THIS INFORMATION SUPPLEMENTS INFORMATION GIVEN TO YOU ELSEWHERE. AS
A PATIENT YOU MUST UNDERSTAND THE REASONS YOU ARE TAKING THE DRUG
AND HAVE SOME KNOWLEDGE OF THE BENEFITS AND RISKS.
YOUR OWN DEPARTMENT WILL PROBABLY PROVIDE SIMILAR GUIDELINES AND YOU
SHOULD ADHERE TO THE PRACTICE AND POLICIES OF YOUR OWN
RHEUMATOLOGY DEPARTMENT

What do the tablets look like?
Methotrexate tablets are usually yellow, but the colour may vary depending on
which brand your chemist is able to obtain. The tablets should all be of 2.5mg
strength - please check this.

Why are you taking Methotrexate?
Methotrexate belongs to the group of medicine known as disease modifying or
second line agents used to treat inflammatory joint disease.
As Methotrexate is not a pain reliever you will not notice an immediate benefit. It
may take up to 3 months to notice an improvement in your symptoms. You will
need to carry on taking your other medication as well.
Methotrexate requires careful monitoring to avoid toxicity (side effects).

How to take Methotrexate
You will usually start on a once weekly dose of between 5mg and 10mg. Choose a
day that is best for you to take your treatment and keep to that routine. The dose
may be increased depending on how your symptoms respond to the treatment. You
will be prescribed folic acid tablets. One tablet should be taken every day except
on the day you take Methotrexate.
What to do if you miss a dose
If you forget to take your medication, do not double your next dose but make a
note of it and remember to tell your doctor at your next appointment. If you
forget on your regular Methotrexate day, it is fine to take your Methotrexate
tablets a day or two later.

Can you take other medicines and alcohol?
Alcohol can interact with Methotrexate and damage your liver. If you take alcohol,
it is advised that you drink only 1 unit per day and that you discuss this with
Rheumatology Team.
Methotrexate interacts with a number of other medicines. Always tell your doctor
you are taking Methotrexate before any other medicines are prescribed for you,
especially the following:
· Probencid
· Trimethoprim
· Co-trimoxazole (brand name Septrin, Bactrim)
You should not take any additional medicines without checking first with your
doctor.
You should avoid buying medicines over the counter as Methotrexate interacts
with a number of other medications, but if you do so please tell the pharmacist
you are taking Methotrexate. Your doctor may prescribe aspirin or non-steroidal
anti-inflammatory drugs, or you may already be taking them. These may interact
with Methotrexate, however it is unlikely to cause a problem at the doses
prescribed for you.
Paracetamol, coproxomol or codeine can be taken with Methotrexate.

Contraception and pregnancy
Treatment with Methotrexate has the potential to affect fertility of men and
women. It is advised that you should not be taking Methotrexate before
conception or for at least six months after treatment. Treatment with
Methotrexate has the potential to affect the development of the unborn child and
men and women of childbearing age should use a reliable method of contraception
to avoid the risk of an unplanned pregnancy during treatment. When planning a
pregnancy, it is important that both men and women on this drug discuss
medication with the Rheumatology Team. This should be at least six months
before conception.

Special precautions
Your doctor will arrange for you to have regular blood tests, two weekly for the
next three months, then every month thereafter.
All infections should be treated promptly. If you are aware of an infection, arrange
to see your doctor.

Possible side effects
" Nausea, upset stomach
Take the tablets with or after food, if possible in the evening, to reduce any
stomach upset. Drink plenty of water with the tablets. The feeling of sickness
usually goes away after a time as your body gets used to the treatment. If the
sickness is severe, consult your doctor.
" Mouth ulcers, sore throat or mouth
" Rash, itching anywhere on the body
" Effects on the bone marrow or the liver
Regular blood tests are carried out to monitor for this.
" Inflammation of the lung tissue
A chest x-ray is taken before starting treatment. If you find yourself becoming
increasingly breathless, report it to your doctor immediately.
" Thinning hair
" Reduced resistance to infection
You should avoid close contact with people who have infections such as
chickenpox. If you know you have been in close contact with somebody with
chickenpox, contact your doctor for advice. Do not have any live vaccinations
without first discussing it with your doctor.
If you have noticed any side effects, tell the doctor or nurse promptly.

Please note: the information here is additional information for you. Please also
read the information sheet that is provided with your medication