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Brand names:

Rasuvo®, TrexallTM

Other names:

Methotrexate Sodium, MTX

Often used for:

Acute lymphoblastic leukemia, Brain tumors, Non-Hodgkin lymphoma, Osteosarcoma, Graft-versus-host disease

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About Methotrexate

Methotrexate is a type of chemotherapy. It works by slowing or stopping the growth of cells. This medicine may be given in the clinic, hospital, or at home. The schedule and dose depends on the type of cancer, child’s age, and method of administration.

If children receive high doses of methotrexate, they may also be given extra IV fluids and a medicine called leucovorin to reduce side effects.

Patients will have regular blood draws to check blood counts, the amount of methotrexate in the blood (if very large doses are given), and monitor liver and kidney function. Methotrexate dose changes may occur based on levels in the blood.

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May be taken as a tablet by mouth

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May be given as a liquid by IV or injected into a muscle

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May be given in the cerebrospinal fluid (intrathecal)

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Possible Side Effects

  • Nausea and vomiting
  • Sores around the mouth, lips, or anus
  • Sun sensitivity
  • Kidney problems
  • Low blood counts, usually after 2-14 days (may cause increased risk of infection, bleeding, anemia and/or fatigue)
  • Loss of appetite
  • Headache (intrathecal route)
  • Diarrhea
  • Hair loss
  • Skin irritation, rash
  • Liver problems

Not all patients who take methotrexate will experience these side effects. Common side effects are in bold, but there may be others. Please report all suspected side effects to your doctor or pharmacist.

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Possible Late Effects

Some patients may experience long-term or late effects of treatment that may continue or develop months or years after treatment ends. Possible late effects due to methotrexate include:

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Tips for Families

Be sure to discuss these and other recommendations with your doctor or pharmacist.

  • While taking methotrexate, patients should not take multivitamins or other supplements containing folic acid, non-steroidal anti-inflammatory drugs (NSAIDS), or proton pump inhibitors (such as omeprazole) unless recommended by a doctor.
  • Sexually active patients should take steps to prevent pregnancy during treatment and for 6 months after completion of therapy.
  • Patients should tell their doctor if they are pregnant or breastfeeding.
  • Patients should protect their skin from the sun.
  • Caregivers should follow instructions for safe handling and disposal of the medicine and avoid contact with patient body fluids. Patient body fluids can contain the drug for 48 hours after it is given.

Methotrexate at home:

  • Take medicine at the same time each day.
  • Take tablets on an empty stomach. A large number of tablets may be needed to make up the total dose. Talk to your care team about ways to make swallowing medicine easier.
  • Follow instructions for safe handling and disposal.