Doses For Inflammatory Conditions
For inflammatory conditions such as psoriasis, rheumatoid arthritis and Crohn’s disease, the dose will vary. This depends on your condition and blood test results. Always follow the instructions from your doctor.
For rheumatoid arthritis, the usual starting dose is 7.5mg, taken once a week. This can be slowly increased up to 20mg or 25mg once a week.
For psoriasis, the usual starting dose is 2.5mg to 10mg, taken once a week. It can be slowly increased up to 30mg once a week.
For Crohn’s disease, the usual dose to prevent flare-ups is 10mg to 25mg, taken once a week. This is often called a “maintenance” dose.
If your child is prescribed methotrexate, the doctor will use their height and weight to work out the right dose.
Other Benefits And Guidelines
Methotrexate is also a boon in managing psoriasis flares in patients on a biologic.
Weve all had patients who are doing well on a biologic, theyre cruising along at 140 weeks, then they get strep throat or another infection, and, next thing you know, you have destabilized psoriasis, Dr. Leonardi noted.
One thing Ill do is add methotrexate to the mix, try to get things under control, and, if we do, then well try to taper the methotrexate, he continued. That whole episode might take 4-6 months to resolve before the patient might be able to tolerate biologic monotherapy, though. If they cant at that point, you might consider rotating to another biologic.
Current American Academy of Dermatology guidelines recommend that women on methotrexate limit their alcohol intake to one drink per day, two drinks for men. British Society for Rheumatology guidelines recommend a ceiling of 32 g to 64 g of ethanol per week.
We dont insist on abstinence. Theres no good evidence that its needed, Dr. Leonardi noted. If you dose this drug on Tuesday, you can be sure that its eliminated from the body on Friday, and thats when Ill generally green-light patients to socialize over the weekend. If you can make life a little more tolerable for your patients and theyre willing to follow your instructions, I think its a better deal all the way around.
Use Of The Methotrexate In Psoriasis During Pregnancy
It has been proved that Methotrexate has a significant teratogenic effect and can provoke death or intrauterine defects of the fetus.
In situations where the patient becomes pregnant during the treatment with Methotrexate medicament, it is necessary to raise the issue of artificial abortion, since the risk of fetal damage is considered very likely. Usually, before proceeding to treatment with the drug, women of childbearing age are recommended to take oral contraceptives in order to avoid a possible pregnancy.
During lactation, taking Methotrexate is also contraindicated, since the drug has the property of getting into the composition of breast milk.
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Methotrexate For Psoriatic Arthritis
Psoriatic arthritis is an inflammatory condition that causes painful, swollen, and stiff joints, along with painful tendons and swollen fingers and toes. It is associated with psoriasis a disease of the skin or nails. If severe, rheumatologists prescribe methotrexate, a diseasemodifying antirheumatic drug , to improve symptoms and prevent worsening. Other DMARDs might include leflunomide, ciclosporin A, sulfasalazine, and gold .
We aimed to assess the benefits and harms of methotrexate compared with placebo or similar drugs for adults with psoriatic arthritis. Methotrexate compared with placebo was the primary comparison. Major outcomes were disease response , function, healthrelated quality of life, disease activity, radiographic progression , serious adverse events , and withdrawals due to adverse events .
We searched for evidence up to 29 January 2018.
After six months of treatment, comparison with placebo showed that methotrexate resulted in the following .
Proportion who responded to treatment as measured by the Psoriatic Arthritis Response Criteria
16% more people, or 16 more people out of 100, improved with treatment
37 out of 100 people taking methotrexate improved
21 out of 100 people taking placebo improved
Function was improved by 10% , or by 0.30 points on a 0 to 3 scale
People taking methotrexate rated their function as 0.7 point
Serious adverse events
What Are The Risks
The risk of liver damage increases if a person drinks alcohol, has abnormal kidney function, is obese, has diabetes or has had prior liver disease. Years after the drug, in rare occasions, certain types of cancer, such as lymphoma, and bone marrow toxicity have occurred. Methotrexate can cause a reduced white blood cell count, increasing infection risk.
