Women who are allergic or have sensitivity to methotrexate should not receive the medication.

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12 mg/m2 intrathecally every 2 to 5 days until the cell count of the CSF returns to normalAt this pointone additional dose is advisableAdministration at intervals of less than 1 week may result in increased subacute toxicity.

Single Dose10 to 25 mg/week orallyIMor IV until adequate response is achievedDivided Dose2.5 mg orallyIMor IV every 12 hours for 3 doses once a weekMaximum weekly dose30 mg.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222An overdose of methotrexate can be fatal.

Methotrexate is used to treat certain types of cancer or to control severe psoriasis or rheumatoid arthritis that has not responded to other treatmentsIt may also be used to control juvenile rheumatoid arthritisMethotrexate belongs to a class of drugs known as antimetabolitesIt works by slowing or stopping the growth of cancer cells and suppressing the immune system.

Nonsteroidal anti-inflammatory drugsNSAIDssuch as ibuprofennaproxenaspirindiclofenacetodolacor ketoprofenIncreased side effects can include bleedingproblems with your bone marrowor serious problems with your digestive tractThese problems can be fatalcause deathSeizure drugs such as phenytoinIncreased side effects can include upset stomachhair losstirednessweaknessand dizzinessGout drugs such as probenecidIncreased side effects can include upset stomachhair losstirednessweaknessand dizzinessAntibiotics such as penicillin drugswhich include amoxicillinampicillincloxacillinand nafcillinIncreased side effects can include upset stomachhair losstirednessweaknessand dizzinessProton pump inhibitors such as omeprazolepantoprazoleor esomeprazoleIncreased side effects can include upset stomachhair losstirednessweaknessand dizzinessSkin drugs such as retinoidsIncreased side effects can include liver problemsPost-transplant drugs such as azathioprineIncreased side effects can include liver problemsAnti-inflammatory drugs such as sulfasalazineIncreased side effects can include liver problemsAntibiotics such as trimethoprim/sulfamethoxazoleIncreased side effects can include bone marrow damageNitrous oxidean anesthesia drugIncreased side effects can include mouth soresnerve damageand a reduction in blood cell counts that may increase your risk of infection.

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concurrent use of nsaids may increase the risk of gi bleeding in patients with methotrexate-induced myelosuppression or mask fever, pain, swelling and other signs and symptoms of an infection.

You should not take methotrexate if you have severe anemia, low white blood cell counts, or low platelet counts.

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DrRanganathan recommends taking 1 mg of folic acid dailythough for convenience some other physicians instruct patients to pop a single 5 mg dose once a weekSome doctors recommend taking folic acid 24 hours after receiving a dose of methotrexateask your physician for complete instructions on using folic acid supplements

This drug may make you dizzy or drowsyAlcohol or marijuana can make you more dizzy or drowsyDo not driveuse machineryor do anything that needs alertness until you can do it safelyAvoid alcoholic beveragesTalk to your doctor if you are using marijuana.

When methotrexate is less effectiveWhen methotrexate is used with certain drugsit may not work as well to treat your conditionThis is because the amount of methotrexate in your body may be decreasedExamples of these drugs include:

Examples of drugs that can cause interactions with methotrexate are listed below.

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more recent evidence suggests that high dose methotrexate may also overcome methotrexate resistance caused by impaired active transport, decreased affinity of dihydrofolic acid reductase for methotrexate, increased levels of dihydrofolic acid reductase resulting from gene amplification, or decreased polyglutamation of methotrexate.

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therefore, you should be monitored carefully if you are receiving penicillin while being treated with methotrexate.
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