Methotrexate counselling

Question 1

action methotrexate

Answer 1

decrease inflammation –> helps symptoms in joint pain, swelling, bowel issues

Question 2

timing methotrexate

Answer 2

once a week, same day each week

folic acid following day

Question 3

how to take methotrexate

Answer 3

before or after food at same time each week

don’t forget folic acid following day of course

Question 4

length methotrexate

Answer 4

long term

Question 5

effects methotrexate

Answer 5

3-12 weeks to kick in

Question 6

tests methotrexate

Answer 6

before starting: FBC, LFT, U+Es to assess for your kidneys, liver & blood; bHCG to rule out pregnancy

repeat above every 2 weeks until stable

then every 2-3 months

Question 7

common & important SEs

safety netting

Answer 7

loss of appetite/diarrhoea
nausea/indigestion
hair loss

seek med attention asap if:
sore throat, bruising, mouth ulcers
SOB, dark colour urine

Question 8

contraindications/complications methotrexate

Answer 8

Active infection; ascites; immunodeficiency syndromes; significant pleural effusion

pregnancy/BF

Question 9

lifestyle advice methotrexate

Answer 9

always mention to health professionals you are taking methotrexate

treatment booklet & an alert card taken to all healthcare appointments to make them aware

Question 10

pregnancy advice methotrexate

Answer 10

female - explore long-term reversible contraception

male - stop methotrexate 6 months before trying for a baby

Question 11

methotrexate interactions

Answer 11

NSAIDs (-fenac)
penicillins
PPIs (-eprazoles)
live vaccines
Levetiracetam