Methotrexate

Methotrexate

Have you ever wondered about a medication that can treat various conditions, from cancer to autoimmune diseases? We are talking about methotrexate, a powerful drug that has made waves in the medical world. This versatile medication has become a go-to option for many doctors, and we want to help you understand why.

Let us explore the ins and outs of methotrexate uses, how to take them, and what side effects to watch out for. We will also discuss precautions, how the drug works, and whether you can mix it with other medicines. 

What is Methotrexate?

Methotrexate is a powerful medication that influences various medical conditions. It is a versatile drug used to treat cancer, severe psoriasis, and rheumatoid arthritis. This antineoplastic agent works by inhibiting enzymes responsible for nucleotide synthesis, which leads to the suppression of inflammation and prevention of cell division.

In cancer treatment, methotrexate tablets slow down the growth of cancer cells. For psoriasis, they slow skin cell growth to stop scale formation. In rheumatoid arthritis, methotrexate has an impact on decreasing immune system activity. Methotrexate is available in different forms, including tablets and injections. 

Methotrexate Tablet Uses

Methotrexate tablets have a wide range of uses in treating various medical conditions, such as: 

• Severe psoriasis
• Severe active rheumatoid arthritis 
• Cancers including breast, lung, and certain head and neck cancers
• Some types of lymphoma and leukaemia
• For children, methotrexate tablets are helpful to treat acute lymphoblastic leukaemia and polyarticular juvenile idiopathic arthritis. 
• In some cases, doctors use methotrexate tablets to treat gestational choriocarcinoma and hydatidiform mole. 

How to Use Methotrexate Tablet

• Always take methotrexate tablets exactly as your doctor has told you. It is mandatory to follow their instructions carefully. Do not take more tablets than prescribed, as it would not make you better faster and could be harmful. 
• For conditions like rheumatoid arthritis or psoriasis, take methotrexate tablets only once a week on the same day. 
• For cancer treatment, the dosage varies based on our condition and body size. 
• Swallow the tablets whole with water, avoiding crushing or chewing them. 
• It is essential not to take methotrexate with milk-rich foods. 
• When taking this medication in liquid form, measure the dose carefully using a measuring cup or device.
• If you forget a dose, take it as soon as you remember, if it is within two days. However, if more than two days have passed, contact your doctor for advice.
• Ensure you take the optimal amount of fluids while taking this medication; this will help your kidneys remove the drug.

Side Effects of Methotrexate Tablets

Methotrexate is a strong medication that may cause several side effects. Common side effects include: 

• Loss of appetite
• Feeling sick
• Stomach pain
• Diarrhoea
• Headaches and drowsiness
• Dizziness
• Feeling tired
• Temporary hair loss
• Mouth ulcers
• Skin may become very sensitive to sunlight 

More serious side effects, although rare, can occur. These may include: 

• Liver issues manifested as yellowing of the eyes or skin, severe abdominal pain, dark-coloured urine
• Lung problems, including persistent cough, chest pain, or difficulty breathing
• Signs of anaemia, such as pale skin, unusual tiredness
• Kidney ailments, like swollen hands and feet 
• Easy bruising or bleeding
• Bone pain and muscle weakness
• Unusual pain and discolouration of the skin

Precautions

Individuals need to be cautious when using methotrexate tablets, including: 

• Medical History: It is mandatory to let your doctor know about any existing or past medical conditions, especially liver disease, kidney problems, lung conditions, bleeding disorders, poor immunity, gastrointestinal diseases (peptic ulcers or ulcerative colitis), or alcohol use.
• Pregnancy: You must avoid pregnancy while taking methotrexate, as it can harm the unborn baby. If you are planning to have children, discuss this with your doctor beforehand.
• Infection Precaution: Methotrexate can make you more susceptible to infections, so stay away from people with contagious illnesses. 
• Sun Sensitivity: You must also be careful about sun exposure, as the medication can make your skin more sensitive to sunlight.
• Vaccination: Tell your doctor that you are using methotrexate tablets before any vaccination or immunisation.
• Activities: Avoid activities that increase the chance of getting cut, bruised, or injured, as well as contact sports while using this medicine.

How Methotrexate Tablet Works

Methotrexate tablets work as antimetabolites, slowing down the growth of rapidly dividing cells. In cancer treatment, methotrexate inhibits enzymes responsible for nucleotide synthesis, preventing cell division. It inhibits the dihydrofolate reductase enzyme, necessary for converting dihydrofolate into tetrahydrofolate, an active form of folic acid needed for DNA and RNA synthesis.

For autoimmune conditions like rheumatoid arthritis, methotrexate has a different mechanism. It inhibits AICAR transformylase, leading to adenosine accumulation. This anti-inflammatory effect suppresses T-cell activation and increases the sensitivity of activated CD-95 T cells. Methotrexate also down-regulates B-cells and inhibits interleukin binding to cell surface receptors.

