Methotrexate Tablets

POSSIBLE SIDE EFFECT

• As with all medicines, as well as helping with your illness, methotrexate may cause some unwanted effects although not everybody gets them.
• All medicines can cause allergic reactions although serious allergic reactions are rare.
• Any sudden wheeziness, difficulty in breathing, swelling of the eyelids, face or lips, rash or itching (especially affecting your whole body) should be reported to a doctor immediately.

Most of the effects listed below will only be seen in patients who are receiving high doses of methotrexate to treat cancer.

• They are not seen as often and are not as severe at the doses used in the treatment of psoriasis or rheumatoid arthritis.
• If you notice any of the following side effects stop taking the medicine and talk to your doctor as soon as possible.
• Methotrexate can make you more likely to catch infections. If you think you have an infection, a sore throat, mouth ulcers, fever, chills, or achiness during treatment you should tell your doctor immediately.
• Methotrexate can cause inflammation of the lung with breathlessness, symptoms of which include persistent cough, experience of pain or difficulty in breathing or becoming breathless Severe skin rash that causes blistering.
• These may be signs of a condition known as Stevens Johnson Syndrome. Your doctor will stop your treatment in these cases.

Tell your doctor straight away if you notice any of the following side effects:
Common – (affects less than 1 in 10 people):

• headache, dizziness, fatigue
• swelling of the mouth
• anorexia (eating disorder)
• feeling sick (nausea) or vomiting
• loose stools
• raised liver enzymes
• a skin rash with reddening of the skin hair loss.

Uncommon – (affects less than 1 in 100 people):

• a lump in your neck, groin or armpits with associated backache, weight loss or night sweats
• decrease in the number of blood cells
• pale skin, weakness, tiredness or difficulties in breathing
• unusual bleeding or bruising
• nose bleed
• itching
• blistering and peeling of the top layer of the skin all over the body
• vaginal ulcers
• kidney damage.

Rare – (affects less than 1 in 1,000 people):

• raised blood sugar levels (diabetes mellitus)
• herpes zoster (shingles) which is a viral disease characterized by a painful skin rash with blisters
• a serious infection affecting the whole body (sepsis) characterized by fever, chills, rapid breathing and low blood pressure
• depression, confusion
• inability to move one half of the body
• fall in blood pressure
• tenderness and swelling of the lower extremities (clot in the veins)
• throat infection
• swelling of the gums
• stomach or intestinal ulcers, bleeding or inflammation of the intestine

Very Rare – (affects less than 1 in 10,000 people):

• drowsiness
• irritation
• difficulty with speech
• blurred vision
• eye infection
• chest pain or tightness of chest, with difficulty in breathing
• lung infection,vomiting blood,boils,blood in urine,infertility,vaginal bleeding.
• small bruises on the skin caused by blood leaking from broken blood vessels
• vasculitis (pain or redness of the blood vessels)
• dilatation of small blood vessels causing focal red lesions
• pain or difficulty in passing urine
• elevation of urea and/or creatinine in the blood,enlargement of breasts

* In a small number of patients methotrexate may cause serious side effects and on rare occasions, death.
* You should contact your doctor immediately if you notice any serious side effects.
Certain other unwanted effects can only be detected by your doctor, these include

• blood disorders
• changes in liver and kidney function or bone density.

HOW TO STORE METHOTREXATE TABLETS

• Keep this medicine out of the sight and reach of children.
• Do not use this medicine after the expiry date which is stated in the carton and blister after “Exp. Date”. The expiry date refers to the last day of that month.
• Do not store above 25°C.

Disposal of the product:

• Medicines should not be disposed of via wastewater or household waste.
• Ask your pharmacist how to dispose of medicines no longer required.
• These measures will help to protect the environment.

HOW TO TAKE METHOTREXATE TABLETS

Always take your tablets exactly as your doctor has told you to.
This information will also be on the pharmacist’s label.
If you are not sure how to take your tablets ask your doctor or pharmacist.
Do not take more tablets than your doctor has told you to.
It will not make you better any faster and it may harm you.

