Methotrexate
Brand: Trexall
Boxed warning · ISMP high-alert drug
Embryo-fetal toxicity, severe hypersensitivity, and serious toxic reactions including death; medication errors: tablets taken daily instead of weekly have been fatal.
- Caution
- For non-cancer use the dose is once WEEKLY: a daily-frequency error is lethal; bone marrow, liver, lung, and kidney toxicity are monitored.
- Storage
- Injection: protect from light.
- Pregnancy
- Avoid in pregnancy: fetal death and birth defects (boxed); contraindicated for non-cancer use, with contraception during and for months after treatment.
Common side effects
- Nausea
- Mouth sores
- Fatigue
- Low blood counts
- Hair thinning
Key interactions
- NSAIDs raise toxicity risk
- Avoid alcohol due to liver risk
- Certain antibiotics increase levels
- Folic acid reduces side effects; leucovorin is used as rescue after high-dose therapy
Counseling points
- Take weekly, not daily, for arthritis
- Report mouth sores or unusual bruising
- Avoid alcohol
- Report cough or trouble breathing
- Use reliable contraception
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