Would you like to know about the injection of methotrexate? Let's talk!

Has your doctor prescribed you a medicine called Methotrexate ? Or have you given this medicine to someone you know? Perhaps the name sounds a little familiar. This is a medicine that is actually given for a number of different diseases , and requires some caution. So, shall we talk about it in detail and very simply today?

What kind of medicine is this? (What is Methotrexate?)

Simply put, Methotrexate is a drug that primarily reduces inflammation in the body. Do you remember that sometimes when your joints hurt and swell, it's because of inflammation inside the body. That's why it's often used for conditions that come with inflammation.

For example:

• Arthritis : This is inflammation of the joints . This causes pain, swelling, and sometimes long-term damage to the joints. Methotrexate can reduce this inflammation, reduce pain , and help prevent further damage to the joints.
• Psoriasis: This is a skin disease. Some people have red, flaky skin, right? That's why this medicine is given.

Not only this, but Methotrexate is also used to treat some types of cancer . What this medicine does is to slow down the growth of cancer cells.

So you probably understand that this is not a medicine that is given for only one disease. Your doctor is the one who will decide whether you need this medicine or not, and for what condition it will be given. So if you have any other questions, don't be afraid to ask your doctor or pharmacist.

What should I tell the doctor before taking this medicine?

Before giving you Methotrexate, your doctor will ask you some questions. There are also a few things you should definitely tell them . This medicine is not for everyone. You need to be very careful when giving it to people with certain conditions.

If you have any of these things, be sure to tell your doctor:

• If there is fluid in the stomach area or fluid in the lungs.
• If you are a regular drinker, this is very important.
• If there is an infection in the body, or if there are weaknesses in the immune system.
• If you have kidney disease.
• If you have liver disease.
• If you have low blood counts, such as white blood cells, platelets, or red blood cells, doctors also call this a ``low blood count.''
• If you have lung disease.
• If you have recently had radiation therapy, or are scheduled to have it in the future.
• If you have recently received a vaccine, or are planning to receive one in the future, you should be especially careful with some live virus vaccines.
• If you have stomach ulcers.
• If you have an inflammatory bowel condition such as ulcerative colitis.
• If you have previously had an allergic reaction to methotrexate, other medications, foods, dyes, or preservatives.
• If you are trying to get pregnant or are currently pregnant, this is a very important point.
• If you are a breastfeeding mother.

It is very important for your own safety to tell your doctor about these facts without hiding them. Then the doctor can choose the most appropriate treatment for you.

How do you use this medicine?

Methotrexate is not a medicine that is usually taken as a pill. It is given as an injection . That is, through a needle.

There are several ways to do this:

• Infusion into a vein: Sometimes it is given as a saline solution, mixed with it, and then slowly infused into a vein.
• Injection into a muscle.
• Injection into the spinal fluid: This is something that is done in somewhat special cases.

This medicine is often given in a hospital or clinic , as there are times when medical supervision is required when giving it.

However, in rare cases , your doctor may instruct you to take this medicine at home. If so, you will be instructed on how to do it. It is very important to take the medicine exactly as prescribed, at the right time . Do not take more than the doctor tells you to, or take it more often.

Special reminder:

If you are given this medicine for arthritis or psoriasis, it is usually taken once a week. Do not take it daily. This is very important! Follow your doctor's instructions exactly.

When using injections, it is very important to dispose of used needles and syringes properly . Do not throw them in the trash. Instead, put them in a special sharps container . If you don't have one, ask your pharmacist or doctor for one. This is safer for the environment and for others.

Can this medicine be given to small children?

Yes, sometimes doctors prescribe this medicine for children as young as 2 years old for certain medical conditions. But there are some things to be very careful about when giving it. If you are giving this medicine to a child, the doctor will explain it to you.

What happens if you take too much medicine? (Overdosage)

If you think you have taken too much of this medicine, call a poison control center or emergency room immediately. Don't delay.

One more thing: This medicine is for you only. Do not give this medicine to anyone else , even if they have the same symptoms as you. The right medicine and dosage for each person is different.

What to do if you miss a dose of medication?

It is very important not to miss the prescribed dose of this medicine. If you are unable to keep your appointment or miss a dose, call your doctor or his/her team immediately.

