Methotrexate Flashcards
1
Q
What contraindications must be excluded before prescribing methotrexate?
A
- Pregnancy (including male partners)
- Breastfeeding
- Hepatic impairment
- Active infection
- Immunodeficiency
2
Q
How would you explain the MOA of methotrexate to a patient?
A
- It is a ‘disease-modifying agent’ which both reduces inflammation and suppresses the immune system
- Early use improves outcomes and symptoms
3
Q
How should methotrexate be taken?
A
- Once weekly tablet with folic acid tablet on another day
- Same day each week
- Dose is built up slowly
- Taken long-term if effective
- Takes 3-12 weeks to work
4
Q
What monitoring is required before prescribing methotrexate and during treatment?
A
Before:
- FBC, LFTs, U&Es
During (FBC, U&Es, LFTs):
- every 2 weeks until therapy stabilised
- every 2-3 months after
*patients should be given a monitoring book
5
Q
What important side effects of methotrexate should patients be made aware of?
A
- Alopecia
- Headaches
- GI disturbance - do not take with NSAIDs or aspirin
- Myelosuppression (infections, unexpected bruising/bleeding, anaemia)
- Seek medical advice for any unexplained bruising.bleeding, or if you have infective symptoms
- Liver and lung toxicity
6
Q
What additional vaccinations should patients taking methotrexate have?
A
Influenza - annually
