Methotrexate

Question 1

Action

Answer 1

It is a ‘disease modifying’ drug which means it both reduces inflammation and suppresses the immune system.

Early use improves outcome and symptoms

Question 2

Timeline

Answer 2

Once weekly with folic acid at another time.

Build up dose slowly

Question 3

How to take

Answer 3

Tablet usually

Injection also available

Question 4

Length of treatment

Answer 4

Long term

Question 5

Effect-time before

Answer 5

4-6 months

Question 6

Tests

Answer 6

FBC, U&Es, LFTs - before starting, every 2 weeks until therapy stabilised, then every 2-3 months

Question 7

Important side effects

Answer 7

Alopecia
Headaches
GI disturbance

Myelosuppression - SEEK MEDICAL HELP if signs of infection, unexplained bleeding / bruising, anaemia

Question 8

Complications and contraindications

Answer 8

Myelosuppression, liver toxicity (care with alcohol), pulmonary toxicity

Pregnancy (include male if trying), hepatic impairment, breast-feeding, active infection, immunodeficiency

Question 9

Supplementary advice

Answer 9

No NSAIDs / aspirin
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