#trexall

[siglerprescriptiondrugcards]

Methotrexate

Common Brand Names: Rheumatrex, Trexall

Therapeutic Class: Disease modifying antineoplastic agent, antimetabolite, antirheumatic.

Common Injectable Dosage Forms:

Powder for Reconstitution (Preservative free): 20 mg and 1 g

Solution for Injection: 25 mg/mL

Lyophilized Preservative-Free Solution: 25 mg/mL

Dosage Ranges:

Psoriasis: 10-25 mg IV or IM given as single once weekly dose. Do not exceed 30 mg/week.

Juvenile Rheumatoid Arthritis: Starting dose is 10 mg/m2/week given as single IM dose or in two divided doses 12 hours apart. Adjust dose to adjust optimal response.

Treatment of Acute Lymphocytic Leukemia (ALL): Adults and children receive IM or IV 3.3 mg/m2 daily for 4-6 weeks or until remission occurs, followed by maintenance regimen.

Treatment of non-Hodgkin's Lymphoma (NHL): Several regimens exist, commonly 200 mg/m2 IV days 8 and 15 every 21 days in combination with chemotherapy is used.

Treatment of cutaneous T-cell Lymphoma (a.k.a. mycosis fungoides): Adults receive 50 mg IM/IV once weekly; 15-37.5 mg IM/IV twice weekly in patients who have responded poorly to once weekly treatment.

Methotrexate has several other indications and variances on dosage, consult package insert for further information.

Patients with hepatic impairment should not use methotrexate and patients with renal impairment require dosage adjustments.

Administration and Stability: Methotrexate may be given IV, IM, IT, or SubQ. IV administration should be slow push, short bolus infusion, or 24–42-hour infusion. High doses should be followed by leucovorin calcium to prevent toxicity. Store vials at room temperature and protect from light. Dilute powder with NS or D5W to a concentration of no greater than 25 mg/mL. Use preservative free formulations for IT or high doses. Once further diluted, admixture is stable for 24 hours at room temperature. Reconstituted solutions are stable up to 3 months when refrigerated, 7 days at room temperature (but recommended to be used within 4-8 hours). pH 7.5-9

Pharmacology/Pharmacokinetics: Methotrexate is a folate antimetabolite that inhibits DNA synthesis. It irreversibly binds to dihydrofolate reductase, inhibiting formation of reduced folates, resulting in inhibition of purine and thymidylic acid synthesis. The exact mechanism of action in rheumatoid arthritis is unknown, but methotrexate may affect immune function. In psoriasis, methotrexate is thought to target rapidly dividing epithelial cells in the skin. In Crohn’s disease, it may have immune modulator and anti-inflammatory activity. Onset of action may take 3-12 weeks. Half-life elimination is 3-12 hours and methotrexate peaks in 30-60 minutes following IM administration.

Drug and Lab Interactions: Concurrent use with NSAIDs may cause severe bone marrow suppression, aplastic anemia, and GI toxicity. Penicillins, probenecid, sulfonamides, and tetracyclines may increase methotrexate levels. Methotrexate may increase cyclosporine and theophylline levels. Concurrent use of live vaccines may result in infections.

Contraindications/Precautions: Contraindicated in patients with severe renal or hepatic impairment, preexisting profound bone marrow suppression, AIDS, preexisting blood dyscrasias, pregnancy, or breastfeeding. Methotrexate is a hazardous agent and requires appropriate handling and disposal. It has been associated with acute hepatotoxicity, acute renal failure, life-threatening pneumonitis, and bone marrow suppression. Pregnancy Category X.

Monitoring Parameters: CBC, LFTs, serum Cr/BUN, serum uric acid

Adverse Effects: Possible adverse effects include diarrhea, severe dermatological reactions (including epidermal necrolysis and Stevens-Johnson syndrome), severe headache, vomiting, and fever. Other adverse effects include leucopenia, thrombocytopenia, nephrotoxicity, diabetes, photosensitivity, cirrhosis, arthralgia, blurred vision, and, to a low degree, cognitive dysfunction.

