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What it is and where it is used?

Methotrexate was first developed to treat cancer. This has been also found effective for the treatment of severe arthritis, Crohn’s disease, and psoriasis in much lower doses. High doses of Methotrexate is still used in chemotherapy treatment of a variety of cancers such as non-Hodgkin’s lymphoma, acute leukemia’s, soft tissue and bone cancers, and a number of solid tumors. Methotrexate comes as a tablet with the dosage strengths of 2.5 mg and 10 mg. This is a prescription approved by the Food and Drug Administration (FDA). 

  • Rheumatoid arthritis

This is a chronic inflammatory disease that affects more than just your joints. For some people, it can damage a wide variety of body systems including eyes, skin, heart, lungs, and blood vessels. Rheumatoid arthritis happens once your immune system inaccurately attacks your own body’s tissues. Signs and symptoms of rheumatoid arthritis may include:

  • Loss of appetite
  • Tender, warm, swollen joints
  • Fatigue
  • Joint stiffness is usually worse in the mornings and after inactivity
  • Fever

Rheumatoid arthritis happens when your immune system attacks the synovium. It is the lining of the membranes that surround your joints. The subsequent inflammation thickens the synovium that might in time destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Progressively, the joint loses its shape and alignment.

  • Psoriasis 

This is a skin condition that causes flaky, red, and crusty patches of skin covered with silvery scales. These patches usually appear on your knees, elbows, lower back, and scalp but can appear anywhere on your body. It can start at any age, but most often develops in adults under 35 years old and affects men and women equally. For some, psoriasis is just a minor irritation but for others it can majorly affect their quality of life.

  • Crohn’s disease

In some people, this condition has only the last segment of the small intestine is affected. In others, the disease is confined to the colon. The colon and the last part of the small intestine are the most common areas affected by Crohn’s disease. The diseases’ signs and symptoms might be mild or severe. They frequently progress slowly but sometimes will come on without warning. When the disease is active, signs and symptoms may include:

  • Fever
  • Diarrhea
  • Reduced appetite and weight loss
  • Fatigue
  • Blood in your stool
  • Abdominal pain and cramping
  • Mouth sores
  • Pain or drainage near or around the anus due to inflammation from a tunnel into the skin 

People with severe Crohn’s disease also may experience:

  • Inflammation of skin, eyes, and joints
  • Delayed growth or sexual development in children
  • Inflammation of the liver or bile ducts

The exact cause of Crohn’s disease is not yet fully known. Beforehand, diet and stress were suspected, but now doctors know that these factors may aggravate but don’t cause Crohn’s disease. A number of factors such as heredity and a malfunctioning immune system likely play a role in its development.

How It Works

In rheumatoid arthritis 

Methotrexate slows down the creation of cells in the immune system that reasons for the inflammation of the joints. In arthritis, this drug is referred to as a disease-modifying antirheumatic drug (DMARD). It suppresses the disease process. Methotrexate is not a painkiller and can take up to 12 weeks to start working. 

In psoriasis

Methotrexate works by slowing down the unnecessary production of skin cells. These cells cause skin scaling and raised plaques in this condition. It can take up to 12 weeks before you start to notice the difference.

In Crohn’s disease

Methotrexate slows down the production of cells in the immune system that cause the inflammation in the bowel. As with arthritis and psoriasis it can take up to 12 weeks to start working.

In cancer

Methotrexate is a form of chemotherapy that prevents cancer cells from multiplying and dividing. It kills cancer cells and stops cancer growth. This medicine might also affect normal and healthy cells. Particularly, it is those that divide rapidly such as the cells lining the mouth and gut or cells in the bone marrow where blood cells are made. Hence, cancer chemotherapy using high doses of Methotrexate is usually followed by a treatment called folinic acid rescue therapy. This involves giving folic acid usually 24 hours after the Methotrexate. It is to bypass the action of this medicine and permits normal cell division to recover. Normal healthy cells recover faster than cancer cells and this helps to prevent side effects. The goal is to gradually shrink cancer over several cycles of chemotherapy and allowing normal cells to recover in between.

How To Use

Methotrexate tablets can be taken either with or without a meal. They should be swallowed whole with a glass of water. Don’t crush or chew the tablets. It is important to pay close attention to the dose of this drug that your doctor has prescribed and how often you should take your dose. This will depend on the condition that is being treated. Always check the strength of the tablets you have been given and make sure you know how many you need to take. 

If you forget to take your weekly dose on your usual day, contact your doctor for advice. Take your next dose as usual when it’s due. Never take a double dose to make up for a missed dose.

Its Side Effects

  • Nausea 
  • Abdominal distress
  • Elevated liver function tests
  • Feeling unwell
  • Fatigue 
  • Chills and fever
  • Dizziness and decreased resistance to infection
  • Ulcerative stomatitis
  • Low white blood cell count 

Warnings and Precautions

  • Drinking alcohol while you’re having Methotrexate treatment increases the risk of getting side effects on your liver. The risk of liver damage is higher for people with psoriasis than people with rheumatoid arthritis. It’s important that you don’t drink more than the recommended guidelines. 
  • Before starting treatment, you may need to have blood tests to check your liver function, kidney function, and levels of blood cells in your blood. These tests will need to be repeated regularly throughout your treatment. It is to check that the medicine is not causing any problems. It’s important that you do not miss any blood tests that your doctor asks you to have. 
  • It’s important to tell your doctor what medicines you are already taking including those bought without a prescription and herbal medicines before you start treatment with Methotrexate.
  • If you are a pregnant or breastfeeding women, consult your doctor first before taking this medicine. 
  • This medication may make you more sensitive to the sun. Limit your time in the sun.