methotrexate (injection)

What is the most important information I should know about methotrexate injection?

What is methotrexate injection?

Methotrexate injection is used in combination with other cancer treatments to treat acute lymphoblastic leukemia and osteosarcoma in adults and children.

Methotrexate injection may also be used alone or in combination to prevent and treat meningeal leukemia, and treat non-Hodgkin lymphoma in adults and children.

Methotrexate injection is used in combination with other cancer treatments to treat gestational trophoblastic neoplasia and breast cancer in adults.

Methotrexate injection is also used alone to treat squamous cell carcinoma of the head and neck in adults.

Methotrexate injection is also used to treat severe psoriasis and rheumatoid arthritis in adults, and to treat active polyarticular juvenile idiopathic arthritis in children.

Methotrexate injection may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before receiving methotrexate injection?

Methotrexate injection should not be used to treat psoriasis or arthritis if you have:

• alcoholism, cirrhosis, or liver disease;
• a blood cell disorder, weak immune system; or
• if you are pregnant or breastfeeding.

Methotrexate injection is sometimes used to treat cancer in people who have a condition listed above. Your doctor will decide if this treatment is right for you.

Tell your doctor if you have ever had:

• kidney disease (or if you are on dialysis);
• breathing problems, fluid build-up around the stomach (ascites), a buildup of fluid around your lungs (also called pleural effusion);
• a stomach ulcer or ulcerative colitis;
• history of neurologic problems such as seizures;
• any type of infection;
• radiation treatment;
• alcoholism; or
• if you plan to have any surgeries with general anesthesia, including dental surgery.

Make sure you are current on all vaccines before you start using methotrexate injection. Tell your doctor if you recently received a vaccine or are scheduled for a booster dose.

• If you are a woman, you may need a pregnancy test to make sure you are not pregnant. Use birth control while using this medicine and for at least 6 months after your last dose.
• If you are a man, use birth control if your sex partner is able to get pregnant. Keep using birth control for at least 3 months after your last dose.

How is methotrexate injection given?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Doses are based on body surface area (height and weight). Your dose may change if you gain or lose weight or if you are still growing.

Methotrexate injection is injected into a muscle, under the skin, or as an infusion into a vein. A healthcare provider will give you this injection and may teach you how to properly use the medication by yourself.

Methotrexate injection is injected in the stomach or thigh when used for psoriasis or arthritis. Do not inject within 2 inches of your navel (belly button), arms or other areas of the body, or areas where the skin is tender, bruised, red, hard, or has scars or stretch marks.

Prepare an injection only when you are ready to give it. Call your pharmacist if the medicine looks cloudy, has changed colors or has particles in it.

Do not reuse a needle or syringe, especially a single-use vial (bottle) or auto-injector. Place them in a puncture-proof "sharps" container and dispose of it following state or local laws.

You will need frequent medical tests, and your next dose may be delayed based on the results.

Using methotrexate injection may increase your risk of developing other cancers. Ask your doctor about this risk.

Follow all storage instructions provided with methotrexate injection. Your pharmacist can provide more information about how to store this medicine.

What happens if I miss a dose?

What happens if I overdose?

What should I avoid while receiving methotrexate injection?

Avoid receiving a "live" vaccine, or you could develop a serious infection. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), and zoster (shingles).

What are the possible side effects of methotrexate injection?

• sudden chest pain, wheezing, dry cough, feeling short of breath;
• swollen lymph glands, night sweats, weight loss;
• blisters or ulcers in your mouth, red or swollen gums, trouble swallowing, feeling very thirsty;
• blood in your urine or stools, skin changes such as redness, warmth, swelling, or oozing;
• unusual bruising or bleeding, new signs of infection (fever, weakness, cough, diarrhea, burning when you urinate);
• signs of metabolic acidosis --confusion, vomiting, lack of energy, irregular heartbeats;
• low blood cell counts --fever, chills, bruising or bleeding, pale skin, cold hands and feet, feeling light-headed or short of breath;
• kidney problems --swelling, urinating less, feeling tired or short of breath;
• liver problems --loss of appetite, stomach pain (upper right side), tiredness, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• nerve problems --confusion, weakness, drowsiness, coordination problems, feeling irritable, headache, neck stiffness, back pain, vision problems, loss of movement in any part of your body, seizure; or
• signs of tumor cell breakdown --tiredness, weakness, muscle cramps, nausea, vomiting, diarrhea, fast or slow heart rate, tingling in your hands and feet or around your mouth.

Common side effects may include:

• low blood cell counts, fever, chills, tiredness, not feeling well;
• headache, dizziness, cough, chest tightness, trouble breathing;
• mouth sores, nausea, vomiting, stomach pain, diarrhea, runny or stuffy nose, sneezing, sore throat;
• abnormal liver function tests; or
• rash, hair loss, skin lesions, eyes being more sensitive to light.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect methotrexate injection?

Tell your doctor about all your other medicines, especially:

• an antibiotic or sulfa drug, folic acid, mercaptopurine, nitrous oxide, phenytoin, probenecid, dapsone, pyrimethamine;
• NSAIDs (nonsteroidal anti-inflammatory drugs) --aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or
• stomach acid reducers --esomeprazole, lansoprazole, omeprazole, pantoprazole, Nexium, Prilosec, Protonix, and others.

This list is not complete and many other drugs may affect methotrexate injection. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Where can I get more information?

Your doctor or pharmacist can provide more information about methotrexate injection.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2023 Cerner Multum, Inc. Version: 8.01. Revision date: 5/8/2023.