Individuals taking methotrexate must have regular blood tests to ensure that the drug is safely processed by the body including the liver, white blood cells and bone marrow. Additional tests are needed at regular intervals. Talk with your health care provider about other tests needed.
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What Should I Do If I Got The Johnson & Johnson Vaccine
Right now, psoriasis patients and other immune-compromised people who received the Johnson & Johnson single-dose vaccine are not eligible for a booster shot.
Since the J& J vaccine has only been available since March 2021, the CDC is waiting for more data before making a recommendation about additional doses for people who are immune-compromised, as well as for the general population.
Preliminary data released by J& J on August 25 suggest that a booster shot could be highly protective.
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Other Warnings For Methotrexate
Methotrexate is associated with increased toxicity if taken with certain other medications, such as nonsteroidal anti-inflammatory drugs , acid reflux medications, and some antibiotics. Such drug interactions may cause harmful toxicity, and possibly even death. Make sure your healthcare provider has a complete list of all medications that you take and discuss possible interactions with methotrexate.
Methotrexate should not be taken by people who have liver disease, significant kidney disease, alcoholism, blood disorders or a bone marrow disorder. Methotrexate should also not be used by women who are pregnant or who are breastfeeding. It also should be stopped by both women and men who are planning a pregnancy.
If you experience signs of an allergic reaction while taking methotrexate, seek emergency medical attention. Such signs would include hives, skin reactions, difficulty breathing, swelling of face, lips, tongue, or throat. You should discontinue methotrexate and call your healthcare provider if you develop a dry cough, shortness of breath, diarrhea, vomiting, white patches or sores inside your mouth, blood in urine or stool, rapid weight gain, decreased urine production, seizure, fever, chills, flu symptoms, weakness, lightheadedness, or any other unusual symptom.
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Treatments For Rheumatoid Arthritis
- medicines such as methotrexate,biological medicines and steroids
Methotrexate is not recommended in pregnancy or while trying for a baby.
This medicine can stay in a woman’s body for 6 months after they stop taking it.
For men, there is a risk that methotrexate can damage sperm. This can affect the way a baby develops during pregnancy.
Women and men wanting to try for a baby need to stop taking methotrexate at least 6 months before trying to conceive.
Ask your doctor about changing to a different medicine before you stop using contraception.
Methotrexate may sometimes make you feel tired, or dizzy and light-headed.
If you are feeling tired or dizzy, do not drive, ride a bike or use tools or machinery until you feel better.
Cautions With Other Medicines
There are many medicines that affect the way methotrexate works.
Children taking methotrexate must not have a “live” flu vaccine . Adults are given an “inactivated” flu vaccine and this usually does not cause problems with methotrexate.
Tell your doctor if you’re taking these medicines before you start methotrexate:
- non-steroidal anti-inflammatories like ibuprofen, or cough and cold remedies containing NSAIDs
- co-trimoxazole,trimethoprimor other antibiotics for bacterial infections
- medicines that make you pee more , such asindapamide andbendroflumethiazide
- epilepsy medicines such asphenytoinorlevetiracetam
- theophylline, a medicine used to treat asthma
- medicines used to treat indigestion, such asomeprazole
- folic acid or vitamin supplements that contain folic acid this is because your doctor may prescribe folic acid to take with your methotrexate
These are not all the medicines that may affect methotrexate.
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When Picking Up Your Prescription
ü Ask the pharmacist to go over the directions for taking the medicine. Be sure it agrees with what the doctor told you.
ü Repeat back the instructions to the pharmacist so he or she can be sure you understand when to take the medicine and the harm that can be caused by taking the medicine more often than you should.
ü Read the information leaflet that comes with the medicine when you get home, before taking the medicine.
When Taking Your Medicine
ü Never take any extra doses of methotrexate. It is not a medicine that can be used as needed for symptom control.
ü Know your monitoring plan and never skip appointments for laboratory and X-ray tests. Some of these tests may at first be frequent , but will be reduced to every 8-12 weeks.
