Metrex (2.5mg) 100 Tablets

Methotrexate exerts its effects primarily by inhibiting the enzyme dihydrofolate reductase (DHFR), which is responsible for converting dihydrofolate into tetrahydrofolate. Tetrahydrofolate is essential for the synthesis of purines and thymidylate, which are necessary for DNA synthesis and cell replication. By interfering with DNA replication and cell division, methotrexate reduces the growth of rapidly dividing cells, such as cancer cells and inflammatory cells involved in autoimmune diseases. In cancer treatment, this action leads to the death of tumor cells, while in autoimmune conditions, it suppresses the abnormal immune response, reducing inflammation and tissue damage. Additionally, methotrexate can inhibit other metabolic pathways involved in cell proliferation, further contributing to its therapeutic effects in both malignancies and inflammatory diseases.

Methotrexate

Antimetabolite

Tablet

The following are the uses of Methotrexate Tablet:

• Treatment of various cancers, including acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma, osteosarcoma, breast cancer, lung cancer, and head and neck cancers.
• Management of autoimmune diseases such as rheumatoid arthritis (RA), psoriatic arthritis, and severe psoriasis.
• Treatment of inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis.
• Medical management of ectopic pregnancy, especially in early stages.
• Used in the treatment of certain immune-related conditions, such as sarcoidosis.
• Management of severe, recalcitrant skin conditions, such as eczema and lupus.

Following are the doses of Methotrexate tablet:

• The usual dose for rheumatoid arthritis in adults is 7.5 mg once a week. The dose can be gradually increased depending on the patient’s response, up to a maximum of 20 mg once a week.
• For psoriasis in adults, the usual starting dose is 10 to 25 mg once a week. The dose can be adjusted based on the response, up to a maximum of 30 mg once a week.
• In cases of juvenile idiopathic arthritis, the recommended dose is usually 10 mg/m² once a week, with adjustments made based on the child’s response and tolerance.
• For certain types of cancer (e.g., acute lymphoblastic leukemia), Methotrexate may be given in much higher doses, often in combination with other chemotherapy drugs. The exact dosing will be determined by the oncologist.
• Methotrexate should always be taken under the supervision of a healthcare provider to ensure proper dosage and monitoring for side effects.

If you suspect an overdose of Methotrexate, immediate medical attention should be sought. Overdose symptoms may include nausea, vomiting, dizziness, fatigue, mouth sores, or more severe effects like difficulty breathing, low blood pressure, or severe skin reactions. An overdose can be life-threatening and may require emergency treatment, such as the administration of folinic acid (leucovorin) or other supportive care.

If you miss a dose of Methotrexate, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to make up for the missed dose, as this may increase the risk of side effects.

To use Methotrexate Tablet, follow the instructions given by your healthcare provider or as indicated on the prescription label. Typically, it is taken once weekly, on the same day each week, to ensure consistent blood levels. Swallow the tablet whole with a glass of water. Do not chew, crush, or break the tablet. It can be taken with or without food, but taking it with food may help reduce stomach upset.

Following are the situations when Methotrexate Tablet should not be used:

• Should not be used in individuals with a known allergy to Methotrexate or any of its components.
• Contraindicated in patients with severe liver disease or liver failure.
• Should not be used in individuals with pre-existing blood disorders such as bone marrow suppression or low blood cell counts (e.g., anemia, leukopenia, thrombocytopenia).
• Contraindicated in pregnant women (especially in the first trimester) as it can cause fetal harm.
• Should not be used in individuals with severe kidney impairment.
• Not recommended for patients with active infections due to its immune-suppressive effects.
• Contraindicated in patients with chronic alcoholism or excessive alcohol consumption.

The side effects of Methotrexate Tablet may include:

• Nausea
• Vomiting
• Fatigue
• Dizziness
• Loss of appetite
• Mouth sores
• Hair loss
• Rash
• Liver toxicity
• Low blood cell count (anemia, leukopenia, thrombocytopenia)
• Diarrhea
• Pneumonitis (inflammation of the lungs)
• Kidney problems
• Stomach pain or discomfort

Following are the precautions and warnings for Methotrexate Tablet:

• Should not be used in individuals with a known allergy to Methotrexate or any of its ingredients.
• Caution is advised in patients with pre-existing liver or kidney disease, as the medication may cause liver damage, kidney toxicity, and bone marrow suppression.
• Avoid alcohol consumption during treatment, as it can increase the risk of liver toxicity.
• Methotrexate should be used with caution in pregnant or breastfeeding women due to potential harm to the fetus or infant.
• Close monitoring of blood cell counts, liver function, and kidney function is required during treatment.
• Avoid live vaccines during Methotrexate therapy, as the immune response may be weakened, increasing the risk of infection.
• It may interact with nonsteroidal anti-inflammatory drugs (NSAIDs), sulfonamides, or other immunosuppressive medications, increasing the risk of toxicity.

