Methotrexate and weight loss

Methotrexate

Methotrexate may cause very serious, life-threatening side effects. You should only take methotrexate to treat cancer or certain other conditions that are very severe and that cannot be treated with other medications. Talk to your doctor about the risks of taking methotrexate for your condition.

Tell your doctor if you have or have ever had excess fluid in your stomach area or in the space around your lungs and if you have or have ever had kidney disease. Also tell your doctor if you are taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, choline magnesium trisalicylate (Tricosal, Trilisate), ibuprofen (Advil, Motrin), magnesium salicylate (Doan’s), naproxen (Aleve, Naprosyn), or salsalate. These conditions and medications may increase the risk that you will develop serious side effects of methotrexate. Your doctor will monitor you more carefully and may need to give you a lower dose of methotrexate or stop your treatment with methotrexate.

Methotrexate may cause a decrease in the number of blood cells made by your bone marrow. Tell your doctor if you have or have ever had a low number of any type of blood cells or any other problem with your blood cells. Call your doctor immediately if you experience any of the following symptoms: sore throat, chills, fever, or other signs of infection; unusual bruising or bleeding; excessive tiredness; pale skin; or shortness of breath.

Methotrexate may cause liver damage, especially when it is taken for a long period of time. If you drink or have ever drunk large amounts of alcohol or if you have or have ever had liver disease, your doctor may tell you not to take methotrexate unless you have a life-threatening form of cancer because there is a higher risk that you will develop liver damage. The risk that you will develop liver damage may also be higher if you are elderly, obese, or have diabetes. Tell your doctor if you are taking any of the following medications: acitretin (Soriatane), azathioprine (Imuran), isotretinoin (Accutane), sulfasalazine (Azulfidine), or tretinoin (Vesanoid). Ask your doctor about the safe use of alcoholic beverages while you are taking methotrexate. Call your doctor immediately if you experience any of the following symptoms: nausea, extreme tiredness, lack of energy, loss of appetite, pain in the upper right part of the stomach, yellowing of the skin or eyes, or flu-like symptoms. Your doctor may order liver biopsies (removal of a small piece of liver tissue to be examined in a laboratory) before and during your treatment with methotrexate.

Methotrexate may cause lung damage. Tell your doctor if you have or have ever had lung disease. Call your doctor immediately if you experience any of the following symptoms: dry cough, fever, or shortness of breath.

Methotrexate may cause damage to the lining of your mouth, stomach, or intestines. Tell your doctor if you have or have ever had stomach ulcers or ulcerative colitis (a condition which causes swelling and sores in the lining of the colon and rectum). If you experience any of the following symptoms, stop taking methotrexate and call your doctor right away: mouth sores, diarrhea, black, tarry, or bloody stools, or vomit that is bloody or looks like coffee grounds.

Taking methotrexate may increase the risk that you will develop lymphoma (cancer that begins in the cells of the immune system). If you do develop lymphoma, it might go away without treatment when you stop taking methotrexate, or it might need to be treated with chemotherapy.

If you are taking methotrexate to treat cancer, you may develop certain complications as methotrexate works to destroy the cancer cells. Your doctor will monitor you carefully and treat these complications if they occur.

Methotrexate may cause serious or life-threatening skin reactions. If you experience any of the following symptoms, call your doctor immediately: fever, rash, blisters, or peeling skin.

Methotrexate may decrease the activity of your immune system, and you may develop serious infections. Tell your doctor if you have any type of infection and if you have or have ever had any condition that affects your immune system. Your doctor may tell you that you should not take methotrexate unless you have life-threatening cancer. If you experience signs of infection such as a sore throat, cough, fever, or chills, call your doctor immediately.

If you take methotrexate while you are being treated with radiation therapy for cancer, methotrexate may increase the risk that the radiation therapy will cause damage to your skin, bones, or other parts of your body.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests before, during, and after your treatment to check your body’s response to methotrexate and to treat side effects before they become severe.

