10 Ways to Reduce the Side Effects from Methotrexate

Now, if you remember from our previous post, What’s the 411 on Methotrexate, this medication was originally developed in the 1950’s as a treatment for cancer patients. Currently, it is often prescribed as an effective form of treatment for rheumatoid arthritis and other autoimmune diseases. While methotrexate has been proven efficient at helping to manage the symptoms of rheumatoid arthritis, some patients have reported some serious side effects after taking it. In order to lower the risk of any potential side effects, patients must remember to adhere to their physician’s directions while taking methotrexate. In order to make this easier, there are 10 things you should remember about methotrexate.

1) Methotrexate is a DMARD

Methotrexate is a form of medication that falls under the disease modifying anti-rheumatic drug (DMARD) classification. DMARDS help to decrease the pain and swelling that is associated with diseases such as arthritis or RA. Methotrexate also has the ability to decrease joint damage caused by these diseases, which can help lower the patient’s risk of long-term disability. In some cases, patients may see improvement after 6 weeks, or it can take upwards of around 6 months for patients to realize the full benefit from this treatment.

2) The FDA Approved Methotrexate for RA Patients in 1988

Prior to its 1988 approval for rheumatoid arthritis, methotrexate had been primarily used to treat patients with cancer and psoriasis. Since then, methotrexate has also been used to treat other rheumatic conditions like lupus, psoriatic arthritis, juvenile arthritis, and vasculitis.

3) Methotrexate should be Taken Once a Week for Arthritis

Nowadays, this medication is available in 2.5 mg tablet form. For most adults who have been diagnosed with rheumatoid arthritis, the starting dose of methotrexate is 7.5 to 10 mg (i.e. 3 to 4 pills). RA patients need to remember that these pills are taken together once a week. If needed, the weekly dosage of methotrexate can be increased to 20 or 25 mg. This medication is available in injectable form as well, and rheumatoid arthritis patients are able to self-inject their doses.

4) Methotrexate Prohibits Certain Enzymes

Dihydrofolate reductase, an enzyme that plays a role in the immune system, is effectively blocked by methotrexate. When this happens, the production of a particular form of folic acid is affected (this folic acid is necessary for actively growing cells). Interestingly, medical researchers are still uncertain on exactly how methotrexate is able to decrease arthritis activity.

5) Liver Function Tests to Look for any Liver-Related Side Effects

In some cases, methotrexate has been known to cause abnormal liver function. For this reason, it is important to have blood drawn for liver panels on a routine basis while taking methotrexate. This way, your primary health care provider can keep an eye out for any unwanted changes.

6) Alcohol Consumption and Methotrexate

If you have been prescribed methotrexate for your rheumatoid arthritis, drinking alcohol can significantly increase your risk of liver damage. All in all, you should really consider not drinking at all while taking methotrexate. However, with your doctor’s permission, you’ll need to keep it to one or two drinks per month at the most.

7) Other Common Side Effects Associated with Methotrexate

Common side effects such as nausea, vomiting, and liver function could be dependent on the patient’s dosage. If you do start experiencing any side effects, this may mean that you need to adjust your dose. Most patients do not experience any serious side effects while taking methotrexate, but some of the reported ones include:

  • Diarrhea
  • Rash
  • Mouth sores
  • Cirrhosis of liver (very rare occurrence)
  • Persistent cough
  • Blood count abnormalities
  • Abnormal shortness of breath
  • Gradual hair loss
  • Sensitivity to the sun

(Anyone with prior kidney or liver disease should not be prescribed methotrexate.)

8) Folic Acid Supplementation

Since methotrexate works to prohibit folic acid production, this must be supplemented with a 1 mg folic acid tablet taken on a daily basis. By supplementing your folic acid, you’ll also be helping to further minimize any possible side effects from taking this medication.

9) Expectant Mothers should not be Taking Methotrexate

Research studies have shown that methotrexate is capable of causing serious birth defects or other pregnancy complications. Women who have been prescribed methotrexate should be using some form of contraception throughout the entire course of treatment and for 3 months after they have stopped taking the medication. Now, although it can cause potential problems during pregnancy, methotrexate will not affect a woman’s chance of getting pregnant in the future.

10) Discuss All Other Medications with Your Doctor

There are other drugs which have been known to cause the toxicity levels of methotrexate to increase, when they are taken in combination. Things like nonsteroidal anti-inflammatory drugs (NSAIDs) and some antibiotics can affect how methotrexate works in the patient’s body. Please remember that it is very important to discuss you treatment options with your primary health care provider and your pharmacist. As mentioned earlier, methotrexate can be used effectively to help treat more severe cases of rheumatoid arthritis, but patients need to remember to be extremely careful while taking this medication.



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