Common Clinical Applications: Methotrexate is used in leukemias, psoriasis, rheumatoid arthritis, and head, neck, breast, and lung carcinomas. Methotrexate has the unlabeled use of treatment and maintenance of remission in Crohn’s disease and ectopic pregnancy.

[siglerprescriptiondrugcards]

Methotrexate

Brand Name: Trexall

Generic Available

Common Dosage Forms:

Tablets: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg

Injection: 25 mg/mL base (as sodium salt)

FDA Indications/Dosages:

Treatment of gestational choriocarcinoma, chorioadenoma, chorioadenoma destruens, and hydatidiform mole: 15-30 mg daily, either orally or intramuscularly, for a five-day course. Such courses are repeated for 3-5 times as required, with rest periods of 1 or more weeks interposed between courses.

Treatment of advanced stage non-Hodgkin's lymphomas: 10-25 mg/day orally for 4-8 days. Several courses are usually given with 7–10-day rest periods between each course.

Treatment of breast cancer, epidermoid cancers of the head and neck, advanced mycosis fungoides (cutaneous T-cell lymphomas), non-metastatic osteosarcoma, and lung cancer: Methotrexate can be used alone or in combination with other anticancer agents. Treatments are variable and depend on multiple factors, including the stage of the disease and whether a combination treatment is being used.

Treatment and prophylaxis of meningeal leukemia: Doses are based on age and must be given intrathecally using preservative-free forms of the drug. Doses are given at intervals of 2-5 days. For children <1 year, give 6 mg. For children 1 year old, give 8 mg. For children 2 years old, give 10 mg. For children 3 years and older, give 12 mg.

Symptomatic control of severe, recalcitrant, disabling psoriasis that is not adequately responsive to other forms of therapy:

Weekly Schedule: 10-25 mg per week until adequate response is achieved.

Divided Oral Dose Schedule: 2.5 mg at 12-hour intervals for three doses.

For the management of severe, acute rheumatoid arthritis in adults: 7.5 mg weekly as one dose or in three 2.5 mg doses given at 12-hour intervals. Maximum weekly dose is 20 mg.

For the management of active polyarticular-course juvenile rheumatoid arthritis in children who have had an insufficient therapeutic response to first-line therapy: Start with 10 mg/m^2 given once weekly with a maximum weekly dose of 30 mg/m^2. Doses over 20 mg/m^2 should be given either intramuscularly or subcutaneously.

Monitor: CBC, SCr, LFT, chest radiograph

Pharmacology/Pharmacokinetics: Methotrexate inhibits dihydrofolic acid reductase, an enzyme which reduces dihydrofolate tetrahydrofolate. Tetrahydrofolate are important in the synthesis of purine nucleotides and thymidylate. Therefore, methotrexate interferes with DNA synthesis, repair, and cellular replication. Actively proliferating tissues are more sensitive to this effect. Its mechanism of action in the treatment of rheumatoid arthritis is unknown. Doses in the therapeutic range are well absorbed orally with peak plasma levels reached in 1-2 hours. Food delays absorption and reduces peak concentrations. Its terminal half-life is 3-10 hours for lower doses and 15 hours for higher doses. Excretion occurs via renal glomerular filtration and active tubular secretion.

Drug Interactions: NSAIDs may increase methotrexate serum levels and should not be used during high-dose therapy. Phenytoin and sulfonamides may displace protein-bound methotrexate. May increase the plasma levels of mercaptopurine. Oral antibiotics may decrease absorption of oral methotrexate. Penicillin may reduce the renal clearance of methotrexate. May decrease the clearance of theophylline.