Tell your doctor if you or your partner is pregnant or plan to become pregnant. If you are female, you will need to take a pregnancy test before you begin taking methotrexate. Use a reliable method of birth control so that you or your partner will not become pregnant during or shortly after your treatment. If you are male, you and your female partner should continue to use birth control for 3 months after you stop taking methotrexate. If you are female, you should continue to use birth control until you have had one menstrual period that began after you stopped taking methotrexate. If you or your partner become pregnant, call your doctor immediately. Methotrexate may cause harm or death to the fetus.

This Is What Can Happen to Your Rheumatoid Arthritis When You Lose 76 Pounds

It took just a random encounter with a trainer at Patty Deters’ local Gold’s Gym to basically change her whole life.

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A post shared by Reclaiming My Life (@pattysfitnessjourney) on Aug 21, 2018 at 11:26am PDT

It was January 2016 and Deters, now 56, was determined to lose the weight she’d gained after being diagnosed with rheumatoid arthritis a few years earlier. She was 276 pounds, nearly 50 pounds more than she was when first diagnosed.

“I didn’t know how to get it off,” says Deters, who lives in Grand Junction, Colorado. “I tried everything. I tried Weight Watchers, I tried every diet book out there, I tried just juicing, I tried vegetarian, I tried when they have meals sent to you.”

While Deters was accompanying her teenage son to the gym — he was venturing back after recovering from surgery for scoliosis — a trainer saw her working out and told her, “I can help you.” In fact, the gym was hosting a 12-week weight loss challenge and the trainer swore to Deters he could help her win.

Deters was shocked. “I remember laughing in his face,” she says. “‘Nobody can help me,’ I told him, ‘I’m beyond help.’”

Boy, was she wrong.

A Painful Road to Weight Gain

A slimmer 145 pounds in college, Deters, a mom of three, started to put on weight gradually over the course of her marriage. For the first 10 years, she and her husband worked for an organization that provided all their meals in a cafeteria. But once they had to fend for themselves, eating healthy proved to be a challenge. “A lot of times for convenience sake, with three small children, we just grabbed McDonald’s or Subway or whatever. So really started getting worse,” Deters says.

Deters wasn’t eating wildly indulgently, but she wasn’t choosing particularly nutritious foods either. A typical breakfast might have been a bowl of sugary cereal and milk; lunches included cold cuts sandwiches and chips; pasta was a popular dinner choice — “spaghetti, ziti, lasagna, of course with French bread; the kids loved pasta.”

“When you take what I was eating with pretty much zero activity, that’s why it wasn’t working,” says Deters.

Then came the RA diagnosis.

“I was about to turn 50 and all of a sudden my hands wouldn’t hold anything anymore,” says Deters. “I couldn’t unscrew water bottle caps or use a can opener. I had a primary doctor who had me try probably four months of different things because she said, ‘You’re too young, it can’t be arthritis.’”

Her symptoms persisted — “I was in severe pain, like 20 Motrins a day”— so her doctor ordered bloodwork and referred her to a rheumatologist, who promptly diagnosed her with RA. The doctor put her on prednisone, which immediately started to relieve her pain and swelling, but further added to Deters’ weight gain. She put on 20 pounds that year and continued to gain weight even after her doctor switched her to methotrexate, which she currently takes to manage her RA.

It All Started With a Food Diary

Nothing about Deters’ weight loss was miraculous or overnight. In fact, it all started with a simple food diary. The trainer had Deters log the food she ate each week and email it to him every Sunday. While she had tracked her food intake before, “I never had anyone care”— and that made all the difference.

“I’d tell him proudly that I ordered an Egg White Delight from McDonald’s,” Deters says. “He’d say, ‘Why didn’t you make eggs at home?’” Deters’ diet changes didn’t focus on strict calorie counting or eliminating foods outright; instead, she emphasized eating more whole foods and cutting back on foods that made her feel crummy. (This is what eating an anti-inflammatory diet looks like.)

