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Methotrexate

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Methotrexate uses and description

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Methotrexate - Used for: Treating certain types of cancer. It is also used to control severe psoriasis and severe rheumatoid arthritis in certain patients. It may be used alone or with other medicines. It may also be used for other conditions as determined by your doctor.

Methotrexate is an antimetabolite. It works to treat cancer and psoriasis by slowing the growth of cancer cells and abnormal skin cells. Exactly how Methotrexate works to treat rheumatoid arthritis is unknown. It reduces symptoms of inflammation (eg, swelling, pain, stiffness) caused by rheumatoid arthritis.

Methotrexate is an antineoplastic anti-metabolite. Anti-metabolites masquerade as purine or pyrimidine - which become the building blocks of DNA. They prevent these substances becoming incorporated in to DNA during the "S" phase (of the cell cycle), stopping normal development and division. Methotrexate inhibits folic acid reductase which is responsible for the conversion of folic acid to tetrahydrofolic acid. At two stages in the biosynthesis of purines and at one stage in the synthesis of pyrimidines, one-carbon transfer reactions occur which require specific coenzymes synthesized in the cell from tetrahydrofolic acid. Tetrahydrofolic acid itself is synthesized in the cell from folic acid with the help of an enzyme, folic acid reductase. Methotrexate looks a lot like folic acid to the enzyme, so it binds to it quite strongly and inhibits the enzyme. Thus, DNA synthesis cannot proceed because the coenzymes needed for one-carbon transfer reactions are not produced from tetrahydrofolic acid because there is no tetrahydrofolic acid. Methotrexate selectively affects the most rapidly dividing cells (neoplastic and psoriatic cells). Methotrexate is also indicated in the management of severe, active, classical, or definite rheumatoid arthritis.

Methotrexate is used to treat rheumatoid arthritis. It helps reduce joint pain and swelling by reducing inflammation in your joints. It may also be used to treat severe psoriasis.

Oral Burkitt's lymphoma

Adult: 10-25 mg daily for 4-8 days, repeated after 7-10 days. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Acute lymphoblastic leukaemia

Adult:

Maintenance: 15 mg/m 2 once or twice wkly, with other agents. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Choriocarcinoma

Adult: 15-30 mg daily for 5 days, repeat after an interval of ≥1 wk for 3-5 courses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Mycosis fungoides

Adult: 2.5-10 mg daily to induce remission. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Psoriasis

Adult: 10-25 mg wkly as a single dose, adjust subsequent doses based on response. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Rheumatoid arthritis

Adult: 7.5 mg once wkly, adjust by response. Not more than 20 mg/wk. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Crohn's disease

Adult: 12.5-22.5 mg once wkly for up to 1 yr. CrCl (ml/min) Dosage Recommendation 61-80 75% of use 51-60 70% of use 10-50 30-50% of use <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intrathecal Meningeal leukaemia

Adult: 12 mg/m 2 (max 15 mg) once wkly for 2-3 wk, then once mthly. Alternatively, 200-500 mcg/kg every 2-5 day until CSF cell count is normalised.

Child: <1 yr: 6 mg, 1 yr: 8 mg, 2 yr: 10 mg, >3 yr: 12 mg. Patients <3 yr should be treated in accordance with combination chemotherapy protocols. Admin is at wkly intervals and repeated until the CSF cell count is normal. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Osteosarcoma

Adult: Initial recommended dose: 12 g/m 2 as a 4-hr infusion, followed by folinic acid, as part of combined therapy. May increase dose to 15 g/m 2 in subsequent treatments if initial dosage is insufficient to achieve peak serum Methotrexate levels of 454 mcg/mL at the end of the infusion. Methotrexate infusion is administered on postoperative wk 4, 5, 6, 7, 11, 12, 15, 16, 29, 30, 44 and 45; in combination with other chemotherapy agents. Folinic acid can be given orally, IM or IV inj starting 24 hr after the beginning of the Methotrexate infusion. Give via parenteral routes If patient experiences GI toxicity (e.g., nausea, vomiting). Usual dosage of folinic acid: 15 mg every 6 hr for a total of 60 hr or a total of 10 doses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Choriocarcinoma

