PATIENT NFORMATION ON METHOTREXATE

1 PATIENT INFORMATION ON. METHOTREXATE . (Brand names: Methoblastin). This information sheet has been produced by It can reduce damage to joints, skin and other the Australian Rheumatology Association to tissues so it belongs to the group of medicines help you understand the medicine that has called disease modifying antirheumatic drugs been prescribed for you. It includes important (DMARDS). It is not a painkiller. information about: how you should take your medicine Low dose METHOTREXATE (5mg-30mg once per what are the possible side effects week) has been used to treat rheumatoid what tests you must have to arthritis for more than 25 years. Most, but not monitor your condition and to all, patients will benefit from this medicine. It is detect unwanted effects also used at very high doses (1000mg-5000mg a day) to treat some cancers.

2 Other precautions you should take when you are taking METHOTREXATE What benefit can you expect from your treatment? Important things to remember METHOTREXATE has been shown to prolong life While taking METHOTREXATE you should and can reduce the risk of heart disease in see your rheumatologist regularly to make rheumatoid arthritis. sure the treatment is working and to minimise possible side effects. It may be 4 to 12 weeks after reaching the best dose for your condition before you notice any You should have regular blood tests as benefits. Many of the conditions that are treated directed by your rheumatologist. with METHOTREXATE are long term and If you are concerned about any side METHOTREXATE may need to be taken for several effects, you should contact your years or in some people, indefinitely.

3 Some rheumatologist as soon as possible. other DMARDs are taken with METHOTREXATE for added benefit. For more information about your condition How is METHOTREXATE taken? see Arthritis Australia's website: METHOTREXATE may be taken by mouth as a tablet or given by injection either into the muscle or under the skin (subcutaneously). For more information on the injections see Injectable What is METHOTREXATE ? METHOTREXATE . METHOTREXATE (brand name Methoblastin or injectable METHOTREXATE (Hospira, Methacord, METHOTREXATE is taken ONCE A WEEK, on the METHOTREXATE Accord & Trexject) is a well- same day each week. If you are taking the established, effective treatment for several tablets, it is a good idea to specify the day of the different types of inflammatory diseases such as week that you will take your tablets to avoid rheumatoid arthritis, psoriatic arthritis, Crohn's making mistakes.)

4 Disease, SLE (Systemic Lupus Erythematosus) METHOTREXATE tablets are best taken on an empty and severe psoriasis. It may also be used for stomach. However if nausea is a problem, taking other conditions. them at mealtime can help to reduce this side effect and does not reduce the benefits too METHOTREXATE Australian Rheumatology Association Revised November 2019. much. Mouth ulcers What is the dosage? Tablets come in or 10mg strengths. If you have two strengths ensure you CHECK THE Less common or rare possible side STRENGTH each time you take it. Treatment effects: may start low at 5mg or 10mg a week, There are some rare but potentially serious side increasing to an average dose of 20mg a week, effects with METHOTREXATE . and sometimes 30mg/week. Skin dryness, a variety of skin rashes The dose is usually taken all at once on a single and increased sensitivity to the sun may day.

5 It may be divided into separate doses taken during that day if necessary. also occur. You should wear sunscreen and a hat when out in the sun. If you stop METHOTREXATE treatment for more than a few weeks there is a risk that your condition Some also experience a temporary may worsen. Continue with your treatment increase in muscle and joint pain after unless advised by your doctor or unless side taking the weekly dose. effects develop. Blood counts: METHOTREXATE may cause If you have an illness that makes you unwell a drop in the number of white blood enough to change plans for the day ( cells, which are needed to fight infection. gastroenteritis or fever), it is reasonable to miss It can also cause a drop in the number the weekly dose until you have recovered. of platelets, which help to stop bleeding.

6 Regular blood tests aim to pick these Can other medicines be taken problems up early if they occur. with METHOTREXATE ? If you develop a sore mouth, mouth In order to reduce side effects, it is ulcers, easy bruising, nosebleeds, recommended that you also take folic acid or bleeding gums, breathlessness, infection folinic acid. Your doctor will explain how much of or fever tell your doctor straight away. the folic/folinic acid to take and when to take it. METHOTREXATE is often taken in combination with Hair thinning: This may occur rarely. It is other arthritis medicines, including: not permanent and hair will grow back when the medicine is stopped. other DMARDs biological DMARDs ( these act on natural Liver: METHOTREXATE can inflame the liver substances in the body that contribute to and this can be seen on blood testing.)

7 Inflammation and joint damage) Regular blood tests aim to pick this up early if it occurs. The dose of METHOTREXATE steroid medicines such as may have to be reduced or stopped if prednisolone or cortisone injections problems occur. Liver problems may be into the joint increased when METHOTREXATE is combined anti-inflammatory medicines (NSAIDs) such with other medicines or with heavy alcohol as naproxen (Naprosyn) or ibuprofen use (see Alcohol overleaf). (Brufen/ nurofen ). Lungs: METHOTREXATE can cause simple pain medicines such as paracetamol. inflammation of the lungs. This may be more likely if leflunomide is being taken at Are there any side effects? the same time. The problem may develop Some experience side effects so tell your doctor quickly, so if you have a sudden onset of if you are concerned about possible side effects.

8 Breathing difficulties seek medical attention A reduction in dose may minimise these so you as soon as possible. It may also develop may be able to continue it. Your doctor will with symptoms such as a dry cough. advise on any dose changes that are necessary. Nodule formations: Some people with rheumatoid arthritis develop nodules on Most common possible side effects: their elbows or other pressure points. In (Folic or Folinic acid helps to reduce some cases METHOTREXATE may increase side-effects) this. Fatigue, mental clouding, nausea, Cancer: see below. vomiting or diarrohea . These can be reduced if METHOTREXATE is taken with food Long term side effects: or in the evening. Anti-nausea tablets can METHOTREXATE may be taken for long periods be used if needed. (more than 25 years). The following are rare METHOTREXATE Australian Rheumatology Association Revised November 2019.

9 But possible long-term issues: developing some infections, especially Herpes zoster (chicken pox and shingles). Liver: Very rare cases of increased fibrous You should try to avoid contact with people who tissue in the liver have been reported after have these infections. If you have an infection or long-term treatment. This risk is increased persistent fever, tell your doctor straight away. when combined with alcohol. Regular monitoring can minimise the risk of this occurring. Use with other medicines: Cancer: People who have rheumatoid METHOTREXATE can interact with other arthritis and other similar inflammatory medicines. You should tell your doctor conditions have an increased risk of (including your GP, rheumatologist and lymphoma (a lymph node cancer). It is not others) about all medicines you are taking or clear whether METHOTREXATE increases this plan to take.

10 This includes over the counter, risk further but any additional risk is likely to herbal or naturopathic medicines. You should be very small. METHOTREXATE may also reduce also mention your treatment when you see the risk of these cancers by controlling the other health professionals. inflammation. For general cancer prevention, METHOTREXATE can be taken safely with stopping smoking is recommended. An anti- inflammatory drugs (NSAIDs), as annual skin check to detect any early skin long as your kidney function is normal. cancer is also recommended. Antibiotics containing trimethoprim ( Fertility: METHOTREXATE does not affect a Bactrim, Septrim or Triprim) can person's ability to have children in the long cause problems when taken with term. See also Precautions. METHOTREXATE . If you are prescribed any of these medications you must tell the doctor you are taking METHOTREXATE .