Shock may occur, though rarely, so the patient still has to be monitored sufficiently. If necessary, the administration should be discontinued and appropriate therapy instituted.
If gastrointestinal tract ulcer, bleeding, stomatitis, abdominal pain, diarrhea, nausea and vomiting occur, which may result in dehydration, methotrexate should be discontinued until recovery occurs. Anorexia, black vomit, enterocleisis may also occur.
Death by interstitial pneumonia has been reported. Occasionally, chronic interstitial occlusive pulmonary disease, pulmonary fibrosis may occur. Pulmonary symptoms (especially a dry, non-productive cough) or nonspecific pneumonia may be the symptoms of potential impairment; therefore, it requires discontinuance of treatment and careful investigation.
Headache, dizziness, blurred vision, dysphasia, hemiplegia, paralysis, convulsion, coma, and arrhythmia, tension of neck and head and backache may occur.
Aspermatism, ovarian insufficiency, catamenia insufficiency, infertility, abortion and fetal abnormality may occur.
Anemia, leukopenia, thrombocytopenia, bleeding, septicemia and hypogammaglobulinemia may occur. If granulocytopenia and flush occur, patient should be examined immediately and appropriate therapy, such as parenteral extensive antibiotic agents should be instituted.
Hepatic impairments (increases of GOT, GPT, AL-P), jaundice, fatty liver, sphacelism of liver tissue, fibrosis of liver tissue, hepatocirrhosis may occur. When crucial fibrosis of liver tissue and hepatocirrhosis occur, the administration should be discontinued.
Urethral necrobiosis, crucial nephropathy, hematuria and increases of BUN or creatinine value may occur. In high-dose administration of methotrexate for the treatment of osteosarcoma, acute renal failure may occur.
Loss of consciousness, hypotension, tachycardia, paralysis, sneezing, and dyspnea, cold and sweating may occur. If these occur, appropriate therapy should be instituted.
Photohypersensitivity, rash, urticaria, pruritus, erythematous rash, erythema, pigmentation, depigmentation, subcutaneous ecchymosis, acne, cavities, telangiectasia and incision of wounds may occur.
Malaise, parotiditis, blennophthalmia, cystitis, arthralgia, myalgia, diabetes, osteoporosis and accidental death may occur.