3 minutes to show you how to use methotrexate safely

In June 2021, the American College of Rheumatology (ACR) issued guidelines for the diagnosis and treatment of rheumatoid arthritis (RA) .
The guidelines involve the use of disease-improving anti-rheumatic drugs (DMARDs).
MTX is still listed as the first-line drug, regardless of the severity of the disease or the use of anti-rheumatic drugs (DMARDs).
Moderate and severe; the course of disease is early, middle, and late, and the prognosis is good or bad
.

The drug should be considered first .

In June 2021, the American College of Rheumatology (ACR) issued guidelines for diagnosis and treatment of rheumatoid arthritis (RA) .

1.
Pay attention to drug interactions

1.
Pay attention to drug interactions and use voriconazole, ketoprofen, indomethacin and compound sulfamethoxazole in combination with caution
.

In animal experiments, drugs such as ketoprofen and indomethacin can affect the renal excretion of methotrexate, so it is not recommended to use such drugs in combination with methotrexate

2.

3.

4.

5.

Two.

2.

If the patient's oral methotrexate is not effective or intolerant, it can be administered by parenteral route

3.

After starting methotrexate treatment, the patient's blood routine, liver function, and renal function can be monitored every 1 to 1.

4.

For patients using MTX, it is recommended to administer at least 5 mg of folic acid per week

In clinical practice, if the patient has overdose of methotrexate, intravenous or oral leucovorin 10mg/m2 can be administered within 24 to 36 hours, once every 6 hours
.
After the patient has an adverse reaction, the blood concentration of methotrexate should be monitored every 12 to 24 hours.
When the blood concentration drops to 10 to 8 μg/L, leucovorin is stopped.
At the same time, the patient needs to drink a lot of water to alkalinize the urine.
Liquid
.
Acute kidney injury caused by high-dose methotrexate can be treated with glucarpidase injection
.

 

3.
The core principles of the use of RA

3.
The core principles of the use of RA

*Before choosing MTX treatment, the risk of adverse reactions should be evaluated, such as history of drinking, hepatitis, HIV infection , etc.
, and blood routine, liver and kidney function, chest X-ray, etc.
should be checked.
If the risk of adverse reactions is greater, you should be cautious Consider
.

*Before choosing MTX treatment, the risk of adverse reactions should be evaluated, such as history of drinking, hepatitis, HIV infection , etc.
, and blood routine, liver and kidney function, chest X-ray, etc.
should be checked.
If the risk of adverse reactions is greater, you should be cautious Consider
.
Infect

*The initial dose of MTX for RA treatment is 10-15 mg/week , and can be increased by 5 mg every 2 to 4 weeks according to the patient’s clinical response and tolerability, up to 20-30 mg/week
.
The above-mentioned MTX dose is better than the low dose (<10 mg/week) in the treatment of RA, and the increase in adverse reactions is not significant
.

*The initial dose of MTX for RA treatment is 10-15 mg/week , and can be increased by 5 mg every 2 to 4 weeks according to the patient’s clinical response and tolerability, up to 20-30 mg/week
.
The above-mentioned MTX dose is better than the low dose (<10 mg/week) in the treatment of RA, and the increase in adverse reactions is not significant
.

*It is recommended that people who use methotrexate drink at least 3L of water a day
.
Methotrexate metabolites are difficult to dissolve under acidic conditions, and during drug excretion, the deposition of methotrexate metabolites in the kidney will lead to the formation of cell crystals in the tube, which will cause kidney damage
.
Therefore, patients should drink more water to promote excretion and reduce the accumulation of metabolites
.

*It is recommended that people who use methotrexate drink at least 3L of water a day
.
Methotrexate metabolites are difficult to dissolve under acidic conditions, and during drug excretion, the deposition of methotrexate metabolites in the kidney will lead to the formation of cell crystals in the tube, which will cause kidney damage
.
Therefore, patients should drink more water to promote excretion and reduce the accumulation of metabolites
.

*It is safe to use MTX during elective joint surgery in RA patients
.

*It is safe to use MTX during elective joint surgery in RA patients
.

* Patients who are preparing for pregnancy , whether male or female, should stop using MTX 3 months before conception .
Women who are pregnant and breastfeeding should not use MTX
.

* Patients who are preparing for pregnancy , whether male or female, should stop using MTX 3 months before conception .
Women who are pregnant and breastfeeding should not use MTX
.

* For patients with renal insufficiency, a lower dose of MTX should be used
.
Once serious side effects occur, the drug should be stopped immediately
.
For patients with obvious risk factors, the experimental drug should be first administered 5mg, and then the response results should be checked before deciding whether it can be used safely
.

* For patients with renal insufficiency, a lower dose of MTX should be used
.
Once serious side effects occur, the drug should be stopped immediately
.
For patients with obvious risk factors, the experimental drug should be first administered 5mg, and then the response results should be checked before deciding whether it can be used safely
.

