Methotrexate is used on its own or together with other medicines to treat meningeal leukaemia, a type of blood cancer wherein cancer cells have spread to the meninges (membrane that covers the brain and spinal cord). It helps by preventing the rapid growth of cancer cells.
This medicine may be used to treat other conditions as decided by your doctor.
Methotrexate injection is to be given intrathecally (into the spine). It is delivered directly into the bloodstream via the blood vessel.
Your doctor or nurse will administer the injection for you.
The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment frequency and timeframe depending on your condition.
Ensure that you keep all appointments with your doctor so that you do not miss any doses. Your doctor also needs to regularly monitor your response to Methotrexate.
If you miss an appointment or miss an injection, alert your doctor or nurse. A replacement appointment or injection should be given as soon as possible.
Alert your doctor if you have any of the following conditions:
- significant liver disease
- alcoholism (alcohol dependence)
- blood disorder e.g. anaemia
- weak immune system
- other infection
- severe kidney disease
as Methotrexate may not be suitable for you.
Do not use this medicine if you are pregnant or planning to have a baby soon. If you become pregnant while being treated with this medicine, alert your doctor immediately. Methotrexate may cause harm to your unborn child. You must use proven birth control methods during and for at least 6 months after stopping the treatment.
Do not use this medicine if you are breastfeeding.
Methotrexate may possibly affect male fertility. Adequate contraceptive methods must be used during therapy and for at least 3 months after stopping the treatment. You may wish to discuss birth control methods with your doctor.
Alert your doctor if you have been recently vaccinated.
You must avoid any vaccinations without consulting with your doctor.
Inform your doctor if you have any of the following conditions:
- mild to moderate kidney disease
- fluid build-up around the lung or in the abdominal cavity
- long-term infection e.g. TB (lung infection known as tuberculosis), hepatitis B or C
- high cholesterol levels
- lung disease
- folate deficiency
If you are going to have radiation therapy, inform your doctor that you are using Methotrexate.
If you are scheduled for an operation, including minor surgery and dental work, inform your doctor or dentist that you are using this medicine.
Why is it important to keep my appointments with the doctor?
Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.
- Pregnancy tests must be done before treatment to know if this medicine is suited for you to use.
- Routine tests (e.g. lung/liver/kidney function, complete blood count, chest x-ray, urine analysis) may be done before and during treatment with this medicine.
- Regular monitoring of skin reactions may also be needed during therapy.
Your doctor will advise you about how often you need to have these tests.
Methotrexate may cause dizziness. If affected, do not drive or take part in any activity in which you need to be alert.
Other side effects include any of the following: headache, burning sensation of the skin, rash, hair loss, diarrhoea, nausea, vomiting, indigestion, loss of appetite, joint and muscle pain, loss of libido, absence of menstruation, nose bleed, changes in mood, and fits or seizures.
This medicine may also make your skin more sensitive to sunlight. Apply sunscreen when going outdoors and avoid prolonged exposure to sunlight and UV lamps.
Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:
- sore or inflammation inside of the mouth
- rashes with peeling of the skin or blistering of the lips, mouth or eyes accompanied by fever
- yellowing of the skin or eyes, stomach pain, persistent tiredness
- dry cough, difficulty breathing
- swelling in the legs, feet or ankles, reduced amount of urine
- cough with greenish, yellow phlegm, chest pain
- spitting or coughing up blood
This medicine will cause the level of your red blood cells, white blood cells and platelets to drop.
Red blood cells carry oxygen around your body. A fall in the level of red blood cells may make you feel tired and worn out.
White blood cells help your body fight infections. A fall in the level of your white blood cells may put you at higher risk for infections, such as coughs, colds and flu, which may lead to more serious infections. Avoid crowded places and people who are sick. Alert your doctor if you have a fever or a cough or flu that does not go away.
Platelets help your blood to clot when there is a cut in the skin. A fall in the level of your platelets may put you at risk of bleeding more than usual. Do not take part in activities where you may fall or get injured, such as contact sports. Alert your doctor if you get any unusual bruising (large bruises or several bruises, especially if the bruises appeared on their own) or bleeding that takes a long time to stop (for example, too much bleeding when you floss or brush your teeth).
Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.
Avoid vaccinations during treatment with Methotrexate.
Inform your doctor and pharmacist if you are taking or using any of these medicines:
- certain antibiotics e.g. chloramphenicol, ciprofloxacin
- NSAIDs (medicines for pain and inflammation) e.g. azapropazone, diclofenac, ibuprofen
- stomach medicines e.g. omeprazole, pantoprazole
- medicines for epilepsy (fits or seizures) e.g. phenytoin, levetiracetam
- other medicines for cancer e.g. cisplatin
- nitrous oxide (medicine used to block pain and sensation)
- other medicine used for rheumatoid arthritis e.g. leflunomide
- medicines used in organ transplant or certain immune disorders e.g. azathioprine, ciclosporin
- sulfasalazine (medicine used for inflammation of the bowel)
- probenecid (medicine for gout)
- theophylline (asthma medicine)
- retinoids e.g. acitretin (medicine used for psoriasis)
This list does not include all medicines that may interact with Methotrexate.
Always inform your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements and medicines that you buy without a prescription.
Store in a cool, dry place away from the reach of children.
Protect from light.
Medicines must not be used past the expiry date.
As this is a cancer medicine, always return any unused or expired medicines to the clinic, hospital, or pharmacy for disposal.