“The clean eating makes my inflammation better,” says Deters, who’s scaled way back on simple carbs like bagels, sandwich bread, and pasta. “If I have a night out and eat bread or pasta, my joints feel it the next day.”

Instead, Deters combines complex carbs with protein, which helps her feel full. For breakfast, she opts for homemade eggs and plain oatmeal (with a few raisins for flavor). For dinner, she’ll have chicken and brown rice, or lean steak with a baked potato — minus the butter, sour cream, and cheese.

Added sugar — or even the taste of sugar— is another thing Deters watches closely. “I hardly eat any sugar. My hands will swell. To me, it’s not worth it.” She cut out the multiple daily cans of Diet Coke she used to drink and chooses fruit, like strawberries, when she craves something sweet.

No More Goal Weight

As for that weight loss competition? Deters technically lost: She came in second place. “But in my world, I won,” Deters says. “The fact that I’ve kept it off and lost even more, I think I’m the winner.”

Even better, her RA management has improved dramatically. In six months, her Vectra score, a multi-biomarker blood test, dropped by half.

And according to Deters’ own personal inflammation test — “Does my wedding ring fit?” — she’s passing with flying colors. She hasn’t had to take ibuprofen to help it fit in more than five months.

“It’s really fun to go see my doctor because she’s so happy for me,” says Deters. “Every blood test I’ve had since I started the weight loss journey has indicated that my RA is in remission. I haven’t had to be on prednisone since I started .”

Deters currently weighs 201 pounds. She’s still trying to lose weight — “every pound I get off also helps my joints” — but she doesn’t have an end number in mind.

“There’s more to life than just the number on the scale,” she says. “It’s easy to become frustrated with trying to reach a goal weight. I used to obsess about the number. Now I focus on how great my quality of life is and wonder why I ever let a number have so much power over me.”

Deters doesn’t need to take afternoon naps anymore. When the weekends roll around, she no longer has to beg off plans with her husband and children because she’s too tired.

‘Do What Doesn’t Hurt’

Deters’ weight loss journey hasn’t been without its share of ups and downs. Last fall, she started feeling pain and swelling in her hands again, and started to worry her RA was flaring again. It was scary and frustrating.

“I would cry because I didn’t understand why it was happening when I was doing everything right,” Deters says.

After bloodwork and X-rays, it turned out that Deters’ RA was still, in fact, in remission. Instead, she had a bad case of tendinitis from overexerting herself. “The doctor said I was just pushing too hard, and when I stopped pushing so hard it went away,” Deters says.

She had to scale back on her workouts, limiting weight training to just two days a week. Her go-to exercise for when she’s not feeling well: swimming, which she did competitively in college.

“There are times especially when you don’t feel well, when everything is hurting again,” says Deters. “For me, I focused on what doesn’t hurt, and swimming didn’t hurt. So instead of just stopping and laying down on my couch, I said ‘do what doesn’t hurt and keep moving.’”

Over time, the tendinitis improved. Today, Deters feels back on track with her weight loss, aiming to continue to slim down while allowing herself to enjoy life and not overdo it too much at the gym.

“People lose weight and gain it back and lose weight and gain it back, so a question I get a lot is ‘How do you stay with it?’” Deter says. “Knowing how I felt when I was originally diagnosed, I don’t ever want to feel that way again, so it’s very easy for me to stick with it.”

Follow Patty on Instagram @pattysfitnessjourney.

