Chemotherapy Patient Resource Area

Methotrexate/Trexall™/Rheumatrex^®

Drug
Methotrexate (generic name) is manufactured as Trexall^® (trade name) (Barr Laboratories, Inc., Pomona, NY) and Rheumatrex^® (trade name) (Lederle, Pearl River, NY).

Action
Methotrexate slows or stops the growth of rapidly dividing cells, such as cancer cells. It is in the class of drugs known as antimetabolites and is used to treat leukemias and trophoblastic neoplasms. It also is used to treat rheumatoid arthritis, psoriasis, and ectopic pregnancy.

What does the drug look like?
Methotrexate is supplied as 2.5-mg, round, yellow tablets. Trexall^® is supplied as 5-mg, green, oval, scored tablets; 7.5-mg, blue, oval, scored tablets; 10-mg, pink, oval, scored tablets; and 15-mg, purple, oval, scored tablets. Rheumatrex^® 2.5-mg tablets are supplied in dose packs (brown packs containing 5 mg per week, blue packs containing 7.5 mg per week, red packs containing 10 mg per week, aqua packs containing 12.5 mg per week, and pink packs containing 15 mg per week).

How long will I take the drug?
The length of treatment varies and depends on your diagnosis and how well your body responds to treatment.

How do I take the drug?
Methotrexate is taken by mouth once a day. The dose of methotrexate is determined by your doctor, and your doctor and pharmacist will tell you how many tablets to take each day. The length of treatment varies depending on the disorder being treated. Be sure to read the label on your medicine vial closely so that you take the dose you need. Swallow each tablet whole; do not chew them. If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. If you accidentally take too many pills or someone else accidentally takes your medicine, contact your doctor or the nearest emergency room immediately.

Storage
Store this medicine at room temperature, away from excess heat and moisture (do not store on a windowsill or in a bathroom). Keep this medicine in its original container, out of the reach of children or pets. Do not keep outdated medication that you no longer need. Ask your nurse or pharmacist how you should dispose of any medicine you do not use.

• Methotrexate lowers the number of white blood cells in your blood, increasing your chance of getting an infection. Avoid crowds and people who have infections. Call your doctor immediately if you develop a temperature higher than 100.5^oF or have chills, a cough, or painful urination. Your complete blood count (CBC) will be monitored throughout treatment, and dosage adjustments (or stopping treatment for a few days) may be needed.
• Methotrexate also lowers the number of platelets in your blood, which are necessary for proper blood clotting. DO NOT take aspirin or aspirin-containing products. Call your doctor immediately if you notice unusual bleeding or bruising, have black or tar-like stools, see blood in your urine, or develop pinpoint red spots on your skin. Use a soft toothbrush, and use care when flossing. Your healthcare providers may give you suggestions on how to care for your mouth, and these directions should be followed carefully.
• Methotrexate may cause mouth sores. If mouth sores occur, avoid spicy foods and do not use mouthwash, because it may contain alcohol and worsen mouth pain. Your healthcare providers may give you suggestions on how to care for your mouth or manage mouth sores, and these directions should be followed carefully.
• Do not drink alcohol while taking methotrexate, because it increases the risk of liver damage.
• Methotrexate may thin hair or make it brittle.
• Before having surgery, including dental surgery, tell the surgeon or dentist that you are taking methotrexate.
• Methotrexate may interfere with the normal menstrual cycle (period) in women and may stop sperm production in men. However, you must use a reliable method of birth control and not assume that you cannot get pregnant or get someone else pregnant. Women who are pregnant or would like to become pregnant need to discuss this with their doctors before taking this drug.

Drug interactions
Let your doctor know if you are taking aspirin, ibuprofen (Advil^® [Whitehall-Robins Healthcare, Madison, NJ]), indomethacin, keoprofen, naproxen (Aleve^® [Bayer Corporation, Morristown, NJ], Anaprox^® [Roche Laboratories Inc., Nutley, NJ], Naprosyn^® [Roche Laboratories Inc.]), or other nonsteroidal anti-inflammatory drugs. When taken along with methotrexate, these drugs can cause gastrointestinal and liver problems. If you are taking oral diabetes medicine, seizure medicine, or oral acne medication, tell your doctor. Also, if you are taking vitamins, herbs, or nutritional supplements, be sure to let your doctor know.

• Temperature (fever) higher than 100.5^oF
• Any signs of infection, such as chills or cough
• Painful urination
• Moderate to severe nausea and vomiting
• Yellow color of eyes or skin
• Any bleeding, such as from your nose or gums or in your urine
• Dark-colored (black or tar-like) stools
• Unusual bruising
• Pinpoint red spots on your skin