Methotrexate is a medicine which is used to treat certain types of cancer and leukaemia.
How is oral methotrexate given?
Oral methotrexate is given by mouth in tablet or liquid form, once a week. Your child should take methotrexate on the same day each week. If your child is also taking co-trimoxazole, he or she should not take the methotrexate on the same day.
The manufacturer does not specify that methotrexate should be taken with food and drink but in our experience children tolerate it better if they take the medicine with food or shortly afterwards.
What are the side effects of oral methotrexate?
Bone marrow suppression
This only tends to occur with higher doses. There will be a temporary reduction in how well your child's bone marrow works. This means he or she may become anaemic, bruise or bleed more easily than usual, and have a higher risk of infection. Your child's blood count will be checked regularly to see how the bone marrow is working. Please tell your doctor if your child seems unusually tired, has bruising or bleeding, or any signs of infection, especially a high temperature. Oral methotrexate doses may be changed weekly according to your child's blood count. Advice will be given by your doctor, nurse or pharmacist.
Sensitivity of the skin to sunlight
While your child is having methotrexate, his or her skin may burn more easily than usual. You should avoid your child being exposed to sunlight and other forms of ultraviolet light. If your child does go out in the sun always use a good sunblock of SPF 25 or higher and ensure they wear a sun hat.
Nausea and vomiting
Anti-sickness drugs can be given to reduce or prevent these symptoms. Please tell your doctor or nurse if your child's sickness is not controlled or persists.
Please tell your doctor or nurse if your child develops a rash. They will advise you on the appropriate treatment to use.
Just as your child can develop a rash on the skin, they can get red, itchy eyes. Please tell your doctor or nurse if this occurs.
Temporary effect on liver function
Methotrexate can cause some mild changes to your child's liver function. This should return to normal when the treatment is finished. Blood tests may be taken to monitor your child's liver function (LFTs).
Mouth sores and ulcers
You will be given advice about appropriate mouthcare including a copy of the mouth care leaflet. If your child complains of having a sore mouth, please tell your doctor or nurse.
Please tell your doctor or nurse if your child has diarrhoea which is not controlled or persists. It is important that your child drinks lots of fluids.
Interactions with other medicines
Some medicines can interact with methotrexate, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicine, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or any herbal or complementary medicines.
Important information you should know about oral methotrexate
- Keep all medicines and tablets in a safe place where children cannot reach them.
- Store in a cool, dry place away from direct sunlight or heat.
- You should handle these medicines with care. Avoid touching the medicines wherever possible. If you are pregnant or think you could be pregnant, please discuss handling instructions with your doctor, nurse or pharmacist. Please see our special handling requirements information sheet for further details.
- Methotrexate should never be given more than once a week.
- Methotrexate tablets are made in two different strengths – 2.5mg and 10mg. They are different shapes but a similar colour so always check you have been given the correct strength by your doctor or pharmacist. Do not take the tablets if you think you have the wrong strength. Check with your doctor or pharmacist first.
- Methotrexate is also available in liquid form. It is important to check with your doctor or pharmacist that you are giving the correct volume.
- Methotrexate should be taken as directed by your doctor, nurse or pharmacist.
- If your child vomits after taking the dose, inform the doctor or nurse as your child may need to take another dose. Do not give them another dose without informing the doctor or nurse.
- If you forget to give your child their dose, do not give them a double dose. Inform your doctor or nurse and keep to your child's regular dose schedule.
- Sometimes it is necessary to halve tablets to get the correct dose. A tablet cutter may be used for this, but you should keep it only for cutting chemotherapy tablets.
- If your child cannot swallow tablets, you can ask the pharmacist for the liquid preparation. If this is unsuitable, you can make tablets into a mixture as follows:
- You will need a small container such as a medicine pot and an oral syringe.
- If you prefer you can wear a pair of household rubber gloves to protect yourself. Do not use them for any other purpose.
- Tip the required number of tablets into a clean container.
- Pour a little water on the tablets and allow to disperse. This may take a few minutes. Do not try to make the tablets disperse faster by stirring or shaking the container.
- Draw up the dose using the oral syringe and give to your child.
- Wash the syringe and container in warm, soapy water and do not use for any other purpose.
- If you accidentally spill the tablets or mixture, wash the area thoroughly with plenty of water.
- If the mixture accidentally gets into your eyes, wash with plenty of running water for five to 10 minutes.
- Used paper towels, masks, vomit and dirty disposable nappies should be placed inside two rubbish bags and disposed of along with your normal rubbish.
- If your doctor decides to stop treatment with methotrexate or the medicine passes its expiry date, return any remaining medicine to the pharmacist. Do not flush it down the toilet or throw it away.
Ref: 2012F0734 February 2013
Compiled by the Pharmacy Department in collaboration with the Child and Family Information Group.
Please read this information in conjunction with any patient information leaflet provided by the manufacturer. However, please note that this information explains about the use of medicines in children and young people so may differ from the manufacturer’s information.
Each person reacts differently to medicines so your child will not necessarily suffer every side effect mentioned. This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.