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Methotrexate

Generic Names: Methotrexate
Brand Names: Rheumatrex®, Trexall™
Drug Class: Immunosuppressant /Immunomodulator

What does this medication do?

Methotrexate is used to help keep patients with Crohn's disease feeling well, and off steroids. It appears to work by decreasing the activity of the immune system. This results in decreased inflammation in the intestine. It has been used for decades to treat psoriasis, rheumatoid arthritis, and some cancers.

How is methotrexate given?

Methotrexate comes in pill and injection form. But in Crohn's disease, it is most effective as a weekly injection. The typical starting dose is 15mg - 25mg once a week. The dose can be titrated up or down based on how well it is tolerated. If a patient responds well to methotrexate, the typical maintenance dose is 15mg a week.

How effective is methotrexate for Crohn's disease?

Studies suggest that approximately 66% (2 out of 3) of patients respond to this treatment.

How quickly does methotrexate work?

Patients typically notice an improvement in symptoms in the first 3-6 weeks, but the full benefit may not be seen for 12 weeks.

Is this medication safe?

It is important to remember that this medication is safe and most patients do not experience any side effects and many of the minor side effects will improve with time. You should be aware of potential side effects which may include, but are not limited to:

  1. Nausea, vomiting, and/or flu-like symptoms (headache, fatigue, diarrhea). Most common side-effect. Increasing folic acid may help with these symptoms.
  2. Abnormal liver function tests/cirrhossis. An increase/elevation in liver tests is not uncommon, and usually responds to reducing the dose of medication. Inflammation and scarring of the liver can be made worse by diabetes, alcohol, and being overweight.
  3. Low blood counts. Neutropenia is a decrease in the number of the body's white blood cells (WBC's) which help fight off infections. The medication may also cause thrombocytopenia, a decrease the number of platelets (PLT) in the blood which are necessary for proper clotting. It may also cause anemia (low red blood cell counts). We may adjust the dose of medication depending on the blood counts.
  4. Infection. You will be at a slightly higher risk than the general population for developing infections. Please call us and your primary care physician with any signs and symptoms of infection including fevers, chills, night sweats, cough, etc. There is no reason to avoid your normal daily activities.
  5. Pneumonitis (inflammation of the lungs). Rare, but can be associated with fever, shortness of breath, or cough. Please notify us if you develop any of these symptoms.
  6. Lymphoma. There is a rare reported, risk of lymphoma (tumor of the lymph glands) in patients receiving methotrexate.
  7. Folate deficiency. Because methotrexate essentially depletes the body's levels of folic acid, this vitamin should be taken at a dose of 1mg daily when receiving methotrexate therapy.
  8. Miscellaneous. Methotrexate can also cause mouth sores (stomatitis), hair loss, and sun sensitivity. The hair typically grows back when the medication is stopped. We recommend limiting sun exposure, and use of sunblock.
  9. Birth defects. This medication can cause serious birth defects and therefore is absolutely contraindicated in pregnancy or if someone is trying to conceive. While on methotrexate, you will need to use 2 effective forms of birth control.

In order for us to monitor your response to the medication, you will be required to have weekly blood tests, and then at prescribed intervals thereafter. Should you choose to have your blood drawn at a local laboratory, we can provide you with a standing order. If this is the case, we ask that you ensure that the results are faxed to us as soon as available, and that you call us a few days after they are drawn to review the results. You will receive a copy of all labs and will be notified if changes are necessary. If you do not hear from us either by telephone or in writing within 2 weeks after your blood is drawn, please call the office at (617)-667-2802.

Points to remember

  • Methotrexate cannot be taken if you are pregnant or plan to become pregnant, or if kidney or liver function is not normal.
  • It is important to take methotrexate exactly as directed.
  • It is important to have routine blood tests performed as directed, at least every 8 to 12 weeks.
  • If you miss a dose, you can generally take it up to 4 to 5 days later.
  • Alcohol significantly increases the risk for liver damage while taking methotrexate, so alcohol intake should be eliminated or minimized to no more than two drinks per month.
  • Methotrexate can cause serious birth defects and complications during pregnancy, so it is important to discuss birth control and pregnancy plans with your physician while taking this medication. An effective form of contraception is critical while taking methotrexate and for at least three months after stopping the medication.
  • You should not receive live vaccines (ex. MMR-Measles, Mumps, & Rubella, chicken pox, nasal flu, varicella) while taking this medication.
  • Inactivated vaccines (ex. Tetanus, influenza, pneumonia, and Gardisil for prevention of HPV, the Human Pappiloma Virus) are safe and recommended. It is a good idea to call your doctor or nurse before receiving any vaccinations.
  • Please be sure that you have your annual health maintenance including PAP smears, mammogram, etc.
  • Please check with us prior to starting any new medications, herbs, or vitamins, since many medications may interact with methotrexate and increase the risk of toxicity. Please do not take NSAIDs (i.e. ibuprofen, naprosen, Motrin, Advil).