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What is methotrexate?

Methotrexate interferes with the growth of certain cells of the body, especially cells that reproduce quickly, such as cancer cells, bone marrow cells, and skin cells.

Methotrexate is used to treat certain types of cancer of the breast, skin, head and neck, or lung. Methotrexate is also used to treat severe psoriasis and rheumatoid arthritis.

Methotrexate is usually given after other medications have been tried without successful treatment of symptoms.

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

Precautions

Instructions

Side-effects

Interactions

Precautions

Do not use this medication if you are allergic to methotrexate. Do not use methotrexate to treat psoriasis or rheumatoid arthritis if you have:

• liver disease;
• alcoholism or cirrhosis of the liver;
• a blood cell disorder such as anemia (lack of red blood cells) or leukopenia (lack of white blood cells);
• a bone marrow disorder; or
• if you are breast-feeding a baby.

Methotrexate is sometimes used to treat cancer even when patients do have one of the conditions listed above. Your doctor will decide if this treatment is right for you.

Before using methotrexate, tell your doctor if you are allergic to any drugs, or if you have:

• kidney disease;
• liver disease;
• lung disease or pneumonia;
• stomach ulcers;
• any type of infection; or
• if you are receiving radiation treatments.

FDA pregnancy category X. Methotrexate can cause birth defects in an unborn baby. Do not use methotrexate to treat psoriasis or rheumatoid arthritis if you are pregnant. Tell your doctor right away if you become pregnant during treatment.

Use birth control to prevent pregnancy while you are using methotrexate, whether you are a man or a woman. Methotrexate use by either parent may cause birth defects.

Before you start taking methotrexate, your doctor may want you to have a pregnancy test to make sure you are not pregnant.

If you are a man, use a condom to keep from causing a pregnancy while you are using methotrexate. Continue using condoms for at least 90 days after your treatment ends.

If you are a woman, use an effective form of birth control while you are taking methotrexate, and for at least one cycle of ovulation after your treatment ends.

Do not give this medicine to a child without the advice of a doctor.

Older adults may be more likely to have side effects from this medication.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds), especially if you are being treated for psoriasis. Methotrexate can make your skin more sensitive to sunlight and your psoriasis may worsen.

Avoid drinking alcohol while taking methotrexate.

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Instructions

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of methotrexate can be fatal.

Overdose symptoms may include pale skin, easy bruising or bleeding, unusual weakness, mouth sores, nausea, vomiting, black or bloody stools, coughing up blood or vomit that looks like coffee grounds, and urinating less than usual or not at all.

Call your doctor if you miss a dose of methotrexate.

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Side-effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using methotrexate and call your doctor at once if you have any of these serious side effects:

• dry cough, shortness of breath;
• diarrhea, vomiting, white patches or sores inside your mouth or on your lips;
• blood in your urine or stools;
• urinating less than usual or not at all;
• fever, chills, body aches, flu symptoms;
• sore throat and headache with a severe blistering, peeling, and red skin rash;
• pale skin, easy bruising or bleeding, weakness; or
• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

• nausea, vomiting, upset stomach;
• dizziness, tired feeling;
• headache;
• bleeding of your gums; or
• blurred vision.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

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Interactions

Before taking methotrexate, tell your doctor if you are using any of the following drugs:

• azathioprine (Imuran);
• chloramphenicol (Chloromycetin);
• hydroxychloroquine (Plaquenil, Quineprox);
• retinol, tretinoin (Retin-A), isotretinoin (Accutane);
• steroids (prednisone and others);
• sulfa drugs such as Azulfidine, Bactrim, or Septra;
• phenytoin (Dilantin);
• probenecid (Benemid);
• tetracycline (Brodspec, Panmycin, Sumycin, Tetracap);
• theophylline (Elixophyllin, Slo-Bid, Theobid, Theo-Dur);
• gold treatments such as auranofin (Ridura) or aurothioglucose (Solganol);
• oral diabetes medications such as acetohexamide (Dymelor), chlorpropamide (Diabinese), glipizide (Glucotrol), glimepiride (Amaryl), or tolbutamide (Orinase);
• penicillin antibiotic such as ampicillin (Principen), amoxicillin (Amoxil, Trimox), carbenicillin (Geocillin), cloxacillin (Cloxapen), dicloxacillin (Dynapen), nafcillin (Unipen), oxacillin (Bactocill), penicillamine (Cuprimine, Depen), or Bee-Pen, Pen-Vee K, Veetids;
• salicylates such as aspirin, Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others; or
• NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), piroxicam (Feldene), and others.

This list is not complete and there may be other drugs that can interact with methotrexate. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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