Methotrexate Please rate this page (bottom of page)

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This page contains a brief description that does not cover the medication. For more information read the review in Felleskatalogen.no for the respective drug.

Definition

Methotrexate is a disease-reducing drug that is used against several types autoimmune diseases.

Usually start with methotrexate as in doses up to 25mg / week. When more than 15-20mg / week is needed, syringes are often better than tablets because the effect is better. Methotrexate has been used against RA for 50 years, but is still a cornerstone of treatment for several reasons.

  1. 25-40% have a good effect of methotrexate alone and combined with prednisolone achieve almost 50% low disease activity or remission in early RA.
  2. Together with biological drugs, methotrexate increases the treatment effect.
  3. Methotrexate reduces the development of neutralizing antibodies through the use of biological drugs

Side effects such as nausea, hair loss, stomatitis and hepatotoxicity can be prevented with prophylactic folic acid 1mg / day or 10mg / week. Approximately 5% still need to discontinue methotrexate due to side effects (Alethaha D, Smolen JS, JAMA 2018).

Contraindications include liver disease, severe renal failure (eGFR <30) and pregnancy or planned pregnancy. In case of low-grade renal failure (slightly increased creatinine or slightly low eGRF, one must be aware that methotrexate may accumulate and cause toxicity. Similarly, when using trimethoprim, trimethoprim-sulfa / Bactrim (against infection).

Dosage

  • dosed ONE day in the UK
  • Combined with Folic acid 1mg / day
  • Tablets or injection
  • In adults, the dose is usually between 10mg one day a week and 25mg one day a week

Rheumatic diseases treated with methotrexate

Side effects that may occur

  • Nausea and decreased appetite are common, usually the day after treatment
  • Methotrexate can cause side effects from the liver (check liver enzymes (AST, ALT) in blood test regularly)
    • In general, 3 alcohol units a week can be tolerated (but not all)
  • Metotrexate is excreted by the body through the kidneys (80-90%)
    • NB Reduced dosage or discontinuation of treatment if renal failure is detected
  • Treatment mustn't end before pregnancy
  • Protection against strong sun is recommended because the medication can contribute to increased risk of skin cancer
  • Control and follow-up of a specialist in collaboration with a general practitioner is recommended

Recommendations

Norwegian Rheumatological Association

Patient information 

Medications, BINDEVEVSSYKDOMMER.no


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