Understanding Methotrexate

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1 Understanding Methotrexate Turnberg Building Inflammatory Bowel Disease Service All Rights Reserved Document for issue as handout.

2 What is my medication? Methotrexate is considered to be effective in the management of inflammatory bowel disease. It aims to reduce the inflammation in your bowel. How does it work? Methotrexate works by reducing inflammation in the bowel, its precise action is unknown. It is used by individuals who have been unable to keep their symptoms under control with traditional medications such as azathioprine, mercaptopurine and steroids. Evidence suggests that four out ten people will achieve remission when using methotrexate in conjunction with other medications to control their inflammatory bowel disease. How and when should I take my methotrexate? Methotrexate will be started by your hospital consultant managing for your inflammatory bowel disease. Initially you will attend clinic on a weekly basis, when the specialist nurse will review you and your progress and administer methotrexate in an injection. You will receive 25mgs of methotrexate in injection form once a week for twelve weeks. The dose may be reduced if you develop side effects to the drug. At twelve weeks your condition will be reviewed by the consultant in outpatients. If you are well and your symptoms have settled, the consultant will change your medication to methotrexate in tablet form. This is usually in a single dose of 15mgs once a week. If you still require steroids your consultant will consider reducing the dose of your injection. The injections will continue for a further period of time. You should continue with all your other medications when you start methotrexate unless the specialist nurse or doctors tell you otherwise. Taking Folic Acid Whilst you take methotrexate you will need to take folic acid tablets. This is given in a dose of 5mgs three times a week. You should not take this on the day of your methotrexate injection or tablet. Folic acid is given to reduce the risk of developing folate deficiency. Which can lead to anaemia, nausea and vomiting. 1 2

3 What are the side effects? If you experience any side effects you should contact the IBD hotline. Side effects include: Infections, including fever, chills or sore throats Unexplained skin rash, ulceration or skin soreness Yellowing of the skin or generalised itching Bleeding gums, black tarry stools or unexpected bleeding or bruising Chest pain, difficulty breathing or a dry, persistent cough Severe or continuing diarrhoea, vomiting or stomach pains Vaginal inflammation or ulcers Chicken pox or Shingles If you are taking methotrexate and you develop chicken pox or shingles you should contact the IBD hotline as soon as possible. Taking other medications Always check with your doctor before taking any new medications. Common medicines that may interact with your methotrexate include trimethropin, cotrimazole and brufen. The specialist nurse will check your medication for interactions before starting your methotrexate. Vaccines You should avoid receiving live vaccines whilst on methotrexate. If you receive a live vaccine you are likely to become unwell. Inactivated vaccines such as the flu vaccine are safe. You should discuss any planned vaccination with your Consultant or Specialist Nurse before having them. Drinking Alcohol Alcohol can react with methotrexate so it is advisable not to drink. However, occasional alcohol may not cause significant side effects. You should discuss this with either the consultant or specialist nurse before commencing therapy. Food Food made from unpasteurised milk, such as soft cheese and pate, may be a source of bacteria which could increase your risk of developing infection. Having a baby and breastfeeding Methotrexate reduces fertility in men and women. It can also affect the development of a baby. Methotrexate can also be passed to baby through breast milk and may cause side effects listed above. It is therefore advised not to conceive or breastfeed during therapy and for six months following. You should discuss reliable forms of contraception with your doctor. 3 4

4 Investigations prior to commencing and during methotrexate The full blood count, liver function tests and urea and electrolytes are checked prior to commencing therapy. For the first month they will be checked weekly. After this, if you have no problems they will be checked monthly. In event of developing problems with your blood tests. Therapy will either be reduced or stopped. You will continue to have your blood tests monitored until they are back to normal. Finally If you have any questions about your medication, your Crohn s disease or colitis then please do not hesitate to contact the IBD Hotline on: or by ibd@srft.nhs.uk Notes 5 6

5 G W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2018 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: MED11(18) Review Date: April 2020 For further information on this leaflet, it s references and sources used, please contact Copies of this leaflet are available in other formats (for example, large print or easyread) upon request. Alternative formats may also be available via www. srft.nhs.uk/for-patients/patient-leaflets/ If you need this information leaflet translated, please telephone: In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities to access this service. Please contact the service/clinic you are attending by phone or prior to your appointment to discuss your requirements. Interpreters are available for both verbal and non-verbal (e.g. British Sign Language) languages, on request. Please contact the service/clinic you are visiting to request this. or InterpretationandTrans@srft.nhs.uk Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on This is a teaching hospital which plays an important role in the training of future doctors. The part patients play in this process is essential to make sure that we produce the right quality doctors for all of our futures. If at any time you would prefer not to have students present please inform the doctor or nurses and this will not affect your care in anyway. Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone If you would like to become a Foundation Trust Member please visit: for-members If you have any suggestions as to how this document could be improved in the future then please visit: for-patients

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