Adult Dosing
Severe rheumatoid arthritis
- 7.5 mg PO qwk
- Alt: 2.5-7.5 PO q12 hrs x 3 doses qwk
- Max: 20 mg/wk
- Use lowest effective dose and give with folic acid 1 mg daily or levoleucovorin 5 mg qwk
Psoriasis
- 10-25 mg PO qwk
- Alt: 2.5-7.5 mg PO q12 hrs x 3 doses qwk
- Max: 30 mg/wk
- Use lowest effective dose and give with folic acid 1 mg daily or levoleucovorin 5 mg qwk
Mycoses fungoides
- 5-50 mg PO qwk
- Alt: 15-37.5 mg PO twice weekly in poor responders
Leukemia
- Induction: 3.3 mg/m2/day PO in combination with prednisone 60 mg/m2/day for 4-6 wks
- Maintenance: 30 mg/m2 PO divided 2/wk
Trophoblastic neoplasms (choriocarcinoma, chorioadenoma destruens, hydatiform mole)
- 15-30 mg/day PO for 5 days
- Repeat after 1 or more weeks for 3-5 courses
Burkitt Lymphomas, stages I and II
- 10-25 mg/day PO for 4-8 days
- Allow 7-10 days rest periods in between courses
Crohn's Disease [Non-FDA approved]
Pediatric Dosing
Juvenile rheumatoid arthritis
2-16 yrs
- Start 10 mg/m2 PO qwk
- May increase to 20-30 mg/m2 PO qwk
- Note: Response is better if doses > 20 mg/m2 are given IM/SC
Leukemia
2-16 yrs
- Induction: 3.3 mg/m2/day PO in combination with prednisole 60 mg/m2/day for 4-6 wks
- Maintenance: 30 mg/m2 PO divided twice/wk
Crohn's Disease [Non-FDA approved]
- 15 mg/m2/week to 25 mg/m2/week SC X 3-6 months
[Outline]
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
- 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
- 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
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.
- Trexall 10 MG TABS [Bottle] (TEVA/WOMENS HEALTH)
30 mg = $556.98
90 mg = $1600.97
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.
