Methotrexate is a commonly used drug for the treatment of rheumatic diseases, but its specific usage and associated toxic side effects are not known to the majority of patients. This article informs you about the correct usage of methotrexate.
1. The following preparations should be made before using methotrexate: assessment of risk factors for methotrexate adverse reactions (such as alcohol consumption, etc.); patient education; testing of routine blood, liver and kidney functions, HIV antibodies, hepatitis B markers, hepatitis C antibodies, blood glucose, lipids and pregnancy tests, and chest X-ray. Xie Yu, Department of Rheumatology, Jiangsu Provincial Hospital of Traditional Chinese Medicine 2. Methotrexate is taken orally once a week. If the efficacy is good and tolerated, it can be increased by 2.5mg every 2-4 weeks to a maximum dose of 15-20mg once a week. If the efficacy is poor or not tolerated, intravenous administration can be considered.
3. Consider combining at least 5 mg of oral folic acid per week. It can reduce the side effects of methotrexate and maintain the efficacy of methotrexate.
4. When starting methotrexate or when its dose is increased, liver and kidney function and blood picture should be tested once every 1 month to 1.5 months. After the dose of methotrexate is stabilized and the indexes are stable, the testing interval can be extended to once every 1-3 months. It is necessary to know whether there are any adverse reactions to methotrexate at each visit and to assess whether there are any risk factors for adverse reactions.
5. When the transaminase level increases to more than 3 times the upper limit of normal, the drug needs to be stopped immediately and treatment with low-dose methotrexate should be restarted after the transaminase level returns to normal. However, if the transaminase level continues to be higher than 3 times the upper limit of normal, the methotrexate dosage should be adjusted. If the transaminase level continues to be more than 3 times the upper limit of normal after stopping methotrexate, other causes should be found.
6.If no adverse reaction occurs with methotrexate, it can be used for a long time.
7.Patients with early rheumatoid arthritis can be active with methotrexate alone. When methotrexate is difficult to control the disease with single treatment, it can be combined with other disease-improving drugs.
8.Methotrexate helps to reduce the hormone dose, and can also be used for the treatment of rheumatic polymyalgia and giant cell arteritis. In addition, it can be used for the treatment of systemic lupus erythematosus and dermatomyositis (including juvenile).
9. For patients with rheumatoid arthritis who need surgery, methotrexate can be used non-stop before surgery.
10. Before pregnancy, both men and women should stop methotrexate for six months to one year. Methotrexate is prohibited during pregnancy and lactation