Adult: 15-30 mg daily for 5 days. Repeat after at least 1 wk for 3-5 courses. Alternatively, 0.25-1 mg/kg (max: 60 mg) every 48 hr for 4 doses followed by folinic acid rescue, repeat at intervals of 7 days for 4 or more courses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Breast cancer

Adult: 10-60 mg/m 2 often with cyclophosphamide and fluorouracil. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Advanced lymphosarcoma

Adult: Up to 30 mg/kg, followed by folinic acid rescue. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Acute lymphoblastic leukaemia

Adult:

Maintenance: 15 mg/m 2 once or twice wkly, with other agents. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Acute lymphoblastic leukaemia

Adult:

Maintenance: 2.5 mg/kg every 14 days. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Mycosis fungoides

Adult: 50 mg wkly as a single dose or 2 divided doses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Parenteral Psoriasis

Adult: 10-25 mg wkly as a single dose. Adjust subsequent doses based on response. May be given via IV/IM admin. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Crohn's disease

Adult: 25 mg once wkly for 16 wk.

Maintenance: 15 mg wkly. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Reconstitution: Reconstitute to 2.5-5 mg/ml with normal saline, D 5 W, lactated Ringer's, or Elliott's B solution. Use preservative-free preparations.

Oral Burkitt's lymphoma

Adult: 10-25 mg daily for 4-8 days, repeated after 7-10 days. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Acute lymphoblastic leukaemia

Adult:

Maintenance: 15 mg/m 2 once or twice wkly, with other agents. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Choriocarcinoma

Adult: 15-30 mg daily for 5 days, repeat after an interval of ≥1 wk for 3-5 courses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Mycosis fungoides

Adult: 2.5-10 mg daily to induce remission. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Psoriasis

Adult: 10-25 mg wkly as a single dose, adjust subsequent doses based on response. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Rheumatoid arthritis

Adult: 7.5 mg once wkly, adjust by response. Not more than 20 mg/wk. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Crohn's disease

Adult: 12.5-22.5 mg once wkly for up to 1 yr. CrCl (ml/min) Dosage Recommendation 61-80 75% of use 51-60 70% of use 10-50 30-50% of use <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intrathecal Meningeal leukaemia

Adult: 12 mg/m 2 (max 15 mg) once wkly for 2-3 wk, then once mthly. Alternatively, 200-500 mcg/kg every 2-5 day until CSF cell count is normalised.

Child: <1 yr: 6 mg, 1 yr: 8 mg, 2 yr: 10 mg, >3 yr: 12 mg. Patients <3 yr should be treated in accordance with combination chemotherapy protocols. Admin is at wkly intervals and repeated until the CSF cell count is normal. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Osteosarcoma

Adult: Initial recommended dose: 12 g/m 2 as a 4-hr infusion, followed by folinic acid, as part of combined therapy. May increase dose to 15 g/m 2 in subsequent treatments if initial dosage is insufficient to achieve peak serum Methotrexate levels of 454 mcg/mL at the end of the infusion. Methotrexate infusion is administered on postoperative wk 4, 5, 6, 7, 11, 12, 15, 16, 29, 30, 44 and 45; in combination with other chemotherapy agents. Folinic acid can be given orally, IM or IV inj starting 24 hr after the beginning of the Methotrexate infusion. Give via parenteral routes If patient experiences GI toxicity (e.g., nausea, vomiting). Usual dosage of folinic acid: 15 mg every 6 hr for a total of 60 hr or a total of 10 doses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Choriocarcinoma

Adult: 15-30 mg daily for 5 days. Repeat after at least 1 wk for 3-5 courses. Alternatively, 0.25-1 mg/kg (max: 60 mg) every 48 hr for 4 doses followed by folinic acid rescue, repeat at intervals of 7 days for 4 or more courses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Breast cancer