Following are the drug interactions for Methotrexate tablets:

• Should not be used concomitantly with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, as they may increase the risk of Methotrexate toxicity, particularly affecting renal function.
• Caution is advised when used with other immunosuppressive agents, such as cyclosporine or azathioprine, as this may enhance the immunosuppressive effects and increase the risk of infections.
• Methotrexate may interact with penicillins and cephalosporins, leading to increased blood levels of Methotrexate and a higher risk of toxicity.
• Concomitant use with alcohol should be avoided, as it may increase the risk of liver damage.
• The drug should be used cautiously in combination with certain antibiotics (e.g., tetracyclines, sulfonamides), as they can interfere with the renal elimination of Methotrexate, increasing its toxic effects.
• Methotrexate may interact with folic acid antagonists, including trimethoprim, leading to increased Methotrexate toxicity, particularly in the bone marrow and gastrointestinal system.
• Should be used cautiously with drugs that may affect renal function, such as diuretics, as they may increase the risk of Methotrexate toxicity.
• Methotrexate may interact with live vaccines, as it can impair the immune response and increase the risk of infection from the vaccine.

Following are the food interactions for Methotrexate Tablet:

• Alcohol consumption should be avoided, as it increases the risk of liver toxicity when taken with Methotrexate.
• Folate-rich foods (e.g., leafy greens, citrus fruits) may interfere with Methotrexate's effectiveness, as the medication works by inhibiting folate metabolism. However, patients should not avoid folate entirely without consulting their healthcare provider, as folate supplementation may be recommended to prevent side effects like mouth sores.
• Dairy products should be consumed with caution, as calcium may interfere with the absorption of Methotrexate, though this interaction is generally less significant.
• Avoid excessive consumption of vitamin C (e.g., citrus juices), as high doses may decrease the efficacy of Methotrexate.

Methotrexate tablets should be stored at room temperature, between 20°C to 25°C (68°F to 77°F), in a dry place away from direct sunlight, moisture, and heat. Keep the medication in its original packaging to protect it from moisture and to help ensure its stability. It is important to keep the medication out of reach of children and pets to prevent accidental ingestion.When disposing of Methotrexate tablets, do not flush them down the toilet or pour them down the drain unless specifically instructed by a pharmacist or healthcare provider. To safely dispose of the medication, follow any local guidelines for medication disposal, or take it to a pharmacy that offers a take-back program. If these options are not available, consult your healthcare provider for advice on proper disposal methods.

Following are the quick tips for Methotrexate tablets:

• Take Methotrexate exactly as prescribed by your healthcare provider to minimize the risk of side effects.
• Do not skip doses or take more than the recommended amount, as this can increase the risk of serious side effects.
• Take Methotrexate with food to reduce stomach irritation, unless otherwise directed by your doctor.
• Avoid alcohol while taking Methotrexate to prevent liver damage.
• Have regular blood tests to monitor your liver function, kidney function, and blood cell counts.
• Stay well-hydrated, and avoid dehydration, as this may increase the risk of kidney-related side effects.
• Inform your healthcare provider of any other medications or supplements you are taking, including over-the-counter drugs.

Methotrexate tablets typically require regular laboratory screening and monitoring due to their potential for serious side effects. The following are the recommended tests and screenings:

• Complete blood count (CBC) to monitor for bone marrow suppression, including low white blood cells, red blood cells, or platelets.
• Liver function tests (including ALT, AST, and bilirubin) to assess potential liver damage, as Methotrexate can be hepatotoxic.
• Renal function tests (creatinine, BUN) to monitor kidney health, as Methotrexate can affect kidney function, especially in high doses or prolonged use.
• Serum Methotrexate levels in certain cases, especially if high doses are used, to ensure the drug is within a therapeutic range and to prevent toxicity.
• Chest X-ray and pulmonary function tests may be required in patients with prolonged or high-dose Methotrexate use to detect any lung-related issues or toxicity.
• Folates and Vitamin B12 levels may also be monitored, as Methotrexate inhibits folic acid metabolism, potentially leading to deficiencies.