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usual recommended starting dose is 7.5 - 10 mg per week and increasing dose versus
response to 15 mg / week. The drug takes approximately 4-6 weeks for a response to
start.
It cannot be used in established / active liver disease, renal impairment, significant lung
disease and excessive alcohol abuse. A history of hepatitis should be established prior
to therapy.
A chest Xray should be performed at start of therapy.
The side effects include nausea, diarrhoea, rashes, alopecia, mouth ulcers and
stomatitis.
More severe effects include marrow suppression, liver toxicity and pulmonary toxicity
(pneumonitis). To prevent nausea, doses should be administered in the evening. Urine
analysis is required every 3-6 months.
The use of folic acid with the drug is used to reduce side effects. In South Africa,
common practice is to use 5mg per day. Use of folic acid does not interfere with drug
activity and is given daily.
Liver biopsy is not considered essential for baseline assessment, or for routine follow up
after a predetermined total dose. Guidelines are now available for follow up and need
for biopsies.20 Routine monitoring must be done using blood count and liver function
assessments -- AST, ALT, GGT and full blood count. Blood tests must be done at
baseline, at one month, and thereafter every 2 months. If levels are persistently
increased 50% above normal, consider biopsy if the drug is to be continued.
Pregnancy: Teratogenicity is reported and therefore, males and females on methotrexate
should be taken off the drug for 3 months before conception. The drug is also
contraindicated in lactation.
Due to the potential for sun sensitivity exposure to direct sunlight should be avoided. If
you are in the sun please wear protective clothing and strong sun block. You will be
required to have frequent blood work while on this medication. It is very important that
you keep all lab and doctor’s appointments. Never stop the use of methotrexate unless
instructed by your physician. Avoid the use of alcohol while on this drug.
Unless instructed otherwise, make sure you drink plenty of water the day before and
after your weekly dose. You may want to schedule your dose on a day when you have
no plans for the next day, until you find out exactly how you react to the drug.
Methotrexate suppresses the immune system. Avoid exposure to illnesses and viruses
when possible.