Adult: 10-60 mg/m 2 often with cyclophosphamide and fluorouracil. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Advanced lymphosarcoma

Adult: Up to 30 mg/kg, followed by folinic acid rescue. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Acute lymphoblastic leukaemia

Adult:

Maintenance: 15 mg/m 2 once or twice wkly, with other agents. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Acute lymphoblastic leukaemia

Adult:

Maintenance: 2.5 mg/kg every 14 days. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Mycosis fungoides

Adult: 50 mg wkly as a single dose or 2 divided doses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Parenteral Psoriasis

Adult: 10-25 mg wkly as a single dose. Adjust subsequent doses based on response. May be given via IV/IM admin. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Crohn's disease

Adult: 25 mg once wkly for 16 wk.

Maintenance: 15 mg wkly. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Special Populations: Monitor blood counts, renal and hepatic functions before, during and after each course. Reconstitution: Reconstitute to 2.5-5 mg/ml with normal saline, D 5 W, lactated Ringer's, or Elliott's B solution. Use preservative-free preparations.

Methotrexate, abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug used in treatment of cancer and autoimmune diseases. It acts by inhibiting the metabolism of folic acid. Methotrexate began to replace the more powerful and toxic antifolate aminopterin starting in the 1950s, and the two should not be confused with each other.

Indications:

Adult: PO Burkitt's lymphoma 10-25 mg/day for 4-8 days, repeat after 7-10 days. Choriocarcinoma 15-30 mg/day for 5 days, repeat after an interval of at least 1 wk for 3-5 courses. Mycosis fungoides 2.5-10 mg/day to induce remission. Rheumatoid arthritis 7.5 mg once wkly, adjust if needed. Up to 20 mg/wk. Crohn's disease 12.5-22.5 mg once wkly for up to 1 yr. PO/IV/IM Psoriasis 10-25 mg once wkly, adjust subsequent doses if needed. IV Osteosarcoma 12-15 g/m 2 as infusion, followed by folinic acid. Breast cancer 10-60 mg/m 2 often w/ cyclophosphamide and fluorouracil. Advanced lymphosarcoma Up to 30 mg/kg, followed by folinic acid rescue. Acute lymphoblastic leukaemia

Maintenance: 2.5 mg/kg every 14 days. PO/IM Acute lymphoblastic leukaemia

Maintenance: 15 mg/m 2 1-2 times/wk w/ other agents. IM Choriocarcinoma 15-30 mg/day for 5 days. Repeat after at least 1 wk for 3-5 courses. Mycosis fungoides 50 mg/wk in 1-2 divided doses. Crohn's disease 25 mg once wkly for 16 wk.

Maintenance: 15 mg/wk. Intrathecal Meningeal leukaemia 12 mg/m 2 (Max: 15 mg) once wkly for 2-3 wk, then once mthly.

Oral Burkitt's lymphoma

Adult: 10-25 mg daily for 4-8 days, repeated after 7-10 days. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Acute lymphoblastic leukaemia

Adult:

Maintenance: 15 mg/m 2 once or twice wkly, with other agents. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Choriocarcinoma

Adult: 15-30 mg daily for 5 days, repeat after an interval of ≥1 wk for 3-5 courses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Mycosis fungoides

Adult: 2.5-10 mg daily to induce remission. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Psoriasis

Adult: 10-25 mg wkly as a single dose, adjust subsequent doses based on response. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Rheumatoid arthritis

Adult: 7.5 mg once wkly, adjust by response. Not more than 20 mg/wk. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Oral Crohn's disease

Adult: 12.5-22.5 mg once wkly for up to 1 yr. CrCl (ml/min) Dosage Recommendation 61-80 75% of use 51-60 70% of use 10-50 30-50% of use <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Osteosarcoma

Adult: 12-15 g/m 2 as infusion, followed by folinic acid, as part of combined therapy. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Breast cancer

Adult: 10-60 mg/m 2 often with cyclophosphamide and fluorouracil. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Advanced lymphosarcoma

