• What is Methotrexate

    Methotrexate is a Disease Modifying Anti-Rheumatic Drug (DMARD) that is also known as Trexall, Folex PFS, Rheumatrex Dose Pack, and Methoxtrexate Sodium. Low dose methotrexate is a very common treatment for rheumatoid arthritispsoriatic arthritis, and many other types of arthritis. Methotrexate is also known as a treatment for cancer. As a cancer treatment, it is prescribed at significantly higher doses than for arthritis treatment. Methotrexate is also occasionally used to treat certain other diseases as well. Methotrexate is understood to work by altering how the body uses folic acid (vitamin B9), a vitamin that is needed for cell growth.

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    Dr. John Wade, MD, FRCPC, Rheumatologist, talks about what Methotrexate is typically used for and the standard dosing schedules commonly used.
    Dr. John Wade, MD, FRCPC, Rheumatologist, talks about what Methotrexate is typically used for and the standard dosing schedules commonly used.
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    Dr. John Wade, MD, FRCPC, Rheumatologist, talks about what Methotrexate and the side effects that some patients may experience and how to mitigate them.
    Dr. John Wade, MD, FRCPC, Rheumatologist, talks about what Methotrexate and the side effects that some patients may experience and how to mitigate them.
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    Dr. John Wade, MD, FRCPC, Rheumatologist, talks about how to titrate Methotrexate to a lower dose or to stop taking it completely.
    Dr. John Wade, MD, FRCPC, Rheumatologist, talks about how to titrate Methotrexate to a lower dose or to stop taking it completely.
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    Dr. John Wade, MD, FRCPC, Rheumatologist, talks about the contraindications and use of Methotrexate in pregnancy.
    Dr. John Wade, MD, FRCPC, Rheumatologist, talks about the contraindications and use of Methotrexate in pregnancy.
  • Methotrexate – Administration, Dose, Frequency

    To treat arthritis, methotrexate is taken once a week. It is available in oral tablet form (2.5 mg tablets) and in liquid injectable form (25 mg/mL vials or pre-filled syringes) for subcutaneous (under the skin) injection.

    The standard dose for tablets ranges from 3 per week (7.5 mg) to 10 per week (25 mg). On the day that it is taken, tablets can be taken all at once or split up and taken twice over a 24 hour period. The standard dose for injection ranges from 0.3 mL (7.5 mg) to 1.0 mL (25 mg) per week.

    Watch our video to learn how inject Methotrexate at home:

    Learn How to Inject: Subcutaneous Injections

    Subcutaneous injections (under the skin injections) are easy to do compared to other types of injections. A small needle pokes just under the skin to deliver medicine into the “fatty tissue” below.

    And obviously if they were to go back and to restart methotrexate and to have those symptoms again, they should see their doctor just to make sure that they should be continuing on with methotrexate. If you have any questions or concerns about methotrexate, you should contact your healthcare practitioner or your specialist.

    Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC

    Local Practitioners: Rheumatologist

  • Taking Methotrexate

    Methotrexate is available in oral tablet form and in a liquid injectable form for subcutaneous (under the skin) injection.

    Injected methotrexate has a number of benefits over oral methotrexate. It tends to have fewer side effects like nausea and it is absorbed by the body better and more consistently (85% absorption for injected vs. 20-80% variability for oral).

    A few small studies have even suggested that the injected form of methotrexate may be a more effective treatment for Rheumatoid Arthritis.

    When methotrexate works, most patients start to feel improvement after 6 to 8 weeks. The maximum effect can take 6 to 12 months. If a patient starting on methotrexate doesn’t feel any effects after a 3 month “trial period” then the medication is usually stopped.

    And obviously if they were to go back and to restart methotrexate and to have those symptoms again, they should see their doctor just to make sure that they should be continuing on with methotrexate. If you have any questions or concerns about methotrexate, you should contact your healthcare practitioner or your specialist.

    Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC

    Local Practitioners: Rheumatologist

  • Who Should Not Take Methotrexate

    Patients who should NOT be taking Methotrexate include:

    • Patients taking sulfa antibiotics, such as co-trimoxazole (Septra) or trimethoprim
    • Women who are pregnant or breastfeeding
    • Women of child bearing potential who do not use reliable contraception
    • Patients with an infection. It is often best for patients who have a fever or think they have an infection to stop taking methotrexate. Phone your doctor for advice.
    • Patients who are heavy drinkers. It is best not to drink alcohol at all while taking methotrexate.

    Anyone who becomes pregnant while taking Methotrexate should notify their doctor immediately.

    And obviously if they were to go back and to restart methotrexate and to have those symptoms again, they should see their doctor just to make sure that they should be continuing on with methotrexate. If you have any questions or concerns about methotrexate, you should contact your  Local Pharmacists healthcare practitioner or your specialist.

    Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC

    Local Practitioners: Rheumatologist

  • Important Tests and Risks

    Methotrexate is generally a safe medication that is tolerated by most patients taking the lower dosages used to treat arthritis.

    Blood Tests

    Patients should have their blood tested every 1-3 months so their doctor can monitor for potential side effects on the liver or blood counts.

    Interaction with Sulfa Antibiotics

    Methotrexate should not be taken with sulfa antibiotics such as co-trimoxazole (Septra) or trimethoprim.

    Interaction with Alcohol

    People taking methotrexate should avoid drinking alcohol. Alcohol significantly increases the risk for liver damage while taking methotrexate.

    Rare Lung Reaction

    Methotrexate can very rarely cause an unusual lung reaction that is more likely to occur in older patients with underlying lung disease.

    And obviously if they were to go back and to restart methotrexate and to have those symptoms again, they should see their doctor just to make sure that they should be continuing on with methotrexate. If you have any questions or concerns about methotrexate, you should contact your healthcare practitioner or your specialist.

    Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC

    Now Health Network Local Practitioners: Rheumatologist

  • How Methotrexate Works

    Scientists don’t yet completely understand exactly how methotrexate works inside the body to help arthritis.

    It is known that methotrexate changes how cells inside the body uses folic acid (vitamin B9), which is needed for cell growth. It is not well understood how exactly this effect, or other possible effects of methotrexate, work to help improve arthritis.

    What is known is that the lower doses of methotrexate used in the treatment of arthritis can help patients by:

    • reducing the pain and swelling (inflammation) in arthritic joints
    • improving day to day function
    • preventing long-term damage caused by joint inflammation

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