ü Be alert to any signs of serious side effects and report them to your doctor right away. Such side effects might include fever, sore throat, mouth ulcers, abdominal pain, jaundice , new or increased shortness of breath, chest pain, dry cough, diarrhea, nausea, or vomiting. Toxicity from methotrexate can progress rapidly and may not be fully reversible it can potentially be fatal.
ü Ask your doctor before taking over the-counter or prescription NSAIDs . Many times, these other medicines can be safely taken with methotrexate. However, it is important to check blood cell counts, and liver and kidney function.
ü Ask your doctor before receiving immunizations .
ü Let your doctor know if you must take an antibiotic to treat an infection.
ü Let your doctor know if you have an active infection, a decrease in appetite, or have been in contact with someone who has chicken pox or shingles infection.
ü Do not drink alcohol while taking methotrexate.
ü If you realize you have been taking too much of the medicine, seek immediate medical attention.
ü If you realize you have been taking too much of the medicine, seek immediate medical attention.
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Evaluation For Methotrexate Therapy
A premethotrexate evaluation is important to ensure that the patient is a suitable candidate for therapy with the drug. The evaluation consists of a thorough history, which should address alcohol consumption as well as hepatic and renal risk. It is important to assess the expected reliability of the patient for physician visits and follow-up laboratory visits. If the patient is deemed unreliable, then injection of methotrexate at the physician’s office should be considered to increase adherence to therapy and reduce toxicity. The American Academy of Dermatology consensus conference on the use of methotrexate in psoriasis recommends the tests listed in Table 3.13
Who Should Take Methotrexate
Initial therapy for psoriasis often involves a topical cream or ointment, such as a steroid cream. When topical therapy is no longer effective or does not provide adequate improvement in symptoms, systemic therapy is used. Methotrexate is a systemic therapy that can be used for moderate to severe psoriasis. This medication has not been used as frequently since biologics became available, as clinical trials have shown methotrexate to have a better treatment response over placebo, but reduced effectiveness when compared to biologic therapy.
I definitely do use methotrexate, Dr. Kimball said. I certainly use it less for psoriasis than I used to. Methotrexate has a success rate of 25 percent to 30 percent as compared to biologics, which feature a success rate of 80 percent to 85 percent, she explained.
Dr. Kimball finds that the group in which she uses methotrexate most often includes people on the borderline of having too much disease for topical treatments, but not so much disease as to require biologics. We also sometimes use it in combination with biologics because of its effectiveness, she noted.
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If I Get A Third Shot How Good Is The Protection
A third dose will likely provide you with better protection, but how much better is not yet clear, says Zaba.
Some studies have found that people who were severely immunocompromised and had virtually no protection from the Pfizer or Moderna vaccine had an improved antibody response after a third shot of the same vaccine, says the CDC.
Right now, we dont know if a third or booster shot has clinically meaningfully benefits , says Gelfand. But given the emergence of the Delta variant, which is much more transmissible than previous variants, its likely that booster vaccines will be necessary and helpful.
Even after receiving a third dose of the vaccine, youll need to take extra precautions to avoid exposure to COVID-19, such as wearing a mask and avoiding crowds.
To reduce your odds of exposure, its also important that your family members and other close contacts get vaccinated.
If they are already immunized, they too will be eligible for a third shot beginning on September 20. Thats when the federal government is planning to roll out boosters for all Americans who received their second vaccine dose at least eight months prior.
Methotrexate 25 Mg/ml Injection
This information is intended for use by health professionals
Methotrexate 25 mg/ml Injection
Each ml of solution contains 25 mg methotrexate
Each vial of 2 ml of solution contains 50 mg methotrexate
Each vial of 10 ml of solution contains 250 mg methotrexate
Each vial of 20 ml of solution contains 500 mg methotrexate
Each vial of 40 ml of solution contains 1 g methotrexate
Excipient with known effect
Methotrexate 500 mg/20 ml contains 41.1 mg sodium per vial
Methotrexate 1 g/40 ml contains 82.2 mg sodium per vial
For the full list of excipients, see section 6.1.