Weight, diet and rheumatoid arthritis

Taken from the NRAS magazine, Spring 2016

by Dr James Galloway, Kings College London and trainee Gloria LlisoAs we enter the second half of the second decade of the 21st century, the global community is growing ever more aware of the health challenges associated with weight. Worldwide there are now over 1 billion adults who fall into the category of ‘obese’. UK estimates now suggest that the NHS is spending more on obesity-related disease than it does on smoking-related illnesses. Indeed, the UK has the highest prevalence of obesity of any Western country, with the proportion of obese adults have risen from just 7% in 1980 to 25% in 2012.The World Health Organisation defines obesity as abnormal or excessive fat accumulation that results a risk to health. A crude measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres). A person with a BMI of 30 or more is generally considered obese (see Figure 1). Obesity itself is not a disease, but nonetheless ithas far reaching implications. Obesity is a major risk factor for several illnesses, including diabetes, heart attacks, stroke and cancer.

Definitions of obesity

Despite worldwide acceptance of the problem, as a society we are still in the early days of learning how to help people reduce weight in a sustainable manner. Many diets exist, although the results are mixed, and few studies demonstrate long-term success. Current thinking in the medical arena is that there is a ‘window of opportunity; people who are normal or slightly overweight, but not yet obese, likely represent the group most important to target from a public health strategy.

Studies exploring the frequency of obesity in people with rheumatoid arthritis suggest that the patterns are similar to the general population. However, the situation is different for people with rheumatoid arthritis. We know that rheumatoid arthritis directly impacts upon weight. Patients with arthritis lose muscle bulk (termed ‘sarcopenia’). As muscle is heavier than fat BMI may underestimate obesity in people with rheumatoid arthritis. What is clear is that people with a BMI above 25 with rheumatoid have worse outcomes, reporting more pain and higher levels of disability.

A further challenge facing people with rheumatoid arthritis is how to tackle weight gain. The management of obesity evolves around two aspects: dietary change and increased exercise. People with rheumatoid arthritis are disadvantaged here, as exercise is impacted upon by the inherent nature of the disease. Whilst in general exercise is beneficial for joints – in particular it helps strengthen the surrounding muscles – it can be painful. During times of disease flare it is important to try and rest particularly inflamed joints but it is equally important to keep moving and exercise a limited amount.

In addition, doctors often prescribe corticosteroid tablets (e.g. prednisolone) as a treatment for rheumatoid, and a direct side effect of corticosteroids is weight gain.

The positive news however is that studies have shown that by far the most important step in achieving weight loss is dietary change: research shows that compared to diet alone, exercise plus diet only has a small additional benefit on weight loss.

Advice on diet

Many patients, who enquire about diet and arthritis, are specifically interested to know whether a certain diet is beneficial for their symptoms. Unfortunately this is challenging to answer. Whilst there is no doubt whatsoever that many people with rheumatoid notice diet influences their joint pains, everyone seems to be slightly different. Recommending a one-size fits all diet as a panacea for rheumatoid is therefore unhelpful. Studies (and there have been many) have failed to convincingly show any one diet has specific benefit for rheumatoid arthritis.

Therefore, the most sensible and pragmatic advice is to adhere to the standard recommendations for a balanced diet that apply to the population at large. Individuals may get to know their own particular foods that they need to avoid, but the overarching principles should be as follows:

Appropriate calorie intake:

Maintaining the correct amount of calories in diet is important in achieving a healthy weight. It can sometimes be difficult to know how many calories we should eat. There are a number of online calorie calculators that can help you understand how many calories there are in different types of food. (www.nhs.uk/Livewell/weight-loss-guide to find the calorie counter and much more.). Understanding calorie content in food must then be combined with knowledge of how many calories you need. The amount of calories you need can be estimated from your weight and your daily activities. Again, several free online calculators exist (www.calculator.net/calorie-calculator).

Balancing the source of calories:

A number of guidelines recommend that the total caloric intake should be broken down by percentage of intake according to food type:

  • 45 to 65 % from carbohydrates
  • 10 to 35 % from protein
  • 20 to 35 % from fat

Carbohydrate – there are many sources of carbohydrate and each varies with regards to effect upon your bodies sugar metabolism (referred to as the glycaemic index of the food). Diets containing foods with a low glycaemic index have been associated with lower risks of developing diabetes, coronary heart disease, and some cancers. Therefore an important way of achieving a healthy diet is to replace carbohydrates having a high glycaemic index (e.g., pizza, rice, pancakes) with a low glycaemic index (e.g., fruits, vegetables). It is also important to try to reduce foods with added sugars (as opposed to natural sugars). Many prepared foods and ready meals contain astonishing amounts of added sugar, as do soft drinks and alcoholic beverages.

