Methotrexate counselling

Question 1

How methotrexate works?

Answer 1

DMARD - reduces inflammation in the body and dampens host immune response to it’s own tissues

Question 2

How to take methotrexate?

Answer 2

Taken once weekly

Need to take folic acid once weekly as well on another day of the week

Question 3

How long is methotrexate taken for? How long until it works?

Answer 3

Taken long term

Titrate the dose up gradually
3-12 weeks to work
Usually 4-6 months until optimal effect is achieved

Question 4

Monitoring required for methotrexate?

Answer 4

“Check bone marrow, kidney and liver function”

FBC, U&E’s and LFT’s
- Before starting
- Every 2 weeks until dose is stable
- Every 2-3 months after that

Question 5

Common, less severe side effects of methotrexate ?

Answer 5

Hair loss, headaches and stomach upset

Question 6

Other side effects of methotrexate?

Answer 6

Bone marrow suppression

Liver toxicity - don’t binge alcohol when on it

Lung toxicity (pulm fibrosis)

Question 7

Safety netting advice for methotrexate? (when to seek help)

Answer 7

Signs of infection or easy bruising - bone marrow suppression

Breathlessness / chest pain - lung toxicity

Question 8

Fertility info for methotrexate?

Answer 8

Can’t try for a baby until 6 months after last dose

Use contraception when on methotrexate if sexually active