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Indications

High Alert

Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

Derm: alopecia, ERYTHEMA MULTIFORME, painful plaque erosions (during psoriasis treatment), photosensitivity, pruritus, rash, skin ulceration, soft tissue necrosis, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, urticaria.

EENT: blurred vision, transient blindness.

GI: anorexia, diarrhea, nausea, stomatitis, vomiting, GI PERFORATION, HEPATOTOXICITY.

GU: nephropathy, fertility, acute renal failure, menstrual abnormalities, oligospermia.

Hemat: anemia, leukopenia, thrombocytopenia, APLASTIC ANEMIA.

Metab: hyperuricemia.

MS: hemiparesis, osteonecrosis, stress fracture.

Neuro: arachnoiditis (IT use only), confusion, dizziness, drowsiness, dysarthria, headache, leukoencephalopathy, malaise, SEIZURES.

Resp: INTERSTITIAL PNEUMONITIS.
Misc: chills, fever, (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS , INFECTION, SECONDARY MALIGNANCY, tumor lysis syndrome.

Interactions

Drug-Drug:

Drug-Natural Products:

Availability

(Generic available)

Route/Dosage

see Calculator

Acute Lymphoblastic Leukemia

Meningeal Leukemia

Non-Hodgkin's Lymphoma

Osteosarcoma

Breast Cancer

Squamous Cell Carcinoma of Head and Neck

Gestational Trophoblastic Neoplasia

Mycosis Fungoides

Rheumatoid Arthritis

Polyarticular Juvenile Idiopathic Arthritis

Psoriasis

Therapy may be preceded by a 5–10-mg test dose

US Brand Names

Jylamvo, Otrexup, Rasuvo, Rheumatrex, Trexall, Xatmep

Action

Therapeutic Effects:

Classifications

Therapeutic Classification: antineoplastics, antirheumatics (DMARDs), Immunosuppressant agents

Pharmacologic Classification: antimetabolites

Pharmacokinetics

Absorption: Small doses are well absorbed from the GI tract. Larger doses incompletely absorbed.

Distribution: Actively transported across cell membranes, widely distributed. Does not reach therapeutic concentrations in the CSF. Absorption in children is variable (23–95%) and dose-dependent.

Metabolism/Excretion: Excreted mostly unchanged by the kidneys.

Half-life: Low dose: 3–10 hr; high dose: 8–15 hr ( in renal impairment).

Canadian Brand Names

Metoject

Time/Action Profile

(effects on blood counts)

ROUTEONSETPEAKDURATION
PO, IM, IV4–7 days7–14 days21 days
SUBQunknownunknownunknown

Patient/Family Teaching

Pronunciation

meth-o-TREX-ate