Protein – it is healthier to eat a variety of protein-rich foods, including fish, lean meat such as poultry, eggs, beans, peas, soy products, and unsalted nuts and seeds. Studies suggest that it is better to avoid protein sources with trans and saturated fats, including red and processed meats.

Fat – consumption of fat in diet has always been controversial. It appears that the type of fat is as important as the quantity of fat in our diets. So called ‘trans’ fats contribute to coronary heart disease, while polyunsaturated fats (found in oily fish) are protective. Trans fatty acid consumption should therefore be kept as low as possible. The major sources of trans fats include margarines and partially hydrogenated vegetable fats. These fats are also present in many processed and fast foods.

Fibre – the current recommendations are that adults consume at least 5 items of fibre (fruit/veg) every day. The evidence for the benefit of high fibre diets is strong, with studies showing lower risks for heart disease, diabetes, cancer and death. Foods high in fibre include fruits, vegetables and whole grains (brown rice, whole grain bread, oatmeal).

Getting support:

It is all very well describing what an ideal diet might include, but we all know that there is a reason why people chose to eat less healthy options. Foods higher in refined sugars and salt taste better (in fact there is good evidence that such diets are addictive). Eating is also enjoyable and has a pivotal role in society, bringing families and friends together. Setting out to change your diet as a solo venture is an enormous task. Thankfully, there are now many weight loss groups available (e.g. weightwatchers, slimming world) that can help. A crucial advantage of dieting as part of a group is the motivational support obtained. Many GPs are now able to refer to weight loss classes, although sometimes having to pay a membership to a group can be a motivation to attend in its own right!

In summary:

There is no doubt that the rising spectre of obesity in western society is going to have dramatic adverse consequences for society. The impact of obesity for people living with rheumatoid arthritis is exaggerated further, linking with more pain and greater levels of disability. However, having rheumatoid arthritis should not be perceived as a barrier to weight loss.

MONDAY, April 30, 2018 (HealthDay News) — Obesity may accelerate and amplify the crippling symptoms of rheumatoid arthritis, new research suggests.

Conversely, the researchers also found that unexplained weight loss might also signal problems for these patients, because it could mean that they’re at greater risk for disability.

“While patients and rheumatologists may be focused mostly on disease activity, we should also consider this common condition , which can contribute to problems that are usually attributed to the arthritis itself,” said study author Dr. Joshua Baker.

“In addition, unintentional weight loss should alert us that the patient may be becoming frail and is at risk for developing new disability,” he added. Baker is an assistant professor of medicine at the University of Pennsylvania’s Perelman School of Medicine.

Rheumatoid arthritis is an autoimmune condition. It develops when immune cells that normally fight germs attack the lining of the joints, or cartilage. This causes the joints to swell and the surrounding bones, ligaments and muscles to gradually erode. Rheumatoid arthritis worsens over time, often leading to disability.

For the study, Baker and his colleagues looked at the effects of obesity on the progression of rheumatoid arthritis in just over 25,000 people with the disease.

The investigators found that the disease advanced more quickly among those who were very obese. This was true regardless of the level of inflammation in their joints.

In addition, people who were thin but lost weight without trying also became disabled more quickly.

The study was published April 30 in the journal Arthritis Care & Research.

“So, this study suggests that patients with rheumatoid arthritis and obesity would benefit from intentional weight loss through a comprehensive management strategy,” Baker said in a journal news release.”

“However, when we see that someone is losing weight without trying, it’s probably a poor prognostic sign, especially if they are already thin,” he added.