ADULTS:
Patients with psoriasis:
USUAL DOSE: between 10 and 25mg (4 to 10 tablets) taken once a week on the same day each week.
Patients with rheumatoid arthritis:
USUAL DOSE: between 7.5 and 20mg (3 to 8 tablets) taken once a week on the same day each week.
These doses may alter as your condition changes
Patients with cancer:
* Your doctor will decide the dose depending on your condition.
* Methotrexate may be the only drug given or it may be given with other drugs.
* Your doctor will want to monitor your progress, usually every 2-3 months, whilst you are receiving Methotrexate Tablets.
* Before, during and after your treatment you may have tests, such as a chest X-ray, physical
* Examination and blood tests to check that your liver and kidneys are working properly.
* Do not miss your appointments as these are necessary to ensure that Methotrexate Tablets are used safely.
* Your doctor may give you additional medication to help make sure that Methotrexate does not collect in the kidneys.

BEFORE YOU TAKE METHOTREXATE TABLETS
Do not take Methotrexate Tablets :

• If you know that you are allergic to methotrexate
• Are pregnant, breastfeeding or trying for a baby, you and your partner should avoid conception (becoming pregnant or fathering children) for at least six months after your treatment with methotrexate has stopped.
• suffer from a problem of excessive drinking (alcoholism)
• Have severe liver problems, including alcoholic liver disease and recent or active hepatitis (inflammation of the liver)
• have severe kidney problems
• have any serious blood disorders including severe anaemia or abnormal numbers of blood cells
• Such as low white cells (leucopenia) or low small blood cell numbers (platelets) causing (thrombocytopenia)
• have a medical condition or are receiving medication which lowers your resistance to infection
• have symptoms which may suggest an active infectious disease (e.g. fever, chills, achiness).

Take special care and talk to your doctor or pharmacist before taking Methotrexate Tablets if you:

• have any mild or moderate liver or kidney problems or blood disorders
• have stomach ulcers or suffer from inflammation and ulceration of the gut
• have severe mouth ulcers
• have diarrhea, are weak or infirm
• have excess fluid between the lungs and chest wall (pleural effusion) causing breathlessness or in the abdomen causing swelling of the stomach (ascites).
• These may affect the levels of
  — methotrexate in your blood
  — are receiving or intend to receive any vaccine, as methotrexate can reduce their effect
  — have diabetes mellitus
  — are an elderly patient or a very young child
  — have impaired respiratory function
  –are receiving radiotherapy or ultraviolet (UV) radiation concurrently.
  Taking other medicines:
• Please tell your doctor or pharmacist if you are taking, or have recently taken, any other medicines.
• This includes medicines obtained without a prescription.
• The effects of these medicines may change, especially if you are taking:
  * NSAIDs (non-steroidal anti-inflammatory drugs) e.g. ibuprofen, indomethacin, azopropazone or aspirin (for relief of pain or inflammation) including any preparations of these bought without a prescription.
  * Taking these products together with Methotrexate Tablets can increase its toxic effects
  — diuretics (e.g. loop diuretics like furosemide, hydrochlorothiazide or triamterene – water pills)
  — phenytoin, carbamazepine and valproate (for seizures)
  — antibiotics including penicillins, sulphonamides, trimethoprim/sulfamethoxazole (as cotrimoxazole),
  — neomycin, ciprofloxacin, doxycycline, tetracyclines, chloramphenicol
  — nitrous oxide-based anaesthetics
  — vaccinations
  — oral hypoglycaemics (lower blood sugar levels)
  — olazepine used for the treatment of schizophrenia
  — pyrimethamine (medication against malaria)
  — digoxin (used to treat heart failure)
  — corticosteroids used for the treatment of arthritis, allergic reactions or skin diseases
  — cytostatics (medication against cancer), e.g. cisplatin,
  — retinoids, e.g. acitretin (for psoriasis or skin disorders)Taking Methotrexate Tablets with food and drink:
  * You should not drink alcohol whilst you are taking this medicine.
  Pregnancy and breast feeding:
• Methotrexate temporarily affects sperm and egg production and can harm unborn babies or cause miscarriages.
• It MUST NOT be taken during pregnancy or breast feeding. You should avoid becoming pregnant for at least six months after your treatment with methotrexate has stopped.
• Men: Methotrexate affects sperm. You should avoid fathering a child for at least six months after your treatment has stopped. Ask your doctor or pharmacist for advice before taking any medicine.

• Driving and Using Machines:
• Methotrexate Tablets may make you feel tired, dizzy or may give you blurred vision.
• You should not drive or use machines when you first start to take this medicine until you are certain that you are not getting these side effects. If in any doubt, speak to your doctor before you drive or use machines.