Adult: Up to 30 mg/kg, followed by folinic acid rescue. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intravenous Acute lymphoblastic leukaemia

Adult:

Maintenance: 2.5 mg/kg every 14 days. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Choriocarcinoma

Adult: 15-30 mg daily for 5 days. Repeat after at least 1 wk for 3-5 courses. Alternatively, 0.25-1 mg/kg (max: 60 mg) every 48 hr for 4 doses followed by folinic acid rescue, repeat at intervals of 7 days for 4 or more courses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Acute lymphoblastic leukaemia

Adult:

Maintenance: 15 mg/m 2 once or twice wkly, with other agents. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Mycosis fungoides

Adult: 50 mg wkly as a single dose or 2 divided doses. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intramuscular Crohn's disease

Adult: 25 mg once wkly for 16 wk.

Maintenance: 15 mg wkly. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Parenteral Psoriasis

Adult: 10-25 mg wkly as a single dose. Adjust subsequent doses based on response. May be given via IV/IM admin. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Intrathecal Meningeal leukaemia

Adult: 12 mg/m 2 (max 15 mg) once wkly for 2-3 wk, then once mthly. Alternatively, 200-500 mcg/kg every 2-5 day until CSF cell count is normalised.

Child: <1 yr: 6 mg, 1 yr: 8 mg, 2 yr: 10 mg, >3 yr: 12 mg. Patients <3 yr should be treated in accordance with combination chemotherapy protocols. Admin is at wkly intervals and repeated until the CSF cell count is normal. CrCl (ml/min) Dosage Recommendation 61-80 75% of dose 51-60 70% of dose 10-50 30-50% of dose <10 Avoid use Hepatic impairment: Bilirubin 3.1-5 mg/dl: Administer 75% of dose; Bilirubin >5 mg/dl: Avoid use. Reconstitution: Reconstitute to 2.5-5 mg/ml with normal saline, D 5 W, lactated Ringer's, or Elliott's B solution. Use preservative-free preparations.

Active ingredients: Methotrexate
Unit description, dosagePrice, USD
Injectable; Injection; Methotrexate Sodium 100 mg / ml
Injectable; Injection; Methotrexate Sodium 25 mg / ml
Tablet; Oral; Methotrexate Sodium 10 mg
Tablet; Oral; Methotrexate Sodium 2.5 mg
Injectable; Injection; Methotrexate 100 mg / ml
Injectable; Injection; Methotrexate 2.5 mg / ml
Injectable; Injection; Methotrexate 25 mg / ml
Tablet, Film-Coated; Oral; Methotrexate 2.5 mg
Injectable; Injection; Methotrexate Sodium 10 mg / ml
Injectable; Injection; Methotrexate Sodium 2.5 mg / ml
Tablet; Oral; Methotrexate 2.5 mg
Injectable; Injection; Methotrexate Sodium 100 mg
Injectable; Injection; Methotrexate Sodium 20 mg
Injectable; Injection; Methotrexate Sodium 50 mg
Injectable; Injection; Methotrexate Sodium 1 g
Injectable; Injection; Methotrexate Sodium 250 mg
Tablet; Oral; Methotrexate 10 mg
Injectable; Injection; Methotrexate 10%
Injectable; Injection; Methotrexate 2.5%
Methotrexate powder$ 261.33
Rheumatrex 8 2.5 mg tablet Disp Pack$ 169.98
Rheumatrex 24 2.5 mg tablet Disp Pack$ 129.06
Rheumatrex 20 2.5 mg tablet Disp Pack$ 107.59
Rheumatrex 12 2.5 mg tablet Disp Pack$ 63.65
Methotrexate Sodium 25 mg/ml (pf) Solution 40ml Vial$ 58.99
Trexall 15 mg tablet$ 25.98
Methotrexate Sodium 25 mg/ml (pf) Solution 10ml Vial$ 24.99
Trexall 10 mg tablet$ 17.67
Methotrexate Sodium 25 mg/ml Solution 1 Vial = 2ml$ 15.11
Methotrexate Sodium 25 mg/ml (pf) Solution 2ml Vial$ 14.99
Trexall 7.5 mg tablet$ 12.99
Rheumatrex 2.5 mg tablet$ 11.23
Trexall 5 mg tablet$ 8.66
Methotrexate Sod. (Preserved) 25 mg/ml$ 8.38
Methotrexate Sod.(Unpreserved) 25 mg/ml$ 4.56
Methotrexate 2.5 mg tablet$ 2.71
Methotrexate 10 mg Tablet$ 2.58
Ratio-Methotrexate Sodium 2.5 mg Tablet$ 0.66
Apo-Methotrexate 2.5 mg Tablet$ 0.66
Methotrexate 2.5mg TAB / 100$ 3.15
Methotrexate 5mg INJ$ 0.50