If you are taking your medication at home and you miss a dose, talk to your doctor about it. Never take a double dose or an extra dose to make up for a missed dose.

What other medications may interact with this medicine? (Interactions)

This is a very important part. Methotrexate is a drug that can interact with many other medications. This means that another medication you are taking may change how Methotrexate works, or Methotrexate may change how another medication works. Sometimes, side effects may increase.

Never take methotrexate with the following medications:

• Acitretin ( also a medicine for a skin condition)

Also, the following medications may interact with Methotrexate. So be sure to tell your doctor if you are taking any of these:

• Aspirin or aspirin-like drugs, drugs containing salicylates.
• Azathioprine
• Some antibioticsTypes: For example `(chloramphenicol)`, `(penicillin)`, `(tetracycline)`.
• Some medicines that prevent or treat blood clots: For example `(warfarin)`, `(apixaban)`, `(dabigatran)`, `(rivaroxaban)`.
• Some medicines for stomach upset: For example `(esomeprazole)`, `(omeprazole)`, `(pantoprazole)`.
• Cyclosporine
• Dapsone
• Diuretics ( medicines that remove water from the body)
• Folic acid. (However, sometimes the doctor may give a lower dose of folic acid with methotrexate to reduce side effects. This is at the doctor's discretion.)
• Gold (given for some arthritic conditions)
• Hydroxychloroquine
• Live virus vaccines
• Medicines for infections: Examples include `(acyclovir)`, `(adefovir)`, `(amphotericin B)`, `(bacitracin)`, `(cidofovir)`, `(foscarnet)`, `(ganciclovir)`, `(gentamicin)`, `(pentamidine)`, `(vancomycin)`.
• Mercaptopurine
• NSAIDs (N.S.A.I.D.) are painkillers and anti-inflammatory drugs: For example, ibuprofen or naproxen.
• Pamidronate
• Pemetrexed
• Penicillamine
• Phenylbutazone
• Phenytoin
• Probenecid
• Pyrimethamine
• Retinoids (like vitamin A): Examples include isotretinoin and tretinoin.
• Steroid medications: For example, prednisone or cortisone.
• Sulfonamides: Examples include `(sulfasalazine)` and `(trimethoprim/sulfamethoxazole)`.
• Theophylline
• Zoledronic acid

This list may not be complete. Therefore, tell your doctor about all the medications you take (prescribed by a doctor, over-the-counter), traditional medicines, vitamins (dietary supplements), and if you smoke, drink alcohol, or use other drugs. Some things can interact with your medication.

What are the things to be careful about when taking this medicine?

When you take methotrexate, you may feel a little more uncomfortable and sick than usual.You may feel it. This is not unusual. This is because this medicine, especially when given to cancer patients, can affect not only cancer cells but also healthy cells. Therefore, if you experience any side effects, tell your doctor. However, continue taking the prescribed treatment until your doctor tells you to stop, even if you feel unwell.

Your doctor will monitor your condition closely while you are taking this medicine. He or she may also perform any necessary tests.

• Avoid drinking alcohol. This is very important because alcohol can increase the effects of this medicine on the liver.
• This medicine can cause serious side effects . To reduce this risk, your doctor may give you other medicines before you start taking methotrexate. Follow your doctor's instructions exactly.
• This medicine may make your skin more sensitive to sunlight . Therefore, limit your exposure to the sun as much as possible. If you must go out in the sun, wear clothing that covers your skin, wear sunglasses, and use sunscreen. Do not use sun lamps or tanning beds/booths.
• You may feel drowsy or dizzy . So, until you know how this medicine affects you, avoid driving, operating machinery, or doing anything that requires concentration . Avoid standing up or sitting down too quickly, especially if you are elderly. This can reduce the risk of dizziness and falling.
• You will need to have blood work done while taking this medicine. Do the tests as your doctor tells you.
• If you have symptoms like fever, chills, sore throat, or a cold , call your doctor for advice. Do not take medication on your own. This medication can reduce your body's ability to fight infections . So try to stay away from people who are sick as much as possible.
• This medicine may increase your risk of bleeding or bruising. If you notice any unusual bleeding (e.g. nosebleeds, bleeding gums, black tarry stools), tell your doctor right away.
• Be very careful when brushing, flossing, or using a toothpick. This can easily lead to infection or bleeding. If you are having any dental treatment, tell your dentist that you are taking this medicine.
• If you have severe diarrhea, nausea, vomiting, or excessive sweating , talk to your doctor. If you lose too much fluid from your body, it may be dangerous for you to take this medicine.
• Talk to your doctor about the risk of cancer.It is said that if you take this medicine, your risk of developing certain types of cancer may be slightly increased. Before you panic, ask your doctor for advice.

