What is methotrexate?
Methotrexate is a medicine used to treat rheumatoid arthritis, psoriasis, several kinds of cancer, and IBD. When used for IBD, the dose is lower than when taken for cancer.
Why am I taking methotrexate?
Your doctor may order methotrexate to help control the number of IBD flare ups. Methotrexate can reduce the damage to your intestines and improve your quality of life.
What do I need to know?
Methotrexate injection is given once a week. It may take 4 to 8 weeks to work. You must keep taking it every week even if you think it is not helping.
Methotrexate tablets are taken by mouth once a week. It may take 4 to 8 weeks to work. You must keep taking it every week even if you think it is not helping.
You will have blood tests when you start the medicine, then again in 2, 4, 8 and 12 weeks. If the tests are normal, your blood test will be done every 3 months.
It can increase your risk of infection. You should have a working thermometer at home in case you feel sick.
You will need to take folic acid tablets when you are on methotrexate. Your doctor will order these for you.
Both you and your partner must use birth control at the same time. Stop taking this medicine at least 3 to 6 months before you get pregnant. Men also need to stop taking this medicine before trying to conceive. This medicine can cause birth defects.
Do not breast feed while taking methotrexate.
Do not drink alcohol.
Do not take any herbal products that have echinacea or cat’s claw.
You should never be given a vaccination with a live virus. Always talk to your doctor before getting any vaccination.
What are common side effects?
Muscle aches and a low-grade fever for a couple days after the injection. This should get better as your body gets used to the medicine. If you still have this after a couple of injections, call your doctor.
Mouth sores or bleeding of the gums. Use soft toothbrushes and avoid forceful flossing of your teeth. Rinsing your mouth with salt water will help.
Sensitivity to the sun. Always use strong sunscreen (at least 45 SPF) and do not use tanning beds.
Nausea, vomiting, fatigue
When should I call my doctor right away?
If you have a fever over 100.5 F degrees.
If you have chest pain, cough, or trouble breathing.
If you get sores in your mouth or lips. The dose of methotrexate may need to be changed.
How should I store this medicine at home?
Methotrexate for injection comes in vials (small bottles). Vials should be stored at room temperature and kept away from light and heat. Methotrexate tablets should be stored at room temperature and kept in the prescription bottle to protect them from light. Do not keep the medicine in the refrigerator or in the bathroom cabinet. Keep all the medicine, syringes, needles and supplies in a safe place away from children and pets.
What supplies do I need to give the injection and where can I get them?
The supplies can be bought at the drugstore or wherever you get your medicines. If you have questions, talk to your nurse about where or how to get these supplies.
Items Needed For the Injection
Vial of methotrexate. The concentration should be 25 mg/1 ml. Some vials can be used for more than one injection. If the vial has preservative in it you can use it for more than one injection. If not, you will need to throw it away after one use.
Syringe and needle. You may get syringes with needles already attached.
Puncture proof container to dispose of the syringe & needle. This can be an empty Clorox bottle or coffee can.
How To Give the Methotrexate Injection
The nurse will teach you how to do the injections.
Find an area in your home that is well-lit, flat and quiet. You should have a work area that is flat, such as a table.
Clean the table with soap/water or a mild bleach solution.
Wash and dry your hands. If someone else is giving you the shot, they should wash/dry their hands also, and wear gloves. This is a very important step!
Gather all the supplies. Have a paper towel handy in case of spills.
Select the site for the injection. Find a spot you can “pinch an inch” of fat, such as the stomach or thigh (see picture below) If someone else is giving you the injection, you can use the back of the arm. Avoid any area that has a bruise, scars, redness, swelling or visible veins. After you find the site you will use, clean the area with an alcohol pad in a circular motion. Allow the site to dry.
Prepare the vial. If using a new vial, pop off the protective cap. Discard the cap; it will not reattach. If you have used the vial for an injection before, clean the top of the vial with an alcohol swab. Let the top dry for about 10 seconds.
Pull back on the plunger end up to ½ the dosage you need (image A). Remove the cap on the needle. Insert the needle into the vial. Push the plunger to push the air into the vial. This will make it easier to withdraw the medicine out of the vial.
Hold onto both vial and syringe. Turn the vial & syringe upside down, keeping the needle in the vial. The needle is now pointing up.
Pull the plunger back to “draw” the methotrexate into the syringe. Draw back slightly more than the dose you need. If air bubble is seen, gently tap the syringe with your finger. Push the plunger up to get rid of any air. Push back in any extra medicine to get the right dose.
With needle still in the vial, turn the vial/needle right side up. Set the vial on the table.
Hold the syringe like a dart or pencil and remove it from the vial.
With your other hand, “pinch an inch” of skin (the spot you have cleaned earlier in # 5).
Insert the needle all the way into the clean spot straight into your skin like a dart.
Press down on the plunger until all the medicine has been pushed out and into your fatty tissue.
Remove the needle by quickly pulling it out and away. You can now let go of the skin fold. If a small drop of medicine or blood is on your skin, use a cotton ball on the spot. You can apply a little pressure but do not rub the spot.
Put the syringe into the sharps container you are using (Clorox bottle or coffee can). Do not put the cap back on the needle. Syringe and needle should only be used one time.
After the injection:
Clean the top of the methotrexate vial with an alcohol swab. Place all used alcohol swabs, vials and cotton balls in the Sharps container. Close the lid on the container. (Do not fill the container more than ¾ full.) Supplies cannot be put in the regular trash.
Wash your hands with soap and water. If someone gave you the injection, they should also wash their hands after removing their gloves. (Used gloves should also go in the Sharps container).
Store the methotrexate vial, syringes and supplies in a safe place out of the reach of children and pets.
Label container used for syringes and used supplies as “Chemo Waste” on the outside. It can be taken to the doctors’ office for disposal. Tell them it is a container of used needles & syringes used for methotrexate.