List of methotrexate brand and generic drugs

Methotrexat-Teva (Czech Republic, Slovakia, Switzerland)
Methotrexate - Bolai Pharm (China)
Methotrexate - Wanma Pharm (China)
Methotrexate Aeon (Greece)
Methotrexate APP (United States)
Methotrexate Bellon
Injectable; Injection; Methotrexate 2.5%
Tablet; Oral; Methotrexate 2.5 mg
Methotrexate BP (New Zealand)
Methotrexate David Bull (Greece)
Methotrexate DBL (Australia, Indonesia, Malaysia, Singapore, Turkey)
Methotrexate DBL 50 mg/2 mL x 5's$ 13.83
Methotrexate DBL 50 mg/2 mL x 5 loï
Methotrexate Ebewe (Hong Kong, Myanmar, New Zealand, Tunisia, Turkey, Vietnam)
Methotrexate Ebewe 5 mg x 1 mL x 1 oáng
Methotrexate Ebewe 10 mg x 1 mL x 1 oáng
Methotrexate Ebewe 50 mg x 5 mL x 1 oáng
Methotrexate Ebewe 500 mg x 5 mL x 1 oáng
Methotrexate Ebewe 1000 mg x 10 mL x 1 oáng
Methotrexate Ebewe 5000 mg x 50 mL x 1 loï
Methotrexate Ebewe 2.5 mg x 50 Tablet
Methotrexate Ebewe 5 mg x 50 Tablet
Methotrexate Ebewe 10 mg x 50 Tablet
Methotrexate Hospira (Greece)
Methotrexate Injection (Ireland)
Methotrexate Injection BP (Australia, New Zealand)
Methotrexate Kabi (Australia)
Methotrexate Kalbe (Indonesia)
Methotrexate Kalbe 50 mg/2 mL x 1's$ 5.61
Methotrexate Lederle (Greece, South Africa, Thailand)
Methotrexate Leovan (Greece)
Methotrexate LPF
Injectable; Injection; Methotrexate Sodium 25 mg / ml
Methotrexate Mayne Pharma (Slovenia)
Methotrexate Meda (Denmark)
Methotrexate Mylan (Japan)
Methotrexate Orifarm (Denmark)
Methotrexate Orion (Sweden)
Methotrexate Orion 2.5 mg x 1's
Methotrexate Paranova (Denmark)
Methotrexate Pfizer (Denmark, Iceland, Philippines, Singapore)
Methotrexate Pfizer (vial) 50 mg/2 mL x 1's
Methotrexate Pfizer 1000 mg/10 mL x 1's
Methotrexate Pharmachemie (United States)
Methotrexate Pharmacia (Vietnam)
Methotrexate Pharmacia 25 mg/1 mL x 2 mL x 5 loï
Methotrexate Pharmacia 25 mg/1 mL x 20 mL x 1 loï
Methotrexate Pharmacia 100 mg/1 mL x 10 mL x 1 loï
Methotrexate Pliva (Croatia (Hrvatska), Slovenia)
Methotrexate preservative free
Injectable; Injection; Methotrexate Sodium 1 g

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