DRUG STUDY

GENERIC NAME:METHOTREXATE
Brand name:Folex, Mexate
Drug Classification:ANTINEOPLASTIC AGENT; ANTIMETABOLITE, ANTIFOLATE; IMMUNOSUPPRESSANT

DOSAGE, ROUTE, SIDE EFFECTS and

FREQUENCY (prescribed and MECHANISM OF ADVERSE REACTIONS
INDICATION
recommended) ACTION (by system)

Principally in Antimetabolite and folic NS: Headache,

Trophoblastic combination regimens acid antagonist. Blocks drowsiness, blurred
Neoplasm to maintain induced folic acid participation in vision, dizziness,
remissions in neoplastic nucleic acid synthesis, aphasia, hemiparesis;
Adult: PO 15–30 mg/d diseases. Effective in thereby interfering with arachnoiditis,
for 5 d, repeat q12wk treatment of gestational mitotic process. convulsions (after
for 3–5 courses IM/IV choriocarcinoma and intrathecal
15–30 mg/d for 5 d, hydatidiform mole and administration); mental
repeat q12wk for 3–5 as immunosuppressant confusion, tremors,
courses in kidney ataxia, coma.
transplantation, for
acute and subacute GI: Hepatotoxicity, GI
leukemias and leukemic ulcerations and
Leukemia meningitis, especially in hemorrhage, ulcerative
children. Used in stomatitis, glossitis,
Adult: IM/IV Loading lymphosarcoma, in gingivitis, pharyngitis,
Dose 3.3 mg/m2/d certain inoperable nausea, vomiting,
PO/IM/IV Maintenance tumors of head, neck, diarrhea, hepatic
Dose 20–30 mg/m2 2 and pelvis, and in cirrhosis.
times/wk mycosis fungoides. Also
used to treat severe
Child: PO/IM 7.5–30 psoriasis nonresponsive Urogenital: Defective
mg/m2 q1–2 wk to other forms of oogenesis or
therapy, rheumatoid spermatogenesis,
arthritis nephropathy, hematuria,
menstrual dysfunction,
Lymphoma infertility, abortion, fetal
defects.
Adult: PO 12–25 mg/d
for 4–8 d with 7–10 d Hematologic:
rest intervals Leukopenia,
thrombocytopenia,
anemia, marked
myelosuppression,
aplastic bone marrow,
Psoriasis
telangiectasis,
thrombophlebitis at
Adult: PO 2.5–5 mg
intraarterial catheter site,
q12h for 3 doses each
hypogammaglobulinemia,
wk up to 25–30 mg/wk
and hyperuricemia.
IM/IV 10–25 mg/wk

Skin: Erythematous
rashes, pruritus, urticaria,
Rheumatoid Arthritis folliculitis, vasculitis,
photosensitivity,
Adult: PO 2.5–5 mg depigmentation,
q12h for 3 doses each hyperpigmentation,
wk or 7.5 mg once/wk alopecia.
Child: PO/IM 5–15
mg/m2/wk as single Body as a Whole:
dose or in 3 divided Malaise, undue fatigue,
doses 12 h apart systemic toxicity (after
intrathecal and
intraarterial
administration), chills,
Oral fever, decreased
resistance to infection,
● Give 1 h before or 2 h septicemia, osteoporosis,
after meals. metabolic changes
precipitating diabetes and

Patient’s Name / Room No. | 1

 ● Use a test dose (5–10
mg parenterally) 1 wk
before therapy for
treatment of psoriasis.
● Avoid skin exposure
and inhalation of drug
particles.
●
CONTRAINDICATION/S
Pregnancy (category D), men and
women in childbearing age; lactation;
hepatic and renal insufficiency;
concomitant administration of
hepatotoxic drugs and hematopoietic
depressants; alcohol; ultraviolet
exposure to psoriatic lesions; pre-
existing blood dyscrasias
sudden death,
pneumonitis, pulmonary
fibrosis.
NURSING RESPONSIBILITIES
(at least 10)
Assessment & Drug Effects
● Lab tests: Obtain baseline liver and kidney function, CBC with
differential, platelet count, and chest x-rays. Repeat weekly during
therapy. Monitor blood glucose and HbA1c periodically in diabetics.
● Prolonged treatment with small frequent doses may lead to
hepatotoxicity, which is best diagnosed by liver biopsy.
● Monitor for and report ulcerative stomatitis with glossitis and gingivitis,
often the first signs of toxicity. Inspect mouth daily; report patchy
necrotic areas, bleeding and discomfort, or overgrowth (black, furry
tongue).
● Monitor I&O ratio and pattern. Keep patient well hydrated (about 2000
mL/24 h).
● Prevent exposure to infections or colds during periods of leukopenia.
Be alert to onset of agranulocytosis (cough, extreme fatigue, sore
throat, chills, fever) and report symptoms promptly.
● Be alert for and report symptoms of thrombocytopenia (e.g.,
ecchymoses, petechiae, epistaxis, melena, hematuria, vaginal
bleeding, slow and protracted oozing following trauma).
Patient & Family Education
● Report promptly any abnormal symptoms to physician.
● Avoid or moderate alcohol ingestion, which increases the incidence
and severity of methotrexate hepatotoxicity.
● Practice fastidious mouth care to prevent infection, provide comfort,
and maintain adequate nutritional status.
● Do not self-medicate with vitamins. Some OTC compounds may
include folic acid (or its derivatives), which alters methotrexate
response.
● Use contraceptive measures during and for at least 8 wk following
therapy.
● Avoid exposure to sunlight and ultraviolet light. Wear sunglasses and
sunscreen.
● Do not breast feed while using this drug.
Patient’s Name / Room No. | 2