Methotrexate

Methotrexate is a drug to treat cancer, such as breast cancer, choriocarcinoma, leukemia, bone cancer, lymphoma, or mycosis fungoides . In addition, this drug can also be used in the treatment of autoimmune diseases, such as psoriasis, rheumatoid arthritis, Crohn's disease, or lupus.

Methotrexate is included in the anticancer group that has an immunosuppressant effect. This drug works by inhibiting the work of enzymes that are important for the formation of cell DNA. Thus, the process of cell replication and growth can be slowed down or stopped.

Brand names of methotrexate: Emthexate PF , Ferxate, Metoject, Methotrexate, Rheu-Trex, Kemotrexate, Sanotrexate, Methorexate Ebewe

What Is Methotrexate

Warnings Before Using Methotrexate

Methotrexate can only be used according to a doctor's prescription. Below are some things you need to pay attention to before consuming methotrexate:

• Tell your doctor about any allergies you have. Methotrexate should not be used by patients who are allergic to this drug.
• Tell your doctor if you have ever or currently suffer from liver disease, kidney disease, pulmonary fibrosis , alcohol addiction, stomach ulcers , immune system weakness, blood disorders , bone marrow disease, ulcerative colitis , folic acid deficiency, or infectious diseases , such as chicken pox.
• Tell your doctor if you are undergoing cancer treatment with radiation therapy or radiotherapy . Methotrexate can increase the risk of side effects of radiation therapy and cause damage to the skin, bones, or other parts of the body.
• Tell your doctor if you are pregnant, breastfeeding, or planning to become pregnant. Use effective contraception during treatment with methotrexate.
• Tell your doctor that you are using methotrexate if you are going to undergo surgery, including dental surgery.
• Consult your doctor if you plan to undergo vaccination during treatment with methotrexate.
• Avoid close contact with people with infectious diseases that are easily contagious, such as flu, measles, or chicken pox , during treatment with methotrexate, because it can increase your risk of getting infected.
• Do not drive a vehicle or do activities that require alertness, while undergoing treatment with methotrexate, because this drug can cause dizziness .
• See a doctor immediately if you experience a drug allergic reaction , overdose, or serious side effects after taking methotrexate.

Dosage and Administration of Methotrexate

The dose of methotrexate varies, depending on the purpose of the treatment as well as the patient's condition and age. The following is the general dose of methotrexate based on the form of the drug and purpose of use for adults:

Drug form: Tablet

• Purpose: Overcoming choriocarcinoma
  The dose is 15–30 mg per day, for 5 days. The dose is given again after a break of at least 1 week. Dose repetition can be done 3-5 times.

• Purpose: Overcome acute lymphoblastic leukemia
  Maintenance dose of 15 mg/m ² body surface area (LPT) 1-2 times a week, combined with other types of medicine.

• Purpose: Overcome Burkitt's lymphoma ( Burkitt lymphoma )
  The dose is 10–25 mg per day, for 4–8 days. Repeat the dose after 7-10 days.

• Purpose: Cutaneous T-cell lymphoma of the mycosis fungoides
  type The dose is 2.5–10 mg per day.

• Purpose: Overcoming psoriasis
  The dose is 10–25 mg per week as a single dose. Dosage adjustments are made based on the body's response.

• Purpose: Overcome rheumatoid arthritis
  The dose is 7.5 mg once a week. Dosage adjustments are made based on the body's response. The maximum dose is 20 mg per week.

• Purpose: Overcome Crohn's disease
  The dose is 12.5–22.5 m, 1 time per week. Treatment is done up to 1 year.

Drug form: Injection

Injectable methotrexate will be given directly by a doctor or medical staff under the supervision of a doctor, in a hospital. Injection is done through a muscle (intramuscular/IM) or injection into a blood vessel (intravenous/IV), or intrathecal space.

• Purpose: Overcome acute lymphoblastic leukemia
  If given by IM injection, maintenance dose 15 mg/m2 LPT 1–2 times a week. Whereas if given by IV injection, the dose is a maintenance dose of 2.5 mg/kgBW every 14 days.

• Purpose: Overcoming choriocarcinoma
  If given by IM injection, the dose is 15–30 mg per day, for 5 days. The dose is given again after a break of 1 week for 3-5 times. Alternative doses of 0.25–1 mg/kgBW are given, every 48 hours, as many as 4 doses. The maximum dose is 60 mg per day.

• Purpose: Overcome Crohn's disease
  The dose is 25 mg, 1 time per week, for 16 weeks. Maintenance dose 15 mg per week. Medicines are given by IM injection.

• Purpose: Overcome mycosis fungoides The
  dose is 50 mg once a week, divided into 1-2 doses. Medicines are given by IM injection.

