Use methotrexate well, don't forget these 3 precautions!

Methotrexate (MTX) is not only an anti-folic acid antitumor drug, but also a common drug
for the treatment of rheumatic diseases.
To use MTX well, the following three considerations are important!

When used for intrathecal injection, methotrexate injection should be diluted to a concentration
of 1 mg/ml with an appropriate preservative-free solvent (such as 0.
9% sodium chloride injection).

1.
Before starting the injection of methotrexate, confirm the pregnancy status
of women with reproductive potential.

2.
For patients switching between oral methotrexate products and methotrexate injections, consider potential differences in bioavailability [1].

3.
Patients should be informed of the early signs and symptoms of toxicity, and once they occur, they need to seek medical attention immediately and require close follow-up, including regular laboratory tests to monitor toxicity
.

4.
Doctors and pharmacists should emphasize to patients that for rheumatoid arthritis and psoriasis, taking the recommended dose every week, and using the wrong dose daily can lead to fatal toxicity
.

Folinic acid and L-folate reduce toxicity and counteract the effects of
unintentional methotrexate overdose.
Give folinic acid or L-folate as soon as possible after an overdose, and closely monitor serum methotrexate concentrations to guide folinic acid or L-folate therapy
.
Monitor serum creatinine concentrations closely, as high serum methotrexate concentrations may lead to renal impairment, as well as acute renal failure
.

Glucuronidase is used to treat patients with toxic concentrations of methotrexate who delay methotrexate clearance
due to impaired renal function.
If glucosidase is used, do not use folinic acid within 2 hours before or after glucosidase administration, as folinic acid is the substrate of glucuronidase
.

Hydration and alkalinization of urine may be required to prevent precipitation
of methotrexate and/or its metabolites in the renal tubules.
Neither hemodialysis nor peritoneal dialysis improved methotrexate elimination
.
However, acute intermittent hemodialysis with a high-throughput dialyzer has been reported to be effective in clearing methotrexate [1-4].

What other diseases can methotrexate treat? How are medications combined?

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