of the lungs (pneumonitis) or slow long-term scarring of the lungs (fibrosis). The most common risk with methotrexate is rapid decreases in the white and/or red blood cell count because of bone marrow suppression. Nausea, loss of appetite, and other gastrointestinal side effects may occur. Methotrexate is toxic to a developing fetus and must not be used by women who are pregnant or trying to become pregnant.
Why is folic acid taken during treatment with methotrexate?
Folic acid supplements are usually taken with methotrexate to reduce the risk of hematologic (blood) and gastrointestinal side effects.
How will I be monitored for side effects while on methotrexate?
Before starting methotrexate, you will have blood tests to check your blood count, liver function and kidney function. You may also be tested for HIV and viral hepatitis. While on methotrexate, your blood count will initially be monitored on a weekly basis, but the frequency of testing will decrease after the first several weeks if no problems develop. Blood tests to evaluate your liver and kidney function will also be drawn periodically. A biopsy of the liver will likely be necessary if you remain on methotrexate for a long period of time.
Why would I need a liver biopsy while taking methotrexate?
One of the most worrisome long-term side effects of methotrexate is fibrosis of the liver leading to possible cirrhosis. This process cannot be effectively detected with a blood test. The only way to monitor for this adverse effect is by inserting a needle through the skin into the liver to obtain a small specimen for examination (a percutaneous liver biopsy). There is a low risk of hitting a blood vessel or causing problem with the liver. CT guidance of the needle is used to reduce these rare complications. Depending on your risk factors for liver disease, an initial baseline biopsy of the liver may be performed once it is clear that you are tolerating the medication and that it is helping your condition. If you have no risk factors or if the initial biopsy results are normal, biopsies will be performed after every 1.5-2.0 grams of cumulative methotrexate dose.
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