Take special care during pregnancy, breastfeeding, and fertility.

This is a very important point.

• Do not become pregnant while taking this medicine and for 6 months after stopping the medicine. If you are planning to become pregnant or think you may be pregnant, tell your doctor immediately.
• If a man is taking this medicine, he should not father a child while taking the medicine and for 3 months after stopping the medicine.
• It can cause serious harm to an unborn child. Ask your doctor for more information about this.
• Do not breastfeed your child while taking this medicine and for one week after stopping the medicine.
• This medicine may affect your ability to get pregnant or father a child . If you have any questions about your fertility, talk to your doctor.

Although these instructions are a bit long, they are all very important for your safety. If there is anything you don't understand, ask your doctor again.

What are the possible side effects of this medicine?

Like any medicine, methotrexate can cause side effects in some people. Not everyone gets them, some people do. Some side effects are serious, and you should tell your doctor right away if they happen. Some are not serious, but if they persist or are bothersome, you should tell your doctor.

Side effects that you should report to your doctor immediately:

• Allergic reactions: skin rash, itching, hives, swelling of the face, lips, tongue, or throat.
• Blood clot: leg pain, swelling, or warmth, difficulty breathing, chest pain.
• Dry cough, difficulty breathing, or shortness of breath.
• Infection: Fever, chills, cough, sore throat, non-healing wounds, pain or difficulty urinating, general discomfort, and feeling unwell.
• Kidney injury: Decreased urine output, swelling of the ankles, hands, or feet.
• Liver injury: Pain in the upper right side of the stomach, loss of appetite, nausea, light-colored stools, dark yellow or brown urine, yellowing of the skin or eyes, unusual tiredness or weakness.
• Low red blood cell count (Anemia): Unusual tiredness or weakness, dizziness, headache, shortness of breath.
• Redness, blistering, peeling, or peeling of the skin can also occur inside the mouth.
• Seizures.
• Unusual bruising or bleeding.

Side effects that usually do not require medical advice, but should be reported to your doctor if they persist or are bothersome:

• Diarrhea
• Dizziness
• Hair loss (This doesn't happen to everyone, only to some people. Hair may grow back after stopping the medication.)
• Nausea
• Sores in the mouth or throat with pain, redness, or swelling.
• Vomiting

This list may not include all side effects. If you notice anything unusual in addition to these, ask your doctor about it. You can also report side effects to the FDA, but in Sri Lanka, it is best to tell your doctor directly.

Where do you keep this medicine?

Since this medicine is usually given in a hospital or clinic , you don't have to keep it at home. So you don't have to worry about it. If you are rarely given it at home, your doctor or pharmacist will tell you how to store it (for example, whether to keep it in the refrigerator or out of the sun).

Finally, the most important things you need to remember (Take-Home Message)

So, you probably now understand that Methotrexate is a very useful drug, but one that requires some caution.

• Follow your doctor's instructions exactly. Be sure to follow the dosage, time of day, and day of the week (especially once a week for arthritis and psoriasis).
• Tell your doctor about all other medications you take, any other illnesses you have, and any allergies you have .
• If you are pregnant, trying to get pregnant, or breastfeeding, be sure to tell your doctor. This is very important.
• Be aware of side effects. If you experience any serious side effects, tell your doctor immediately.
• Avoid alcohol completely.
• Don't skip scheduled blood tests and doctor appointments.
• If you have any questions or doubts, don't be afraid to ask the doctor. You have the right to know everything clearly.

Remember, this medicine is to help you control your condition. So, let's work with the doctor and follow this treatment exactly. Wishing you a speedy recovery!

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