Contraindications/Precautions: BECAUSE OF THE POSSIBILITY OF SERIOUS TOXICITY REACTIONS (WHICH CAN BE FATAL), METHOTREXATE SHOULD ONLY BE USED IN LIFE-THREATENING NEOPLASTIC DISEASES, OR IN PATIENTS WITH PSORIASIS OR RHEUMATOID ARTHRITIS WITH SEVERE, RECALCITRANT, DISABLING DISEASES WHICH IS NOT ADEQUATELY RESPONSIVE TO OTHER FORMS OF THERAPY. Use is contraindicated in pregnant women except in neoplastic cases where the potential benefit to the patient outweighs the risk to the fetus. Pregnancy should be avoided if either partner is receiving methotrexate and for three months after discontinuing the drug for male patients and for one ovulatory cycle for female patients. Do not use in nursing mothers. Do not use in psoriasis or rheumatoid arthritis patients with alcoholism, alcoholic liver disease, other chronic liver diseases, immunodeficiency syndromes, or preexisting blood dyscrasias. Patients undergoing methotrexate therapy should be closely monitored on a monthly basis including a baseline assessment of complete blood count, hepatic enzymes, renal function tests, and a chest X-ray. For chronic use indications (psoriasis, arthritis), a liver biopsy should be performed pretreatment, at 4-8 weeks, and when cumulative dose reaches 1.5 gram. Use with caution during infections and in immunocompromised patients. Pregnancy Category X.

Adverse Effects: The most frequent adverse effects are ulcerative stomatitis, leukopenia, nausea, and abdominal distress. Other frequent adverse effects are malaise, fatigue, chills and fever, dizziness, sun sensitivity, and decreased resistance to infection. Potentially serious effects include rash, nephrotoxicity, hepatotoxicity, cough, and anemia.

Patient Consultation:

Preferably taken on an empty stomach.

It is important to keep well-hydrated while taking this medication.

Avoid alcohol and salicylates while taking this medication.

Avoid prolonged exposure to natural or artificial sunlight.

It is important to follow appropriate contraceptive measures during therapy and for 3 months (males) and one ovulatory cycle (females) after completing therapy.

If a dose is missed, and you are on a weekly dosing schedule, take the dose as soon as possible and restart your weekly schedule from that date.

If a dose is missed and you are on a daily schedule, contact your physician.

It is important to have periodic blood work completed during therapy.

Contact your physician if any of the frequent adverse effects (listed above) are persistent or troublesome.

Contact your physician if you experience any of the following: diarrhea, vomiting, abdominal pain, black stools, jaundice, unexplained muscle pain, any type of infection, sore throat, cough, dyspnea, hypoxemia, or any type of unknown skin reaction.

[cannabisrefugee-esq]

Advertising vs. Reality.  Crohn’s Drug Commercials are Big Pharma Propaganda, People!  It’s Not Real!

In the end, the best and only thing I could’ve done was to abandon Big Pharma and start treating my previously untreatable Crohn’s disease with medical cannabis. Although even on my best days I am still significantly ill, because systemic, incurable and progressive, at least now I am able to eat and digest food relatively well and have regained a quality of life I was never able to regain or maintain with Big Pharma poisons that didn’t work and were only making me worse.  That is where have I finally found and maintained relief from the unrelenting agony of un- and undertreated Crohn’s and I have paid dearly for the privilege but it worked.  How to maintain my new-found relative health after having liquidated my assets and bankrupted myself just getting there, and whether maintaining health is even possible under capitalism and patriarchy that has so much to gain when we’re sick and ignorant of the Big Pharma propaganda campaign, remains to be seen.  Frankly, however, it does not look good.

[opiateoverworld]

so ive been taking this serious pill for about 2 months now, one that requires blood tests every so often to make sure my body is taking it ok. it's serious enough that if you are pregnant or impregnate someone while taking the pill, the baby will be born with defects apparently. this had been only slightly different from previous pills i had taken, although this one i take 4 pills a day once a week. when my doctor gave them to me he said without worry just not to drink while on these. i dont usually drink much at all, but lately ive been having a lot more than what i usually drink with my friends. as of recently i havent been getting drunk no matter how much i drink, not even a buzz, so i tried looking as to why that is, with little result. i think it may be my folic acid imbalance because of the previously mentioned pills, but im not sure. but i did find out you're not supposed to drink AT ALL NO DISCUSSIONS YOU CAN ABSOLUTY NOT CONSUME ALCOHOL WHILE ON TREXALL (the pill) THERAPY. but i still think im gonna do it. what am i saving myself for anyway? if i can start getting drunk again hell yeah, and ii still dont want to be a killjoy either way so.