Although the study could not prove a cause-and-effect link, the researchers suggested that new treatments and strategies to help people maintain a healthy weight might help prevent disability among people with rheumatoid arthritis.

And, Baker’s team noted, the findings could help doctors recognize signs of frailty among their rheumatoid arthritis patients who may benefit from strength training and physical therapy.

Can methotrexate cause weight gain? Wine and methotrexate?

Hi, Punda,

There are no side effects listed here on drugs.com that reveal methotrexate will cause weight gain.

You should NOT drink while taking methotrexate.

As far as taking alcohol (ethanol) and methotrexate, I found the following here on drugs.com:

Talk to your doctor before using methotrexate together with ethanol. Methotrexate may cause liver problems, and taking it with other medications that can also affect the liver such as ethanol may increase that risk. You should avoid or limit the use of alcohol while being treated with these medications. Call your doctor immediately if you have fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark colored urine, light colored stools, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Since you enjoy several glasses of wine once a week, call your doctor and ask him to be sure since we don’t know your dose of methotrexate or what it is being treated for – cancer of the breast, skin, head and neck, or lung, severe psoriasis, or rheumatoid arthritis.

All the best to you,
Tony

Trexall

SIDE EFFECTS

IN GENERAL, THE INCIDENCE AND SEVERITY OF ACUTE SIDE EFFECTS ARE RELATED TO DOSE AND FREQUENCY OF ADMINISTRATION. THE MOST SERIOUS REACTIONS ARE DISCUSSED ABOVE UNDER ORGAN SYSTEM TOXICITY IN THE PRECAUTION SECTION. THAT SECTION SHOULD ALSO BE CONSULTED WHEN LOOKING FOR INFORMATION ABOUT ADVERSE REACTIONS WITH METHOTREXATE.

The most frequently reported adverse reactions include ulcerative stomatitis, leukopenia, nausea, and abdominal distress. Other frequently reported adverse effects are malaise, undue fatigue, chills and fever, dizziness and decreased resistance to infection.

Other adverse reactions that have been reported with methotrexate are listed below by organ system. In the oncology setting, concomitant treatment and the underlying disease make specific attribution of a reaction to methotrexate difficult.

Alimentary System: gingivitis, pharyngitis, stomatitis, anorexia, nausea, vomiting, diarrhea, hematemesis, melena, gastrointestinal ulceration and bleeding, enteritis, pancreatitis.

Blood and Lymphatic System Disorders: suppressed hematopoiesis causing anemia, aplastic anemia, pancytopenia, leukopenia, neutropenia and/or thrombocytopenia, lymphadenopathy and lymphoproliferative disorders (including reversible). Hypogammaglobulinemia has been reported rarely.

Cardiovascular: pericarditis, pericardial effusion, hypotension, and thromboembolic events (including arterial thrombosis, cerebral thrombosis, deep vein thrombosis, retinal vein thrombosis, thrombophlebitis, and pulmonary embolus).

Central Nervous System: headaches, drowsiness, blurred vision, transient blindness, speech impairment including dysarthria and aphasia, hemiparesis, paresis and convulsions have also occurred following administration of methotrexate. Following low doses, there have been occasional reports of transient subtle cognitive dysfunction, mood alteration, unusual cranial sensations, leukoencephalopathy, or encephalopathy.

Patientdisorders, hepatotoxicity, acute hepatitis, chronic fibrosis and cirrhosis, decrease in serum albumin, liver enzyme elevations.

Infection: There have been case reports of sometimes fatal opportunistic infections in patients receiving methotrexate therapy for neoplastic and non-neoplastic diseases. Pneumocystis carinii pneumonia was the most common opportunistic infection. There have also been reports of infections, pneumonia, sepsis, nocardiosis, histoplasmosis, cryptococcosis, herpes zoster, H. simplex hepatitis, and disseminated H. simplex.

Musculoskeletal System: stress fracture.

