How to use
Methotrexate should be taken orally as prescribed by your doctor. You must use the correct dosage of Methotrexate and follow the directions of your healthcare professional exactly. Do not miss any dosages in the prescribed schedule. Methotrexate is usually take once or twice a week, but not on a daily basis.

Discuss with your doctor, pharmacist or healthcare any concerns or questions you may have. It is important to clear up any confusion you have with regard to the usage of Methotrexate as soon as possible. Incorrect use of Methotrexate could lead to serious side effects and even death.

Overdose

Seek emergency medical attention if you think you have used too much of this medication. Taking too much Methotrexate can be fatal. Overdose symptoms may include:

• Pale skin, easy bruising or bleeding
• Unusual weakness
• Mouth sores
• Nausea
• Vomiting
• Black or bloody stools
• Coughing up blood or vomit that looks like coffee grounds
• Urinating less than usual or not at all

Missed dose

Contact your doctor immediately if you miss a dose of Methotrexate. Do not take double or extra doses of Methotrexate. If you vomit after taking a dose of Methotrexate, you should contact your health care professional straightaway.

Notes

Do not let anyone else take your prescription of Methotrexate as they may have a condition that is not effectively treated by this medication.

Storage

Store at room temperature between 59 and 86 degrees F (15-30 degrees C) away from light and moisture. KEEP THIS AND ALL MEDICATIONS OUT OF THE REACH OF CHILDREN.

Important note

The above information is intended to supplement, not substitute for, the expertise and judgement of your physician, pharmacist or other healthcare professional. It should not be construed that the taking of this medication is safe, appropriate or effective for you. 

* Illustrations are for graphic purposes only and the ordered medication may differ in appearance.

Precautions
Do not use Methotrexate if you are allergic to it. Also do not use Methotrexate for the treatment of arthritis or psoriasis if you suffer from any of the following:

• Liver disease
• Alcoholism or cirrhosis of the liver
• A blood cell disorder such as anemia (lack of red blood cells) or leukopenia (lack of white blood cells)
• A bone marrow disorder

Methotrexate is sometimes used to treat cancer even when patients do have one of the conditions listed above. Your doctor will decide if this treatment is right for you.

If you suffer from any of the following conditions, notify your doctor, as you may need a dosage adjustment or special tests to determine if taking Methotrexate will be safe for you:

• A kidney or liver disease
• A lung disease or pneumonia
• A stomach ulcer
• Any type of infection
• If you are receiving radiation treatments

Do not use Methotrexate if you are pregnant or planning to become pregnant as this medication can cause birth defects in an unborn baby. Both men and women should use an effective form of birth control while either they or their partner is taking Methotrexate.
Equally do not use Methotrexate when you are breastfeeding as this medication can filter into breast milk and be harmful to a nursing infant. If your doctor deems it necessary for you to keep taking Methotrexate, you should temporarily stop breastfeeding your baby.

You should have regular blood, kidney and liver tests to make sure that Methotrexate is not causing a harmful effect on you.  Do not miss any scheduled appointments with your doctor.

Drug interactions

 Before taking Methotrexate, inform your doctor if you are using any of the following drugs:

• Azathioprine (Imuran)
• Chloramphenicol (Chloromycetin)
• Hydroxychloroquine (Plaquenil, Quineprox)
• Retinol, tretinoin (Retin-A), isotretinoin (Accutane)
• Steroids (prednisone and others)
• Sulfa drugs such as Azulfidine, Bactrim, or Septra
• Phenytoin (Dilantin)
• Probenecid (Benemid)
• Tetracycline (Brodspec, Panmycin, Sumycin, Tetracap)
• Theophylline (Elixophyllin, Slo-Bid, Theobid, Theo-Dur)
• Gold treatments such as auranofin (Ridura)
• Oral diabetes medications such as acetohexamide (Dymelor), chlorpropamide (Diabinese), glipizide (Glucotrol), glimepiride (Amaryl), or tolbutamide (Orinase)
• A penicillin antibiotic such as ampicillin (Principen), amoxicillin (Amoxil, Trimox), dicloxacillin (Dynapen), nafcillin (Unipen), oxacillin (Bactocill), penicillamine (Cuprimine, Depen) or Bee-Pen, Pen-Vee K, Veetids
• Salicylates such as aspirin, Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others
• NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), naproxen (Aleve, Naprosyn), meloxicam (Mobic), piroxicam (Feldene) and others

This list is not complete and there may be other drugs that can interact with Methotrexate. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Get emergency medical help if you have any of these signs of an allergic reaction to Methotrexate:

• Hives
• Difficulty breathing
• Swelling of your face, lips, tongue or throat.

Stop using this medicine and call your doctor at once if you have any of these serious side effects:

• Dry cough, shortness of breath
• Diarrhea, vomiting, white patches or sores inside your mouth or on your lips
• Blood in your urine or stools
• Urinating less than usual or not at all
• Fever, chills, body aches, flu symptoms
• Sore throat and headache with a severe blistering, peeling, and red skin rash
• Pale skin, easy bruising or bleeding, weakness
• Nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)

Less serious Methotrexate side effects may include:

• Nausea, vomiting, upset stomach
• Dizziness, tired feeling
• Headache
• Bleeding of your gums
• Blurred vision

This is not a complete list of side effects and others may occur. Notify your doctor immediately if you experience any other side effects than the ones mentioned above, especially if they are bothersome.