These mechanisms make methotrexate effective for treating various conditions, from cancer to inflammatory diseases like psoriasis and rheumatoid arthritis.

Can I Take Methotrexate with Other Medicines?

Many medications can interact with methotrexate, such as:

• Acitretin
• Antibiotics, such as penicillins, tetracyclines, sulfa medications
• Asparaginase
• Azathioprine
• Chloramphenicol
• Cisplatin
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
• Phenytoin
• Probenecid
• Procarbazine
• Proton pump inhibitors, like omeprazole, esomeprazole
• Pyrimethamine
• Sulfasalazine
• Retinoids such as isotretinoin

Always consult your treating expert doctor before starting any new medication while on methotrexate. 

Dosing Information

Methotrexate dosing varies based on the condition being treated. 

For rheumatoid arthritis, doctors start with 7.5 to 10 mg once a week, which is about 3 to 4 tablets. Your doctor may increase this to 25 mg per week if needed. 

The usual dose ranges from 10 to 25 mg once weekly for psoriasis. 

In cancer treatment, methotrexate doses can be much higher, ranging from 20 to 5000 mg/m2, depending on the type of cancer and specific regimen. 

It is necessary to take methotrexate tablets exactly as prescribed, usually on the same day each week. 

Conclusion

Methotrexate tablets have proven to be a versatile and powerful medication in modern healthcare. They have an influence on various conditions, from cancer to autoimmune diseases, by slowing down cell growth and reducing inflammation. The drug's ability to treat different illnesses makes it a valuable tool for doctors, but it is important to use it carefully and under close medical supervision.

FAQs

1. What happens if I miss a dose?

If the dose of methotrexate is missed, one should contact the doctor immediately for advice. It is important not to double the dose to catch up. The doctor will provide a new dosing schedule. For rheumatoid arthritis or psoriasis, patients take methotrexate once a week on the same day. If a person forgets and remembers within two days, they can take it as soon as possible. However, if more than two days have passed, they must consult their doctor for guidance.

2. What happens if I overdose?

Methotrexate overdose is a serious medical emergency. If you suspect an overdose, emergency services immediately. Symptoms may include severe nausea, vomiting, and bloody stools. Overdosing can lead to life-threatening complications, so it is essential to seek immediate medical attention. 

3. What to avoid when taking methotrexate?

Individuals should avoid or limit alcohol consumption. Drinking alcohol excessively can make a person susceptible to liver problems. It is best to stay away from unpasteurised milk and soft cheeses. Individuals should also limit their caffeine intake from coffee, tea, and energy drinks, as it may interfere with methotrexate's effectiveness. Additionally, individuals must avoid close contact with people who are unwell to reduce the risk of infections.

4. Is methotrexate safe?

Methotrexate can be safe when used as prescribed, but it requires careful monitoring. Individuals need regular blood tests to check their liver function and blood count. While it is effective for treating various conditions, methotrexate can have side effects. These may include nausea, fatigue, and increased susceptibility to infections. 

5. What is methotrexate drug commonly used for?

The versatility of methotrexate tablets makes it a valuable medication in modern healthcare. Doctors primarily use it for rheumatoid arthritis, severe psoriasis, and certain cancers, such as leukaemia, lymphoma, and solid tumours. Additionally, it is prescribed for Crohn's disease, juvenile idiopathic arthritis, and some autoimmune conditions. 

6. Who cannot take methotrexate?

Certain individuals should not take methotrexate. Doctors avoid prescribing it to pregnant or breastfeeding women, people with severe liver disease, kidney problems, or blood disorders. Those with active infections, including tuberculosis or HIV, and a history of alcohol use should not take methotrexate. Individuals with a known hypersensitivity to the drug are also excluded. 

7. When to take methotrexate?

Individuals take methotrexate once a week on the same day for conditions like rheumatoid arthritis or psoriasis. The specific day is chosen in consultation with your doctor. It is important to maintain this schedule consistently. If individuals are using methotrexate for cancer treatment, the dosing schedule may be different and should be precisely followed as prescribed by your oncologist.

8. Why is methotrexate taken once a week?

Methotrexate is taken once a week to balance its effectiveness and minimise side effects. This weekly dosing allows the medication to build up in our system and maintain consistency. It also gives our body time to recover between doses, reducing the risk of toxicity.

9. How long is methotrexate used for?

The duration of methotrexate treatment varies and depends on your condition and response to the medication. For rheumatoid arthritis, we may need to take it for several years to control symptoms effectively. In psoriasis treatment, the duration can also be long-term. The length of use for cancer treatment depends on the specific type of cancer and treatment plan. 

10. What foods should you avoid while taking methotrexate?

While taking methotrexate, individuals should be mindful of their diet. It is best to avoid non-pasteurised milk and soft cheeses due to the increased risk of infections. Individuals should limit their intake of caffeine-containing foods and drinks and alcoholic beverages. It is also necessary to maintain a balanced diet rich in folic acid.