• Purpose: Overcoming breast cancer
  The dose is 10–60 mg/m ² LPT, combined with cyclophosphamide and fluorouracil, given through IV injection.

• Purpose: Overcoming advanced
  lymphosarcoma The dose is up to 30 mg/kgBB, given through IV injection, followed by the administration of leucovorin .

• Purpose: Overcoming psoriasis
  The dose is 10–25 mg per week given in a single dose, via IM or IV injection.

• Purpose: Overcome osteosarcoma
  The recommended initial dose is 12 grams/m ² LPT, given by infusion over 4 hours. The dose can be increased up to 15 grams/m ² LPT.

• Purpose: Treat leukemia of the brain and spinal cord (meningeal leukemia) in adults
  The dose is 12–15 mg/m ² LPT, once a week for 2–3 weeks. Further doses are then given once every 1 month. Alternate dose, 0.2–0.5 mg/kgBW every 2–5 days. The drug is given by intrathecal injection.

• Purpose: To treat leukemia of the brain and spinal cord (meningeal leukemia) in children
  Children aged >3 years the dose is 12 mg. Children aged 2 years the dose is 10 mg. Children aged 1 year the dose is 8 mg. Children aged <1 year the dose is 6 mg. The drug is given by intrathecal injection

How to Use Methotrexate Correctly

Methotrexate in injection form will be given by a doctor or medical staff under the supervision of a doctor. Injections can be done intramuscularly, intravenously, intrathecally , or put in an infusion into the blood vessels. Always follow the doctor's advice during treatment with this medicine.

Consumption of methotrexate tablets according to the dosage recommended by the doctor. Avoid increasing or decreasing the dose without the doctor's knowledge.

Methotrexate in tablet form should be consumed before meals. Wash your hands before and after handling the tablet. Swallow the tablet whole with a glass of water. Avoid taking medicine with milk. If you experience stomach pain, then it is best to consume methotrexate tablets after eating.

This medicine needs to be consumed regularly to be effective. If you forget to take medicine immediately contact your doctor.

Before and after treatment with methotrexate, you may need to routinely undergo chest X-rays, liver or kidney function tests, skin reaction tests, or complete blood tests. This is done so that the development of the condition and the effectiveness of the medicine can always be monitored.

Methotrexate tablets should be stored in a closed container in a cool, dry place. Avoid exposure to direct sunlight and keep this medication out of the reach of children.

Methotrexate Interactions with Other Drugs

The following are some drug interaction effects that can occur when methotrexate is used with other drugs:

• Decreased effectiveness of methotrexate if used with folic acid
• Decreased levels of valproic acid in the blood
• Decreased levels of methotrexate in the blood if used with cholestyramine
• Increased levels of methotrexate in the blood if used with omeprazole
• Increased risk of side effects if used with fluorouracil or metamizole
• Increased risk of liver damage if used with pyrazinamide
• Increased levels of mercaptopurine in the blood
• Increased risk of drug poisoning if used with nonsteroidal anti-inflammatory drugs ( NSAIDs ), aspirin, probenecid , penicillin, aminoglycosides , neomycin, paromomycin , sulfonamides, cotrimoxazole , trimethoprim, cisplatin , etretinate, or ciclosporin

Side Effects and Dangers of Methotrexate

There are several side effects that can occur due to the use of methotrexate, among others:

• Headache or dizziness
• Drowsy
• Gums feel sore and swollen
• Decreased appetite
• Nausea, vomiting , or stomach pain
• Red eye
• Hair loss

Contact a doctor if the above side effects do not improve or worsen. See a doctor immediately if there is a drug allergic reaction or serious side effects in the form of:

• Chest pain, wheezing, shortness of breath, cough, which does not improve
• Canker sores , difficulty swallowing, or swollen gums, which do not improve
• Diarrhea, vomiting, bloody stools , or bloody urine
• A low number of blood cells that can be marked by the appearance of symptoms of anemia , a low number of blood platelets ( thrombocytopenia ), or a low number of white blood cells ( leukopenia )
• Kidney function disorders marked by certain symptoms, such as infrequent urination, very little urine coming out, or swelling in the legs
• Liver function disorders that can be marked by certain symptoms, such as severe abdominal pain, jaundice , loss of appetite, or dark colored urine
• Nerve function disorders that can be marked by certain symptoms, such as confusion, neck stiffness, blurred vision, movement disorders, seizures , or restlessness
• The emergence of tumor lysis syndrome which can be characterized by symptoms such as fatigue, weakness, muscle cramps, nausea, vomiting , heart palpitations, bradycardia , or tingling