Ophthalmic: conjunctivitis, serious visual changes of unknown etiology.

Pulmonary System: respiratory fibrosis, respiratory failure, interstitial pneumonitis; deaths have been reported, and chronic interstitial obstructive pulmonary disease has occasionally occurred.

Skin: erythematous rashes, pruritus, urticaria, photosensitivity, pigmentary changes, alopecia, ecchymosis, telangiectasia, acne, furunculosis, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson Syndrome, skin necrosis, skin ulceration, and exfoliative dermatitis.

Urogenital System: severe nephropathy or renal failure, azotemia, cystitis, hematuria; defective oogenesis or spermatogenesis, transient oligospermia, menstrual dysfunction, vaginal discharge, and gynecomastia; infertility, abortion, fetal defects.

Other rarer reactions related to or attributed to the use of methotrexate such as nodulosis, vasculitis, arthralgia/myalgia, loss of libido/impotence, diabetes, osteoporosis, sudden death, reversible lymphomas, tumor lysis syndrome, soft tissue necrosis and osteonecrosis. Anaphylactoid reactions have been reported.

Adverse Reactions In Double-Blind Rheumatoid Arthritis Studies

The approximate incidences of methotrexate attributed (i.e., placebo rate subtracted) adverse reactions in 12 to 18 week double-blind studies of patients (n=128) with rheumatoid arthritis treated with lowdose oral (7.5 to 15 mg/week) pulse methotrexate, are listed below. Virtually all of these patients were on concomitant nonsteroidal anti-inflammatory drugs and some were also taking low dosages of corticosteroids. Hepatic histology was not examined in these short-term studies. (See PRECAUTIONS.)

Incidence greater than 10%: Elevated liver function tests 15%, nausea/vomiting 10%.

Incidence 3% to 10%: Stomatitis, thrombocytopenia, (platelet count less than 100,000/mm³).

Incidence 1% to 3%: Rash/pruritus/dermatitis, diarrhea, alopecia, leukopenia (WBC less than 3000/mm³), pancytopenia, dizziness.

Two other controlled trials of patients (n=680) with Rheumatoid Arthritis on 7.5 mg to 15 mg/wk oral doses showed an incidence of interstitial pneumonitis of 1%. (See PRECAUTIONS.)

Other less common reactions included decreased hematocrit, headache, upper respiratory infection, anorexia, arthralgias, chest pain, coughing, dysuria, eye discomfort, epistaxis, fever, infection, sweating, tinnitus, and vaginal discharge.

Adverse Reactions In Psoriasis

There are no recent placebo-controlled trials in patients with psoriasis. There are two literature reports (Roenigk, 1969 and Nyfors, 1978) describing large series (n=204, 248) of psoriasis patients treated with methotrexate. Dosages ranged up to 25 mg per week and treatment was administered for up to four years. With the exception of alopecia, photosensitivity, and “burning of skin lesions” (each 3% to 10%), the adverse reaction rates in these reports were very similar to those in the rheumatoid arthritis studies. Rarely, painful plaque erosions may appear.

Adverse Reactions In JRA Studies

The approximate incidences of adverse reactions reported in pediatric patients with JRA treated with oral, weekly doses of methotrexate (5 to 20 mg/m²/wk or 0.1 to 0.65 mg/kg/wk) were as follows (virtually all patients were receiving concomitant nonsteroidal anti-inflammatory drugs, and some also were taking low doses of corticosteroids): elevated liver function tests, 14%; gastrointestinal reactions (e.g., nausea, vomiting, diarrhea), 11%; stomatitis, 2%; leukopenia, 2%; headache, 1.2%; alopecia, 0.5%; dizziness, 0.2%; and rash, 0.2%. Although there is experience with dosing up to 30 mg/m²/wk in JRA, the published data for doses above 20 mg/m²/wk are too limited to provide reliable estimates of adverse reaction rates.

Read the entire FDA prescribing information for Trexall (Methotrexate)

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