Methotrexate- Monitoring

A guide to monitoring methotrexate prescribing in primary care.Folic acid antagonist - antimetabolite cytotoxic agent Inhibits dihydrofolate reductase - prevents DNA and RNA synthesis Anti-inflammatory effect Immunosuppressive action Tablets of 2.5 mg strength - once weekly Metoject® 7.5 mg , 10 mg , 12.5 mg , 15 mg , 17.5 mg , 20 mg , 22.5 mg and 25 mg Oral solution Folic acid @ 5 mg is given ( separate day to MTX ) to reduce SEs

Indications - Disease modifying agent Wide range of neoplastic conditions such as○ leukaemias○ Non-Hodgkins's lymphoma○ soft-tissue and osteogenic sarcomas○ solid tumours particularly breast , lung , head and neck , bladder , cervical , ovarian and testicular tumours Psoriasis and psoriatic arthritis ( severe ) First line in active rheumatoid arthritis or○ In combination with other DMARDSs for e.g sulfasalazine , leflunomide or hydroxychloroquine○ parenteral - s/c or im Neurology for conditions as○ myasthenia gravis○ inflammatory myopathies and neuropathies○ vasculitis○ other immune mediated CNS and PNS system diseases Inflammatory bowel disease e.g Crohn's( NICE recommends not to use for ulcerative colitis unless no other alternative ) Interstitial lung disease , sarcoidosis and pulmonary vasculitis Scleritis ,vasculitis or mixed connective tissue diseases

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