Adult Dosing
Severe rheumatoid arthritis (methotrexate (generic), Otrexup)
- 7.5-25 mg IM qwk or 7.5 mg SC qwk
- Polyarticular Juvenile Idiopathic Arthritis (Otrexup) : 10 mg/m2 SC qwk
Psoriasis (methotrexate (generic), Otrexup)
- 10-25 mg IM/IV/SC qwk
- Max: 30 mg/wk
Trophoblastic neoplasms (choriocarcinoma, chorioadenoma destruens, hydatiform mole) (methotrexate (generic))
- 15-30 mg/day IM x5 days
- Repeat after 1 or more weeks for 3-5 courses
Leukemia (methotrexate (generic))
- Induction: 3.3 mg/m2 IV with prednisone 60 mg/m2 per day
- Maintenance: 2.5 mg/kg IV q14 days
Meningeal leukemia (methotrexate (generic))
- 12 mg/m2intrathecally 2 of 5 days
Osteosarcoma (methotrexate (generic))
- 12 g/m2 as a 4 hr infusion followed by leucovorin rescue, usually as a part of combination chemotherapeutic regimen
- May increase dose until peak serum methotrexate level is 1 × 10-3 M/L
- Max: 15 g/m2
Pediatric Dosing
Leukemia
- Induction: 3.3 mg/m2 IV with prednisone 60 mg/m2 per day
- Maintenance: 2.5 mg/kg IV q14 days
Meningeal leukemia
- Doses are typically given in intervals of 2 to 5 days
- < 1 yr: 6 mg intrathecally
- 1 yr: 8 mg intrathecally
- 2 yrs: 10 mg intrathecally
3 yrs: 12 mg intrathecally
Juvenile rheumatoid arthritis
2-16 yrs
- Oral methotrexate may be the preferred route
- Start 10 mg/m2 IM qwk
- May increase to 20-30 mg/m2 IM qwk
[Outline]
Neoplastic diseases (methotrexate (generic))
- Treatment of gestational choriocarcinoma, chorioadenoma, destruens and hydatidiform mole
- In acute lymphocytic leukemia for prophylaxis of meningeal leukemia and for maintenance therapy in combination with other chemotherapeutic agents
- Treatment of meningeal leukemia
- Alone or in conjunction with other anticancer agents for the treatment of breast cancer, epidermoid cancers of the head and neck, advanced mycosis fungoides (cutaneous t cell lymphoma), and lung cancer, particularly squamous cell and small cell types
- Concomitant use with other chemotherapeutic agents for the treatment of advanced stage non-hodgkin’s lymphomas
Psoriasis (methotrexate (generic), Otrexup)
- Symptomatic control of severe, recalcitrant, disabling psoriasis that are not adequately responsive to other forms of therapy, but only when the diagnosis is established by biopsy and/or after dermatologic consultation
Rheumatoid arthritis (methotrexate (generic), Otrexup)
- Management of selected adults with severe, active rheumatoid arthritis (ACR criteria), or children with active polyarticular-course juvenile rheumatoid arthritis having an insufficient therapeutic response or are intolerant of an adequate trial of first-line therapy including full dose NSAIDs agents
Renal Dose Adjustment (Based on CrCl)
- 10-50 mL/min: Decrease dose by 50%
- <10 mL/min: Avoid use
- Hemodialysis: Decrease dose by 50%
Hepatic Dose Adjustment
RA/psoriasis
- Alcoholic liver disease/other chronic hepatic diseases: Contraindicated
Other indications
- Hepatic impairment: Use with caution; dose adjustments not defined
See Supplemental Patient Information
- Avoid using methotrexate formulations and diluents containing preservatives for intrathecal or high dose methotrexate therapy [US Black Box Warning]
- Potential for serious toxicity exists. Toxicity may occur at all doses and at any time during therapy, closely monitor patients throughout course of therapy. On development of such reactions reduce the dosage or discontinue therapy and institute appropriate corrective measures. If essential include the use of leucovorin calcium and/or acute, intermittent hemodialysis with a high-flux dialyzer
- Exercise caution on reinstitution of therapy. Adequately consider further need for the drug and increased alertness is essential as possible recurrence of toxicity exists
- The clinical pharmacology of methotrexate has not been well studied in geriatrics. Consider low doses in presence of diminished hepatic and renal function as well as decreased folate stores. Closely monitor patients for early signs of toxicity
- Potential toxicities include bone marrow depression, hepatotoxicity, lung disease (suggested by symptoms of dry, nonproductive cough), nephrotoxicity, and GI toxicity. Monitor patients closely
- Suppression of hematopoiesis, which may cause anemia, pancytopenia, leukopenia, neutropenia, and thrombocytopenia, may occur
- Avoid NSAID agents
- Gastrointestinal toxicity may require interruption of therapy
- Do not administer live vaccines, severe reactions may occur
- Perform CBC with differential count, Plt, LFTs, renal function tests, chest X-ray at baseline
- For RA and psoriasis monitor CBC with differential count, Plt qmo; renal function tests and LFTs q1-2 months. more frequent monitoring may be required in patients receiving chemotherapy
- Monitor uric acid levels. Alkalinize urine. Force fluids (2 to 3 L daily). Leucovorin resuscitation is necessary in high dose protocols
- Males must avoid impregnating females during and for a minimum of 3 months after therapy
- Avoid live vaccines
- Leukoencephalopathy has been reported
- Lung disease may occur at any time during therapy
- Tumor lysis syndrome may occur
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Active infection
- Concomitant XRT
- Myelosuppression
- Ulcerative colitis
- Plueral effusion
- Ascites
- Peptic ulcer disease
- Debilitated patients
- Elderly patients
Supplemental Patient Information
- Inform patients of the early signs and symptoms of toxicity and the need to see their physician promptly on occurrence of such events and the need for closer follow-up, including periodic laboratory tests to monitor toxicity
- Inform patients of the potential benefit and risk associated with use of this drug. Discuss the risk of effects on reproduction with both male and female patients taking methotrexate
Pregnancy Category:X
Breastfeeding: Unsafe; Breastfeeding is contraindicated during maternal antineoplastic drug therapy. It is considered that low single or weekly doses, such as those used for rheumatoid arthritis, are of low risk to the breastfed infant. Monitor breastfed infants with a complete blood count if methotrexate is used during lactation. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 11 April 2011). According to manufacturer's data use of this drug is contraindicated in nursing mothers.
Pricing data from www.DrugStore.com in U.S.A.
- Methotrexate Sodium 25 MG/ML SOLN [Vial] (APP PHARMACEUTICAL)
10 ml = $24.99
30 ml = $61.97 - Methotrexate Sodium 25 MG/ML SOLN [Vial] (HOSPIRA)
2 ml = $14.99
6 ml = $28.04
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
