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Methotrexate

 

2.5 mg yellow, round tablet


Purpose

For reduction of inflammation and to retard disease progression

 

Indications

Rheumatoid arthritis, dermatomyositis or polymyositis, psoriatic arthritis, other forms of synovitis.


Dosage

If taken orally, as is usual in rheumatoid arthritis, the dose is usually 5 to 15 mg per week given in two or three doses, twelve hours apart; sometimes as a single weekly dose. It should not be taken every day.


Side effects

These include opportunistic infections, mouth ulcers, and stomach problems. Damage to the liver, a special side effect of this drug, is particularly a problem if the dug is taken orally every day. When taken orally, this drug is absorbed by he intestine and passes through the liver on the way to general circulation. As a result, most doctors have discontinued this daily method of administration.

 

Instead the drug is given intermittently, once a week, so that the liver has an opportunity to heal. Problems can still occur with the newer doe schedules, but are much less frequent. A severe problem with the lungs is occasionally seen with methotrexate. Cancer has not been reported.

 

Special hints

This drug is extremely effective in many cases of rheumatoid arthritis and has become the preferred drug for many patient. Because of its remarkable effectiveness, it is now the most frequently used of the DMARDs. Regular blood tests are required, as with all of these dugs. Some doctors recommend liver biopsy to be sure that the liver is normal before starting the drug. However, this procedure is hazardous and is not necessary as long as blood liver tests are normal before the drug is started. A "baseline" liver biopsy is no longer recommended unless the patient already has a liver problem, in which case the drug probably shouldn't be used anyway. The blood liver tests should be checked every so often -- perhaps at four-to-eight-week intervals during treatment -- and the drug should be stopped if there is any suspicion of difficulty. Since alcohol also can damage the liver, alcohol intake should be extremely moderate during this period of methotrexate treatment. Some doctors recommend liver biopsy after a few years of treatment to make sure that no scarring has occurred. Current belief is that this is not necessary unless the liver blood tests are consistently abnormal. At this time, there seem to be worse complications from liver biopsies ( the death rate is between 1 in 1,000 and 1 in 10,000 ) than from methotrexate liver disease ( no serious events reported yet ). Patients who are taking Plaquenil together with methotrexate seem to have fewer liver test abnormalities.

         
         

     

         

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