Methotrexate

(meth oh TREKS ate)

What key warnings do I need to know about before giving this drug to my child?

• Your child's bone marrow, liver, lung, and kidney function will be watched closely. This drug may cause very bad infections, very bad skin side effects, lymphomas, loose stools, and mouth sores.
• Talk with your child's doctor before giving your child any pain drugs (eg, ibuprofen, ketoprofen, naproxen). Your child's doctor will talk with you about the good effects and bad effects and your child will be closely watched while taking this drug.
• Sometimes drugs are not safe when your child takes them with other drugs. They can cause bad side effects. This is one of those drugs. Be sure to talk to your child’s doctor about all the drugs your child takes.

Is it safe for my child to take this drug?

• Not if your child has an allergy to methotrexate or any other part of this drug.
• Be sure to let the doctor know if your child has any allergies or side effects to drugs, foods, or dyes. Make sure to tell about the allergy and what signs your child had. This includes telling about rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
• Not if your child has any of these health problems: Bone marrow disease, very bad liver disease, low blood cell count, or poor kidney function.

Why does my child need this drug?

• It is used to treat arthritis.
• It is used to treat cancer.
• It is used to treat leukemia.
• It is used to treat psoriasis.
• It is used to treat inflammatory bowel disease.
• It is used to stop graft-versus-host-disease.

How does this drug work?

• Methotrexate harms cancer cells causing their death.
• It helps swelling.
• It lowers the body's harmful response to diseases of the immune system.

How is this drug given?

• Follow how to give this drug as you have been told by your child's doctor. Do not give more than you were told to give.
• If your child is taking this drug by mouth, it is most often only given once a week. Talk with your child's doctor to make sure the dose is right.
• Give on an empty stomach.
• Shot:
• It is given as a shot into a muscle, vein, or into the fatty part of the skin.
• Your child's doctor may teach you how to give the shot.
• This drug may be given as a shot into the spinal fluid.

How long does this drug take to work?

• It may take a few days to see the full effect.

What do I do if my child misses a dose? (does not apply to patients in the hospital)

• Give a missed dose as soon as you think about it.
• If it is close to the time for your child's next dose, skip the missed dose and go back to your child's normal time.
• Do not give 2 doses or extra doses.
• Do not change the dose or stop your child's drug. Talk with your child's doctor.

What safety measures do I need to take when my child is using this drug?

• Keep a list of all your child's drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your child's doctor.
• If your child has had hepatitis, talk with the doctor.
• If your child has kidney disease, talk with the doctor.
• If your child has liver disease, talk with the doctor.
• If your child has mouth sores, stomach irritation, or ulcers, talk with the doctor.
• If your child has a weak immune system, gets infections easy, or is on antibiotics, talk with your child's doctor.
• Have your child's blood work checked. Talk with your child's doctor.
• Check all drugs your child is taking with your child's doctor. This drug may not mix well with some other drugs.
• When taking methotrexate for a long time or at high doses, your child may need closer watching of liver and bone marrow function. Talk with the doctor.
• Talk with the doctor before your child gets any vaccines. Use with this drug may either raise the chance of very bad infection or make the vaccine not work as well.
• Your child may get sunburned more easily. Avoid lots of sun, sunlamps, and tanning beds. Use sunscreen and dress your child in clothing and eyewear that protects him/her from the sun. Keep protecting your child from sunburn for at least a month after using this drug.

What are some side effects of this drug?

• Chance of getting an infection. Avoid people with infections, colds, or flu.
• Upset stomach or throwing up. Many small meals and good mouth care may help. Older children may suck hard, sugar-free candy.
• Loose stools (diarrhea).
• Headache.
• Not hungry.
• Mouth irritation. Using a soft toothbrush or cotton swabs and rinsing the mouth may help. Do not use mouth rinses that have alcohol in them.
• Sore throat.
• Hair loss. Hair most often grows back when this drug is stopped.
• Kidney failure may rarely happen.
• Harm to the liver may rarely happen.
• Harm to the lungs may rarely happen.
• Anemia, low white blood cell count, and low platelet count may rarely happen.
• Other kinds of cancer may rarely happen later in life.

When do I need to call my child's doctor?

• If any of this news causes you to be worried or if any of the unwanted side effects happen after your child is given this drug.
• If you think there was an overdose, call your local poison control center or ER right away.
• If your child shows signs of a very bad reaction, call your child's doctor or the ER right away. These include wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; swelling of face, lips, tongue, or throat; or if your child is not acting normal.
• If your child shows any signs of infection. These include a fever of 100.5°F (38°C) or higher, chills, very bad sore throat, ear or sinus pain, cough, more sputum or change in color or sputum, pain with passing urine, mouth sores, wound that will not heal, or anal itching or pain.
• If your child has chest pain or pressure or a fast heartbeat.
• If your child has trouble breathing.
• If your child has pinpoint red spots on his/her skin.
• If your child is feeling very tired or weak.
• If your child has very bad belly pain.
• If your child has a very bad upset stomach or is throwing up.
• If your child has very loose stools (diarrhea).
• If your child has a cough that does not go away.
• If your child is not able to eat.
• If your child has dark urine or yellow skin or eyes.
• If your child has any bruising or bleeding.
• If your child gets a rash.
• If your child’s health problem does not get better or if you believe your child’s health problem is worse.

How do I store and/or throw out this drug?

• Store at room temperature.
• Protect from light.
• Protect tablets from water. Do not store in a bathroom or kitchen.
• Shot:
• Follow how to store the shot closely. Talk with the doctor.

General drug facts

• If your child has a very bad allergy, he/she needs to wear an allergy ID at all times.
• You may get this drug by drug order only. If there are refills, call your pharmacy. If your child does not have refills left, you may need to call your child's doctor.
• Get rid of this drug when your child no longer needs it or if the drug is outdated.
• Most drugs may be thrown away in household trash after mixing with coffee grounds or kitty litter and sealing in a plastic bag.
• In Canada, take any unused drugs to the pharmacy. Also, visit http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/med/disposal-defaire-eng.php#th to learn about the right way to get rid of unused drugs.http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/med/disposal-defaire-eng.php#th to learn about the right way to get rid of unused drugs.
• Do not share your child's drug with others and do not give anyone else's drug to your child.
• Keep all drugs out of the reach of children and pets.
• Keep a list of all your child's drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your child's doctor.
• Call your doctor for help with any side effects. If in the U.S., you may also call the FDA at 1-800-FDA-1088 or if in Canada, you may also call Health Canada's Vigilance Program at 1-866-234-2345.
• Talk with the doctor before giving your child any new drug, including OTC, natural products, or vitamins.
• If you do not use a drug the right way, it may not be safe. Follow what your child’s doctor tells you.

Copyright © 1978- Lexi-Comp Inc., The Children's Hospital, Denver, CO., and Pediatric Pharmacy Advocacy Group, Inc. All Rights Reserved. This information is protected under US and international copyright law. Unauthorized use or reproduction is prohibited.