*It is recommended that RA patients should be checked or monitored before and after medication and during medication : complete blood count, serum creatinine, liver function (the detection time and frequency of the above three items are as follows: before medication, start of medication or the first 3 months after dose increase every 2 -4 weeks, 3-6 months every 8-12 weeks, 6 months later every 12 weeks), chest X-ray (within 1 year before treatment), B (C) liver examination, PPD test, liver biopsy [Before medication, patients with persistent abnormal liver function, history of alcohol abuse or chronic hepatitis B/C, continuous elevation of liver enzymes during medication (6/12 abnormal results in 1 year of medication or once every 6 weeks monitoring has 5 /9 If the result is abnormal), liver biopsy should be performed]
.

*It is recommended that RA patients should be checked or monitored before and after medication and during medication : complete blood count, serum creatinine, liver function (the detection time and frequency of the above three items are as follows: before medication, start of medication or the first 3 months after dose increase every 2 -4 weeks, 3-6 months every 8-12 weeks, 6 months later every 12 weeks), chest X-ray (within 1 year before treatment), B (C) liver examination, PPD test, liver biopsy [Before medication, patients with persistent abnormal liver function, history of alcohol abuse or chronic hepatitis B/C, continuous elevation of liver enzymes during medication (6/12 abnormal results in 1 year of medication or once every 6 weeks monitoring has 5 /9 If the result is abnormal), liver biopsy should be performed]
.

*MTX has a low clearance rate in patients with renal impairment and abdominal and pleural effusions.
Therefore, the above patients should be closely monitored for their toxicity, and the dose should be reduced, and the drug should be discontinued if necessary
.

*MTX has a low clearance rate in patients with renal impairment and abdominal and pleural effusions.
Therefore, the above patients should be closely monitored for their toxicity, and the dose should be reduced, and the drug should be discontinued if necessary
.

*MTX can cause central nervous system symptoms (such as fatigue, dizziness), affecting driving and operating machinery; it can cause photosensitivity, avoid excessive exposure to sunlight or sun lights without protection during medication; it can cause blood uric acid levels to rise, Patients with gout or hyperuricemia should increase the dose of anti-gout drugs; avoid drinking alcohol or alcoholic beverages during medication
.

*MTX can cause central nervous system symptoms (such as fatigue, dizziness), affecting driving and operating machinery; it can cause photosensitivity, avoid excessive exposure to sunlight or sun lights without protection during medication; it can cause blood uric acid levels to rise, Patients with gout or hyperuricemia should increase the dose of anti-gout drugs; avoid drinking alcohol or alcoholic beverages during medication
.

* MTX can reduce the immune response after vaccination and may also cause severe antigen reactions
.
There have been reports of disseminated vaccine infection in patients after being vaccinated with smallpox vaccine during the use of MTX
.
Therefore, live vaccines are prohibited during the use of MTX
.
        

* MTX may reduce post-vaccination immune responses, may also cause severe reactions antigen immunization
.
There have been reports of disseminated vaccine infection in patients after being vaccinated with smallpox vaccine during the use of MTX
.
Therefore, live vaccines are prohibited during the use of MTX
.
        

Four.
Summary

Four.
Summary

Methotrexate does have some side effects
.
There are many factors that can affect the serious adverse reactions of MTX, such as elderly patients, diabetes , renal insufficiency, hypersensitivity, and combined medications
.

Methotrexate does have some side effects
.
There are many factors that can affect the serious adverse reactions of MTX, such as elderly patients, diabetes , renal insufficiency, hypersensitivity, and combined medications
.
diabetes

Doctors should closely monitor the medication process, stop the medication in time, and select the correct antidote drugs
.
If all these are noticed, the rational and safe medication can be achieved
.
Moreover, studies based on the Chinese population have shown that low-dose methotrexate has fewer adverse reactions and better long-term tolerability, making the status of methotrexate in the treatment of RA still unshakable
.

Doctors should closely monitor the medication process, stop the medication in time, and select the correct antidote drugs
.
If all these are noticed, the rational and safe medication can be achieved
.
Moreover, studies based on the Chinese population have shown that low-dose methotrexate has fewer adverse reactions and better long-term tolerability, making the status of methotrexate in the treatment of RA still unshakable
.
References: 1.
Chinese Medical Doctor Association Rheumatology and Immunology Physician Branch.
The application of methotrexate in rheumatic diseases Chinese expert consensus [J].
Chinese Journal of Internal Medicine, 2018,57( 10 ): 719-722.
Consensus 2.
Rheumatology Branch of Chinese Medical Association.
2018 Chinese Rheumatoid Arthritis Diagnosis and Treatment Guidelines[J].
Chinese Journal of Internal Medicine,2018,57(4):242-251.
3.
Katturajan R, SV,Rasool M,et al.
Molecular toxicity of methotrexate in rheumatoid arthritistreatment: A novel perspective and therapeutic implications[J].
Toxicology.
2021 Aug 25;461:152909.
doi: 10.
1016/j.
tox.
2021.
152909.
4.
Pivovarov K, Zipursky JS.
Low-dose methotrexatetoxicity[J ].
CMAJ.
2019 Apr 15;191(15)

 

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