Methotrexate.
Last updated Friday, February 11, 2005
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Side effects
Common side effects
Side effects do occur in some people taking methotrexate. At the low weekly doses used to treat rheumatoid arthritis, however, serious side effects are rare.
The most common side effects include upset stomach, nausea,
vomiting, loss of appetite, diarrhea, or mouth sores. If these develop,
you should contact your doctor immediately. A change in the dose or in
how you take your methotrexate may reduce these side effects.
Occasional side effects
Occasionally, side effects such as headaches, dizziness, mood
alterations, skin rashes, or unexplained weight loss may occur.
Increased sensitivity to sun has also been observed, although this is
rare. Your blood count may decrease, but this uncommon with weekly low
doses of methotrexate. This could include a decrease in the number of
white blood cell that help fight infection. A decrease in the platelet
count or red blood cell count may also occur, which could lead to
bruising, bleeding, or fatigue. Factors that increase the possibility
for these blood cell changes with methotrexate include pre-existing
kidney disease, low levels of folic acid, certain infections, and the
use of certain medications, including an antibiotic called
trimethoprim/sulfamethoxazole (Bactrim or Septra).Long-term side effects
Lung damage
Rarely, lung damage occurs with this drug. Call your doctor
immediately if you develop a cough, progressive shortness of breath,
and fever.
Liver damage
Methotrexate may also cause liver damage, although this is rare in
patients with RA. Since regular use of alcoholic beverages can increase
the risk of liver damage, you are advised to stop drinking alcohol
while on methotrexate. This issue should be discussed with your doctor.
Blood tests will be done on a regular basis to monitor your liver
and bone marrow for changes. After several years of methotrexate
therapy, your doctor may recommend a liver biopsy to examine directly
the effects of methotrexate on your liver. At this time, there are no
standard recommendations on the necessity or timing of doing a liver
biopsy. If you have concerns or questions, they should be discussed
with your doctor.
Male fertility
Methotrexate may lower the sperm count in men. The sperm count
should normalize with drug discontinuation. There is little information
available regarding the risk of birth defects from a father taking
methotrexate at the time of conception. However, it is recommended that
males discontinue methotrexate three months prior to attempting
conception.
Risk factors for side effects
If you should get the flu or another infection, you should call your
doctor promptly to find out if you should continue to take your
methotrexate while you are sick. Dehydration (loss of fluids) can
increase your risk of side effects.
To reduce the potential for side effects from methotrexate, regular
laboratory tests are absolutely necessary. Prior to starting
methotrexate, standard blood tests should be performed. A chest X-ray
is strongly recommended. Once you start therapy, routine blood tests
will be performed. The time between tests will be shorter at the
beginning of therapy and may be longer when you are on maintenance
therapy.
Please be certain to keep your scheduled laboratory monitoring and
doctor appointments since many side effects can be detected before they
become serious. Side effects are often a sign that your medication
should be changed or stopped. Sometimes a change in dosage of
methotrexate will eliminate or alleviate side effects.
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