Vials containing a clear yellow solution
Methotrexate is indicated in the treatment of neoplastic disease, such as trophoblastic neoplasms and leukaemia, and the symptomatic treatment of severe recalcitrant disabling psoriasis which is not adequately responsive to other forms of therapy.
Methotrexate should only be prescribed by physicians with expertise in the use of methotrexate and a full understanding of the risks of methotrexate therapy.
The prescriber should ensure that patients or their carers will be able to comply with the once weekly regimen.
Important warning about the dosage of Methotrexate
In the treatment of psoriasis, Methotrexate must only be used once a week. Dosage errors in the use of Methotrexate can result in serious adverse reactions, including death. Please read this section of the summary of product characteristics very carefully.
Adults and children
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Methotrexate To Treat Psoriasis
Methotrexate is generally only used to treat severe cases of psoriasis, when symptoms are debilitating. It is also used for psoriasis that has not responded to other treatments.
It is usually prescribed for short periods, but it can be used for up to six months in some people. The goal of treatment is to reduce the severity of your psoriasis so that you can return to a milder therapy that you apply to your skin.
Methotrexate doesnt just work on the skin rash like other psoriasis treatments do. Rather, it suppresses the cells in your immune system that cause the psoriasis rash. Due to the way it works, methotrexate can cause many side effects.
The liver breaks down the drug and then removes it from your body through the kidneys. It can cause harmful effects to these organs if used for long periods.
Your doctor may test your blood regularly while you are taking methotrexate. These tests help your doctor check that the medicine is not affecting your liver or kidneys.
Blood tests are usually done every 2 to 3 months, but you may need them more often while your doctor adjusts your dose.
For most people, the benefit of methotrexate lasts for at least two years. For best results, you should follow the instructions your doctor gives you for taking this medicine.
A Family Physician’s Guide To Monitoring Methotrexate
KELLY W. JONES, PHARM.D., McLeod Family Medicine Center, Florence, South Carolina
SUPEN R. PATEL, M.D., Carolina Health Care, Florence, South Carolina
Am Fam Physician. 2000 Oct 1 62:1607-1612.
See related patient information handout on taking methotrexate, written by the authors of this article.
It is not uncommon for a family physician to monitor the efficacy and safety of methotrexate therapy in a patient receiving concurrent care from the subspecialist who prescribed the drug.
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Who Is Methotrexate For
Methotrexate is for people with moderate to severe psoriasis who have not had a good response from, or are unsuitable for, topical treatments or ultraviolet light therapy.
Methotrexate can also be prescribed for psoriatic arthritis. In this situation, it is known as a Disease Modifying Anti-Rheumatic Drug , meaning it acts on the actual condition itself, rather than just relieve the symptoms.
It Is An Autoimmune Disorder That Causes Your Skin Cells To Grow Much Faster Than Normal
This abnormal growth causes the patches of your skin to become thick and scaly.
The symptoms of psoriasis can affect you physically, but they can also affect you socially. The visible rash of psoriasis causes many people to withdraw from their normal social activities to avoid unwanted attention.
To complicate matters, psoriasis can be difficult to treat. The many different treatments for psoriasis include a combination of prescription creams or ointments, oral tablets, or injections. Your treatment options depend on the severity of your illness.
The methotrexate are sometimes used to treat difficult cases of psoriasis.
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Methotrexate Once Weekly Dosing
- Patients can find the dose schedule for methotrexate taken for rheumatoid arthritis and psoriasis confusing
- Check regularly that your patients understand how to take methotrexate correctly.
- Specify on every prescription, and the dispensed medicine label, the day of the week the dose is to be taken.
- It is important to regularly monitor renal and liver function tests, full blood count and respiratory symptoms in all patients taking methotrexate.
Methotrexate is used to treat cancer and, in lower doses, to treat rheumatoid arthritis and psoriasis. Methotrexate interferes with folic acid metabolism and folic acid tablets are used to reduce adverse effect such as nausea or stomatitis1.