FM1997

Disease Modifying Drugs > Methotrexate

 

Dosage:		Start 7.5mg WEEKLY orally
		Increase by 2.5mg every siw weeks to 15-20mg weekly as appropriate. Lower doses in frail elderly or significant renal impairment.
		Folic Acid 5mg weekly 3 days after methotrexate dose
NB:		Several important drug interactions including aspirin and some antibiotics. Check BNF before co-prescribing
		Stop drug 90 days before possible conception (teratogenic). Restrict alcohol intake while on treatment.

Investigations before starting treatment performed by rheumatologist

• FBC
• U&E, LFT, Bone Profile
• Routine urinalysis
• CXR
• Hepatitis B and C serology

Monitoring of Methotrexate treatment by primary health care team

 

Investigation	Frequency	Action required
FBC	Weekly for ONE month, Then Monthly	STOP if: WBC <4 x 109/L neutrophils <2 x 109/L platelets <150 x 109/L OR if: sequential fall of >10% in 3 counts
		Check B12 and folate if macrocytosis
LFT	Every 2 Months	STOP if: >twofold rise in AST or ALT
U&E	Every 4 Months

Please note that in addition to absolute values for haematological indices a rapid fall
or consistent downward trend  in any values should prompt caution and extra vigilance.

Side effects

Mouth ulcers, stomatitis, cough/dyspnoea	STOP
Nausea	Split or reduce dose - get advice if persistent

These guidelines have been with permission from the department of rheumatology, Gwent Rheumatology Service.

 

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