Methotrexate Injection (patient information)

# IMPORTANT WARNING
Methotrexate can cause a decrease in the number of blood cells in your bone marrow. Methotrexate also can cause cancerous lymphomas, tumor lysis syndrome (electrolyte imbalances), severe skin reactions, infections such as pneumonia, bone and soft tissue damage, and severe damage to your liver, kidneys, lungs, and gastrointestinal tract (some of which can be fatal).
Keep all appointments with your doctor and the laboratory. Your doctor will order lab tests before, during, and after your treatment to see if you are affected by this drug.
Tell your doctor if you have ascites (collection of fluid in the abdomen), kidney disease, or lung disease and if you are getting radiation therapy. Tell your doctor if you are taking aspirin, ibuprofen (Advil, Motrin, or Nuprin), indomethacin (Indocin), ketoprofen (Actron, Orudis), naproxen (Aleve, Anaprox, Naprosyn), or other nonsteroidal anti-inflammatory drugs (NSAIDs).
If you experience any of the following symptoms, call your doctor immediately: dry cough; diarrhea; loss of appetite; nausea, stomach pain; weakness; weight loss; excessive tiredness; lack of energy; yellowness of the skin or eyes; enlargement of the lymph nodes; blisters on the cheek, tongue and lips; or skin rash.
Because of the dangers of taking methotrexate, this drug should be used to treat only life-threatening cancer or severe psoriasis or rheumatoid arthritis that does not respond to other treatments. Talk to your doctor about the risks of taking methotrexate.
If you are pregnant or plan to become pregnant, especially if you have psoriasis or rheumatoid arthritis, talk you your doctor about the risks of taking methotrexate for your condition. If you become pregnant, call your doctor immediately. Methotrexate may harm the fetus.

# About your treatment
Your doctor has ordered the drug methotrexate to help treat your illness. The drug can be given by injection into a vein or a large muscle. In special situations, it may be injected into the spinal cord.
This medication is used to treat:
- trophoblastic neoplasms
- leukemia
- breast cancer
- psoriasis
- osteosarcoma
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Methotrexate is in a class of drugs known as antimetabolites; it slows the growth of certain cells in your body. Methotrexate helps control your symptoms but may not cure your disease.

# Other uses for this medicine
Methotrexate is also used to treat mycosis fungoides, psoriatic arthritis, and a variety of solid tumors. Talk to your doctor about the possible risks of using this drug for your condition.

# Precautions
Before taking methotrexate:
- tell your doctor and pharmacist if you are allergic to methotrexate or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially azathioprine (Imuran); non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin, or Nuprin), indomethacin (Indocin), ketoprofen (Actron or Orudis), or naproxen (Aleve, Anaprox, or Naprosyn);oral acne medications such as isotretinoin (Accutane) and tretinoin (Vesanoid); oral diabetes medications; phenytoin (Dilantin); probenecid (Benemid); sulfa drugs (Bactrim, Septra); tetracycline; (Achromycin V, Sumycin); and vitamins.
- tell your doctor if you have or have ever had kidney or liver disease, ulcers, problems with your immune system, intestinal disease, lung disease, or cancer.
- you should know that methotrexate may interfere with the normal menstrual cycle (period) in women and may stop sperm production in men. However, you should not assume that you cannot get pregnant or that you cannot get someone else pregnant. Women who are pregnant or breast-feeding should tell their doctors before they begin taking this drug. You should not plan to have children while receiving chemotherapy or for a while after treatments. (Talk to your doctor for further details.) Use a reliable method of birth control to prevent pregnancy. Methotrexate may harm the fetus.
- before having surgery, including dental surgery, tell the doctor or dentist that you are taking methotrexate.
- tell your doctor if you have a history of alcohol abuse. Do not drink alcohol; alcohol increases the chance of liver damage with methotrexate.
- do not have any vaccinations (e.g., measles or flu shots) without talking to your doctor.

# Side effects

## Minor side effects
Side effects from methotrexate are common and include:
- thinned or brittle hair
- blistering skin or acne
- loss of appetite or weight
Tell your doctor if either of these symptoms is severe or lasts for several hours:
- mouth blistering
- fatigue

## Severe side effects
If you experience any of the following symptoms, call your doctor immediately:
- painful urination or red urine
- black, tarry stools
- diarrhea
- stomach pain
- unusual bruising or bleeding
- cough
- congestion
- fever
- dizziness
- chills
- shortness of breath
- sore throat
- swelling of the feet or ankles
- nausea and vomiting
- rash
- yellowing of the skin or eyes
- joint pain
- seizures
- severe skin rash
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

# Other names
- Amethopterin
- MTX